Wednesday, 17 October 2018 16:42

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
Wednesday, 10 October 2018 18:47

#ShirtsOff for Breast Cancer Awareness Month

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
Friday, 05 October 2018 19:19

Football fans may be more successful lovers

For those of us who are football enthusiasts, we may be at an advantage when it comes to relationships. Makes sense….when things go sour with our partner we turn to football. When we get sidelined we wait for a signal to get back on the field. And we instinctively “suit up” before each encounter to protect us from the blows we may incur.  So the question arises, do football fans fare better in relationships?

 

We know the field

 

Before any play, we need to position ourselves correctly on the field. Being too close to the “end zone” when you’re supposed to be yards away can give you a severe penalty.

So we start at the line of scrimmage and respect the “neutral zone.”

 

14169268_f496.jpg

 

An infraction of this space could again inflict a costly penalty.  There’s a time and a place when beginning a play and entering this zone is allowed.

 

neutral zone.jpg

 

True our goal is to get to the end zone but it will take some strategy, finesse, and opportunity.  Some good drives will get you a long way, and patience and persistence is key.

 

240_F_128301922_58w07ptHpviYITdXZ5szJXtnSYPAfjqb.jpg

 

We study our competition

 

Before any play we size up our competition.  Some may block your advance but most you can overcome.  As long as you know your routes and can keep other players at bay, you have a chance of advancing.

 

ff-routes.png

 

How do we fumble?

 

Holding a ball loosely and carelessly could cause it to easily fall into another player’s hands.

unsociable-media-man-ignoring-woman-date.jpg

 

But if you hold it too tight it may squeeze out the first opportunity it gets. A proper cradling, warmth, and protection may be the right recipe.

 

embrace.jpg

 

We need to rely on others during a fumble

 

Losing the ball is devastating and someone else can pick it up and run with it. It takes your buddies to help you regain possession so you can start over.

 

fumble.jpg

 

Treat your partner right and don’t lose them to begin with.

We are always prepared for an interception

 

The field is fluid and players are out there watching, waiting to grab your ball and take advantage of the yardage you acquired.

 

steal-your-girl-0.jpg

 

Always be mindful of your position and don’t take your possession for granted.

We adapt when we’re in the red zone

 

Although the red zone is not officially marked on the field, we understand it to be the 20 yards closest to the end zone, or time during a relationship where you can either advance to your goal or fail miserably, losing all the time and work you put into the relationship. Being too aggressive may cause a fumble, interception or even injury.  Being too chill could prevent you from ever making a touchdown.

So us football folk know how to stop, huddle, and plan,  hopefully resulting in the ball sailing into the end zone without a hitch.

 

touchdown.jpg

 

So if you’re in the dating scene and find yourself getting encroached, needing to scramble, or facing a blitz, watch some football and learn how to treat your date right. It might get you a whole new set of fresh downs…….

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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 Opinion
Tuesday, 02 October 2018 17:26

How college students can cut their debt

Student debt has been rising and the average undergraduate doesn’t feel confident they will pay off their loans before middle age.

Lots of factors contribute to the increased debt a student faces. Some of these include:

  • Higher tuition costs

  • Increased time requirements to obtain a degree (5 year program vs 4 year)

  • Fewer students work while taking classes

  • More competition after graduation

  • Higher cost of living precludes early repayment of loans

And it is projected to rise.  The Congressional Budget Office each year projects the total amount of new federal student loans the office believes they will issue with this year projected to be nearly $1.5 trillion.

student loan debt.jpeg

Andrew Coates, candidate for University Regent in Southern Nevada, states, “One way that colleges can help students keep their debt under control is by locking-in tuition rates.  This means that tuition will not be increased while a student pursues their degree.  By locking-in tuition, students will know exactly how much they will pay each year in college, which will help them budget accordingly.”

 

coates.png

ANDREW COATES, CANDIDATE FOR UNIVERSITY REGENT, SOUTHERN NEVADA

 

So how can students curb their debt?

Choose an affordable college

 

According to US News data, the average cost of tuition and fees for the 2018–2019 school year was $35,676 at private colleges, $9,716 for state residents at public colleges and $21,629 for out-of-state students at state school, with many universities easily exceeding these numbers.  So students may want to consider getting early credits completed at community colleges and then finishing their degree at a university.  Additionally, many will need to decide if its worth picking an out-of-state college for a degree that provides the same job market edge as an in-state school.

 

Research available loans, grants and scholarships

 

Many students don’t apply for grants, loans and scholarships because of time constraints, misconceptions such as they don’t fit a demographic, or  “will be credit history required?”, and lack of optimism that they will even qualify.

Mark Kantrowitz, publisher and vice president of saveforcollege.com states, “More than 2 million students did not get a Federal Pell Grant even though they were eligible because they did not file the FAFSA.”  FAFSA (link attached) is a free application for federal student aid assisting students who want to apply for a loan, grant or work study.

Scholarships are ideal in that they do not need to be paid back. Many can be found at scholarships.com.

Learn to budget

 

Many students get a culture shock living on their own when they spend as if Mom or Dad is still footing the bill.  If eating out nightly, shopping online, or using excess data does not fit into the amount your trying to live on each month, budget expenses early on and stick to it.

Avoid the credit card trap

 

When we try to build our credit as a young adult, we may apply for a credit card that advertises to college students with no monthly fee and “rewards.” However, the interest rates can be up to 25%.  If you do use the credit card don’t borrow more than you can pay  off each month, always shooting for a zero balance.

 

Keep your living costs down

 

Rent, transportation, utilities, meals, entertainment, internet and phone service, add up and can be more costly than tuition.  Share expenses with roommates or family members to lessen your loan debt.

Cook and prepare meals for the coming days, use school Wi-Fi, carpool to class, purchase less beer, and use the university gym to save money.

But most importantly, don’t stress about the debt.  Your efforts should be concentrated on your schooling and getting a degree is one of the best ways to combat your debt later in life.

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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 Money
Friday, 28 September 2018 17:54

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.

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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
Thursday, 20 September 2018 18:23

Cannabis Coca-cola could soon be a reality

Reports have surfaced that Coca-Cola is eyeing a deal with Aurora Cannabis, which may result in the production of a cannabis-infused cola drink.

The talks between the Canadian cannabis company and the famous Atlanta-based cola corporation was reported by Bloomberg.

They write:

“We are closely watching the growth of non-psychoactive CBD as an ingredient in functional wellness beverages around the world,” Coca-Cola spokesman Kent Landers said in an emailed statement to Bloomberg News. “The space is evolving quickly. No decisions have been made at this time.”

 

Cannabis-infused foods have been a favorite in legalized markets where consumers wish to avoid inhaling the plant.

A legalized market coupled with a high demand for such a beverage could send shares “flying.”

However its safety, such as when mixed with alcohol, raises concerns.

Marijuana Medical Benefits are Strain Specific

 

Cannabis plants produce cannabinoids, or chemicals that can induce an effect on the body. When cannabinoids are produced by a plant they are called phytocannabinoids. Humans produce their own cannabinoids, called endogenous cannabinoids.  Laboratory  or synthetically produced cannabinoids are called synthetic cannabinoids.

The human body has a very intricate endocannabinoid (endogenous cannabinoid) system, with receptors throughout our brain, organs, glands, and immune system. Hence a wide variety of physiological responses, occur when these receptors are stimulated by cannabinoids.  These include responses to sleep, memory, appetite, pain, immune response, mood, and cell damage repair and death, Research is currently investigating what endogenous chemicals the human body produces, but the majority of medical discussions surrounding cannabinoids includes the phytocannabinoids.

Cannabis plants produce many phytocannabinoids, but the most well-known and studied include CBD (cannabidiol) and THC (Tetrahydrocannabinol).  The latter is psychoactive, meaning it can give the user a feeling of euphoria.   The former, CBD, in non-psychoactive and researched more than others for its medicinal benefits.

Now plants, just like animals, are classified from Kingdom (Plantae) down to Genus and species.  Cannabis comes in a variety of species, including the major ones:  C. sativa, C. indica and C. ruderalis.

 

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C. ruderalis is less popular as it has a lower THC content. However it has “autoflowering” qualities, making them useful to cultivators, and if bred with C. sativa or C. indica could enhance the new hybrid in its reproduction.

C. sativa has a higher THC/CBD ratio, hence can provide more euphoria.  It reportedly helps decrease anxiety, treat depression and increase appetite.  It’s been touted to increase energy and boost creativity.  It's also used to help manage attention deficit disorder.  Although not approved yet in the US, an oral spray, nabiximol, has been developed and sold in multiple countries to treat neuropathic cancer pain.  Its brand name is sold, by prescription, as Sativex® .

C. indica has a higher CBD content and has been used for its sedative properties.  It's also used to help anxiety and induce appetite, but will additionally be used to treat pain and muscle spasms.

 

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Epidiolex has received FDA approval to treat some seizures.  Its high CBD component is credited for its anti-seizure activity.

There are multiple other strains, each touted to have their own unique properties.  420medbook.com provides the below table.

 

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The challenge, however, is the lack of medical research in each of the different strains.  And when a study does come out discussing the medical advantages or disadvantages to using cannabis medicinally, the specific strain may not be mentioned or easily found in the report.

I believe that various strains do have unique properties and there is an art to the field of medical marijuana but more research needs to be done and quickly to avoid random use of cannabis products for treatment of medical conditions.

 

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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
Saturday, 15 September 2018 18:22

Hurricane Florence: How You Can Help

The Category 1 hurricane that hit the Carolinas on Friday is expected to cause “widespread devastation” to multiple states.

Five people, including an infant, have been reportedly killed within the first 12 hours of  Hurricane Florence’s landfall.

Torrential downpours are expected to continue and power outages, floods, raging waters, and the potential for tornadoes threaten coastal and inland residents.

Risks of drowning, crush injuries, infection, malnourishment, chemical exposure, hypothermia are just a few of the grave issues residents are facing.

Malnourishment

 

Many of those who did prepare for the storm may not have stored plenty of food, especially healthy fresh food. Those trapped in their homes may find the food they did store contaminated by flood water.

 

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GREATER BATON ROUGE FOOD BANK 2016

 

Infectious disease

 

The World Health Organization states that floods bring water-borne diseases such as cholera, typhoid fever, leptospirosis and Hepatitis A. Vector-borne diseases include Zika, malaria, dengue hemorrhagic fever, yellow fever, and West Nile.

 

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Mosquitos initially get washed away during the storm, but the resulting puddles of water take weeks to dry and make ideal breeding grounds for insects.

The water gets dirty pretty quickly. People touching the flood water need to wash their hands thoroughly before eating or preparing food.

Moreover due to the moisture that seeped into walls and floors of houses, mold can grow and cause a variety of respiratory issues among other physical ailments. Massive disinfecting needs to take place before coming home to flood water contaminated residencies.

 

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Chemical exposure

 

Chemicals from garages and fuel seeping into flood water expose victims to many compounds such as benzene, toluene and xylene that can cause a multitude of health effects including those that affect breathing, skin, the gut, balance, thought, and memory.

Safety

 

Multiple looters in North Carolina have already been arrested.  During Hurricane Harvey, a Cajun Navy rescuer told CNN that looters fired shots at him and his comrades, trying to take their rescue boat, which had actually broken down.

Panic fuels dangerous behavior and those without resources may try to take from those who prepared.

Sexual assault crimes can rise as predators find the chaos and lack of video surveillance ideal conditions to find victims who can’t yell for help.

 

Psychological

 

When one loses their home, neighborhood, income, treasured belongings and more, its devastating. Post-traumatic stress disorder may ensue.

To combat these risks, medical personnel and the CDC are preparing. Among food, shelter and clothes, paper products, sanitizer, cleaning supplies, tetanus vaccinations and counselors will be needed is mass quantities.

 

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Hurricane Florence, although weakening, is expected to hover over the next few days bringing more deadly conditions.

 

How can we help?

 

Army Emergency Relief is taking donations here to help victims of natural disasters.

Save the Children‘s Hurricane Florence Children’s Relief Fund site can be found here.

Blood supplies will be needed as residents who routinely donate have evacuated the area. Donating blood at your local blood bank may be shipped to the area in need.

United Blood Services have locations throughout the country that can accept your blood Donation. Contact UBS here.

The American Red Cross is accepting monetary and blood donations. Financial donations can be given here or on their website at redcross.org. Moreover one can call 1-800-RED-CROSS or text the word REDCROSS to 90999 to make a $10 donation.

The Salvation Army is also accepting donations online here and by calling 1-800-SAL-ARMY (725-2769).

The Red Cross and Salvation Army may also need local volunteers to help set up shelters.  Contact the above numbers.

Local volunteers are asked to donate supplies to nearby recreation centers for housing evacuees.

Supply drives in out-of-state locations may not be accepted directly but could help local charities who need to ship supplies to the affected area.

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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 U.S.
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