The EpiPen® auto-injector contains epinephrine, used during an emergency to treat severe allergic reactions, or anaphylaxis.
If one is allergic to an insect or food, a severe allergic reaction may ensue upon exposure, in which the immune system releases a flood of chemicals that can cause throat tightness, hives, lip and facial swelling, difficulty breathing, nausea, vomiting, low blood pressure, rapid heart rate, cardiac arrest and possibly death.
Epinephrine stimulates the heart to increase cardiac muscle contractility, cardiac output, subsequently raising the blood pressure. Additionally it relaxes the muscles surrounding the airways, allowing one to breathe easier and take in more oxygen. Moreover it helps to stop the release of additional immune chemicals.
The EpiPen® is manufactured by Mylan. Its cost made headlines when the EpiPen two-pack recently stickered for close to $600. Now generic forms are available costing anywhere from $109-$300 for a dual pack.
The disposable auto-injector, for an adult, delivers 0.3 mg of epinephrine, while the EpiPen Jr., used in pediatric populations, delivers 0.15mg of the medication. It can be self-administered, through clothing if necessary, into the thigh muscle in one smooth movement once the safety release is removed.
After 0.3 ml is administered during the single adult dose, the EpiPen® unit is discarded.
However many are not aware that 1.7 ml of solution remains within the cartridge. This could, in theory, be used for an additional 5 doses if in a remote, “wilderness” setting.
Dr. Arthur (Tony) Islas, Fellow of the Academy of Wilderness Medicine, and professor at the University of Nevada, Reno School of Medicine’s Department of Family Medicine, demonstrated how to extract the remaining doses from the autoinjector at the January Nevada Academy of Family Physicians meeting in Lake Tahoe.
Although it's recommended that all users follow the manufacturer’s labels, those trained in emergency and wilderness medicine may take the used cartridge, cut off the top plastic, and extract the syringe with the remaining fluid.
Dr. Islas states the initial 0.3 mg dose of epinephrine lasts for 20 minutes. For most people this allows plenty of time for emergency responders to come to the site of the victim. However, in a “wilderness” or remote setting, another dose may need to be administered during a very severe case of anaphylaxis.
Canadian neuroscientists suggest taking Ibuprofen daily may prevent the onset of Alzheimer’s.
IMAGE FROM ALZHEIMER’S ASSOCIATION
Researchers from the University of British Columbia believe those who take daily ibuprofen, a non-steroidal anti-inflammatory (NSAID), can decrease inflammation of the brain caused by the abnormal proteins that cause Alzheimer’s.
In 2004, Dokmeci et al suggested ibuprofen could delay Alzheimer’s onset as it protects neurons (nerve cells) and decreases inflammation of the brain.
In this study, Dr. Patrick McGreer and his team believe they can identify those early on who could benefit from the inexpensive, over the counter treatment.
McGreer is President and CEO of Vancouver-based Aurin Biotech. He and his team developed a saliva test that measures the protein Abeta42 (amyloid beta protein 42). In patients at risk of Alzheimer’s, they found levels of Abeta42 to be two to three times higher than normal. Abeta42 accumulates in the brain, causing inflammation and destroying nerve cells. Though previously believed Abeta42 is made exclusively in the brain, the saliva test suggests Abeta42 is made elsewhere in the body and can be detected years earlier. If the protein/peptide is found earlier and known to cause inflammation, McGreer and his team believe preventing the inflammation with ibuprofen could essentially prevent Alzheimer’s onset.
He states, “What we’ve learned through our research is that people who are at risk of developing Alzheimer’s exhibit the same elevated Abeta42 levels as people who already have it; moreover, they exhibit those elevated levels throughout their lifetime so, theoretically, they could get tested anytime. Knowing that the prevalence of clinical Alzheimer’s Disease commences at age 65, we recommend that people get tested ten years before, at age 55, when the onset of Alzheimer’s would typically begin. If they exhibit elevated Abeta42 levels then, that is the time to begin taking daily ibuprofen to ward off the disease.”
Daily ibuprofen would not, however, be without its risks. Gastric upset, ulcers, kidney disease and heart disease could occur with excessive NSAID use. The authors suggest a “low dose” but did not specify an exact milligram quantity.
Advances in Alzheimer’s treatment have met multiple obstacles as the neurodegenerative disease is difficult to detect early and the few treatments we do have are not very effective at slowing and reversing pathology. If protein deposition in the brain can be prevented early, we could potentially save the millions of people destined to get the disease. Currently 5.5 million people in the US have Alzheimer’s, and 44 million people are affected worldwide.
For more on the study read here.
Although flu cases have started to decrease since its peak early this winter, flu season may continue well into late Spring. The CDC warns a second wave of flu may be upon us as Influenza B is making the rounds.
Although first bombarded with H3N2 “A” strain influenza, Americans appear to be reporting more “B” flu cases this time of year, comprising more than 58% of cases lab-identified.
And young children are especially susceptible to B strain viruses.
5 pediatric flu-related deaths have been reported this week. The CDC cites 133 influenza-related pediatric deaths for the current 2017-2018 season.
According to the CDC:
Overall, influenza A(H3) viruses have predominated this season. However, in recent weeks the proportion of influenza A viruses has declined, and during week 11, influenza B viruses were more frequently reported than influenza A viruses.
Week 11 (March 11-17, 2018) has seen the following:
The proportion of outpatient visits for influenza-like illness (ILI) was 2.7%, which is above the national baseline of 2.2%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; nine states experienced moderate ILI activity; New York City, Puerto Rico, the District of Columbia, and 17 states experienced low ILI activity; and 18 states experienced minimal ILI activity.
The trivalent and quadrivalent flu vaccines both protected against Influenza B as well as the A strains of H1N1 and H3N2 this year. However, flu shot efficacy proved poor for the 2017-18 season, being approximately 30% effective. Moreover, flu viruses can mutate as the season progresses.
It is not uncommon for one to be infected with the flu twice by two different strains circulating during the season.
What’s concerning is allergy season is beginning to overlap with flu season. Those with allergies may have a temporary weakness in their immune system, making them more susceptible to catching a cold or flu.
One of the most embarrassing, untalked about faux pas that occurs in families is the accidental witness of two parent figures having sex.
Our children see us make dinner, watch TV, argue about the in-laws, blame each other for the last cookie being eaten, drop each other’s toothbrush in the toilet (Ok I did that once!), so seeing, and hearing, two adults be intimate could potentially leave a mental scar for life.
And the moment the child is being visually and audibly traumatized, what do we do? We scream…..”GET OUT,” or “YOU’RE NOT SUPPOSED TO BE HERE!”
Then once dressed, or finished, we hunt down the child, who’s probably hiding in their room, to try to urgently rectify the situation. My guess is many of us fail at this as well.
Telling them “Mommy and Daddy were just having a conversation,” adulterates any competency in communication skills they might have developed over the past few years.
“Mommy and Daddy were having sex” might work, but the average child who just witnessed it may choose a life of celibacy that instant.
So what should we do?
I don’t care if you told them a million times not to enter your room, it’s YOUR fault the door was unlocked. Blaming the child makes the situation worse and traumatizes them more. Let them know you’re not mad and want to discuss what happened.
Children of all ages learn by mimicry. Watching parents have sex may startle not so much because of the sexual nature, but because it’s an act they don’t want to mimic.
In a child’s mind they think that the act they just witnessed is one they need to engage in later if they want to be a grown up like you…..and it scares them. Reassure them that they do not have to do “everything Mommy and Daddy do.”
If the child thinks “all adults” do what they just witnessed (position, sounds, tools, etc.) they will extrapolate and think their teachers, clergy, and grandparents do the exact same thing. This could be traumatizing as well. Let them know that you and your partner were experimenting and having fun and sex is different for everybody. Which brings us to….
Rather than labeling it sex, calling it Mommy and Daddy time is fine. Let them know that adults need private time and some things or acts may feel good and make them happy.
The child may be more concerned about being yelled at or caught doing something they shouldn’t than actually seeing you have sex. So their first priority is making sure this doesn’t happen again. Set boundaries such as, “When our door is closed, knock first,” will give them a concrete instruction to follow. They may then ask, “But, what happens if there is a fire?” - so let them know in an emergency, getting your attention is OK.
If your child says “I got it, I got it, yeah I understand,” that doesn’t necessarily mean he/she understands. It means they want to leave the conversation. That’s fine. You can always revisit it later. Sometimes during a drive in the car, topics such as this may be easier to discuss than at home with baby brother/sister giggling nearby. They’re a captive audience (unless they choose to jump out of the car), and you can smoothly transition to the subject by asking for permission to have a “big boy/big girl” talk.
Kids like two things, being asked permission by a parent and not being talked to like a little kid. Capturing their attention this way may allow you to then discuss what needs to be discussed.
One more bit of advice …..when the kids are home and you can’t control yourselves, keep it down, avoid loud machinery, and keep it under the covers……
The US Centers for Disease Control and Prevention advisory committee voted this week to return the FluMist, nasal spray flu vaccine, to the recommended options for the 2018-2019 flu season.
In 2016 it was not recommended and discouraged as they found its effectiveness against seasonal flu to be approximately 46%, when 65% efficacy was touted by the injectable flu shot. However this flu season, the current flu vaccine was found to be only 35% effective with one of the worst flu seasons in years taking the lives of healthy young adults and children.
Why was this season so severe? The H3N2 strain was the predominant one, notorious for bad flu seasons, and is crafty, able to mutate before the vaccine is finalized. Hence our flu vaccine was not able to be as close a match as desired.
The panel voted 12-2 this week to include FluMist as an option for medical providers to recommend against the upcoming 2018-2019 flu season.
Why was FluMist removed? Experts found it to be ineffective against one of the influenza A H1N1 strains. With its overall efficacy found to be lower than the flu shot it was deemed a less ideal option than the shot.
FluMist is a live attenuated vaccine that is not recommended in infants and pregnant women. It’s indicated for those between the ages of 2-49 and introduces a live, weakened version of the flu virus to incite an immune response. This differs from the injectable flu vaccine which uses killed versions of the flu strains to induce a flu response.
Children prefer the FluMist as the nasal spray offers a less painful option than an injection.
The FluMist Quadrivalent nasal spray, manufactured by MedImmune of AstraZeneca PLC, offers protection against 4 strains of flu including H1N1, H3N2 and two influenza B strains. According to FluMist’s prescribing information, the FluMist proved 90% effective against H3N2 as opposed to influenza B where it scored 44.3% effectiveness. Another review found its efficacy against H3N2 to be 79%.
Now that’s not to say the FluMist would have been immune to the vaccine issues experienced with this year’s flu shot as H3N2 is a highly virulent and mutable virus, and could have snowed the FluMist vaccine makers as well.
Yet we may need to consider that the FluMist may be more efficacious for some strains of the flu whereas the flu shot may better protect us against others. More research needs to be done in this area. As of now choosing which flu shot to get for the next flu season may be a crap shoot.
The World Health Organization (WHO) has issued a list of diseases that could potentially become worldwide deadly epidemics, and “Disease X” is included in this list.
The list includes the following:
Disease X represents a pathogen, not yet identified, that could turn and become one of the worst threats yet.
Citing biochemical warfare, gene editing, or Mother Nature’s ability to induce mutations, the WHO believes a benign pathogen that’s currently circulating could jump from animal hosts to humans, or evolve to become a highly virulent, infectious bug.
So the next “Disease X” could be:
This warning helps remind the globe of the unpredictability and speed at which new epidemics arise.
WHO stated, “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”
Moreover, diseases such as Zika and Ebola were discovered decades ago, but only recently did they cause fast-moving epidemics, despite smaller sporadic outbreaks in the past. So a currently deadly virus or bacteria that causes isolated cases, if the conditions are right, can ignite a cluster, expand locally in an outbreak, or increase further and become an epidemic.
And humans lack natural immunity to chemical agents and man-made pathogens, hence can be easily overpowered when exposed for the first time.
The formal designation of Disease X will hopefully incite researchers to prepare for what could be a surprise ambush by something that’s been either under our radar for some time or about to be created.
A coyote who attacked several people in Westchester County, NY this week has been captured and killed, testing positive for rabies.
Authorities believe another coyote is on the loose presumed to be rabid as well.
A police officer, a postal worker, two bicyclists and two dog walkers, with their pets, were attacked within a 24 hour period. Three sheep may have been mauled as well.
One dog and a sheep have died as a result of the attacks.
The two coyotes may have been travelling together, with one still being at large.
The attacks occurred in Yonkers, Hastings-on-Hudson, and possibly Somers, NY. Residents have been asked to avoid any wooded areas and keep their pets inside.
An animal with rabies may be very aggressive, more prone to attacks as opposed to one that is not infected.
Rabies is a disease caused by a virus and transmitted through a bite. Although dogs are the most common animal to transmit the virus to humans, it more commonly infects bats, coyotes, raccoons, skunks, jackals, mongooses and foxes.
The animal will be agitated and many times foaming at the mouth due to hypersalivation.
The virus affects the central nervous system, including the brain, and can therefore be fatal. Once symptoms appear it may be too late to save the affected animal or patient.
Once exposed to infected saliva the virus enters the peripheral nervous system (nerves in the limbs, outside of brain and spinal cord.) Then it travels to nerves in the muscle, replicates there and eventually works itself up to the brain. Stages occur as the following:
An incubation period is the time it takes from exposure until symptoms show. With rabies the average incubation period can range anywhere from a few days to years with the average lasting a few weeks. During the incubation period the patient may not know they are infected and the pathogen is multiplying and spreading.
The prodrome causes the patient to feel flu-like with symptoms including:
These symptoms may last anywhere from 2-10 days.
As the central nervous system (brain and spinal cord) become affected symptoms include:
A deep state of unconsciousness can occur within 2-7 days.
Despite ventilatory support for breathing, most die of cardiac and or respiratory arrest.
Although most infections prove fatal, some may survive with an injection of rabies immune globulin that binds to and prevents the virus from replicating. Then four – five vaccines are given over the next two weeks to help stimulate the immune system.
Wild animals suspected of having rabies during an attack will be euthanized and their brain tissue examined for rabies. For domesticated animals, whose suspicion is less, they will be observed for 10 days, and if they do not elicit symptoms, most likely do not have rabies.
If one has been bit by a wild animal who has not been caught, the medical provider may wish to treat empirically with post exposure prophylaxis.
Pet owners can start by vaccinating their pets. Avoiding wild animals, especially bats, preventing them from entering the house. Vaccinations are also available for those who work frequently with animals or travel to areas where rabies is more common.
Taking a selfie at a distance of 12 inches from your face increases the size of your nose by 30%.
According to a study published in JAMA Facial Plastic Surgery, selfies distort the nose by 30% in width in men and 29% in women.
However pictures taken 5 feet away do not distort the nose.
Study author Dr. Boris Paskover, facial plastic surgeon at Rutgers New Jersey Medical School, stated, “At 5 feet, the distance between your nose and the camera and the distance between your facial plane and the camera is almost the same.”
He and his colleagues are finding a huge increase in people requesting plastic surgery to improve their look in selfies.
But if the image taken provides a distorted view, thousands of people may be having unnecessary operations.
According to the American College of Plastic Surgeons, reported by USA Today, minimally invasive cosmetic procedures have increased 200% since 2000 and are rising each year. They find the top 5 cosmetic surgeries in 2017 were:
And the most common minimally invasive cosmetic procedures were:
This week BBC news reported millennials to be on track to be the most overweight generation since records began. Millennials have popularized the selfie on social media and are the most tech savvy when it comes to marketing themselves online. The rest of us are catching up. And our exceptional skills at taking great selfies may unwittingly de-expose us to the truths of our appearance. If we look at our computers more than we look at a mirror, we won’t see the enlarging waist line, large butt, full face or love handles. We think “we’re good” rather than being reminded of our figure’s shortcomings. Complacency leads to laziness and letting one healthy meal or workout slide could lead to down-spiral of our weight maintenance.
Selfies have overtaken how see ourselves, attract dates, entertain others, and communicate with our friends. They’re not going away anytime soon and in fact leading to an epidemic of selfitis. And if we’re not careful we’ll see an epidemic of unneeded plastic surgery as well.
A new study reveals that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.
Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:
We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).
Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”
These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.
Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.
A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.
Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day. They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10 mg/ml. That dose would be commonly consumed by many humans who vape.
They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.
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:
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.
For more on the study read here.
Millions of people view porn every day and the Florida House has approved a resolution to protect their constituents from its inherent health risks.
According to the resolution’s sponsor, Republican Rep. Ross Spano, “Research has found a correlation between pornography use and mental and physical illnesses, difficulty forming and maintaining intimate relationships, unhealthy brain development and cognitive function, and deviant, problematic or dangerous sexual behavior.”
So is pornography a public health risk?
A public health risk is something that could pose a health threat, injury to humans or could contribute to health risks of other humans. This could include drunk driving, mosquitos or rats transmitting disease, or even smoking.
So watching pornography would pose a public health risk if not only the “pornee” gets hurt but affects others surrounding him. Now the effect of others could be in the form of missing work, viewing porn at work (considered sexual harassment and/or assault by others not wanting to view it), and unwanted sexual acts with one’s partner.
Although we do not have any definitive studies telling us porn is good or bad for our health, there are many opinions on the matter.
One concern is inactivity and time spent in front of a screen. Sitting in front of a computer, tablet, or hand-held device watching hours of porn could increase risk of a blood clot, heart disease and (prolonged sitting) has been linked to colon cancer. However, according to PornHub, the average time spent viewing porn only ranges from 9-13 minutes.
What about lack of sleep? Are people secretly watching porn at night, and not getting their 7-9 hours of uninterrupted rest?
According to PornHub the most common time during the day to watch porn was between 10 pm and 1 am. If one is only online for 10 minutes and falls asleep afterwards, they may still receive a good amount of sleep.
In 2009 a study found frequent masturbation in young males could increase their risk of prostate cancer, but in older men (>50 years), reduced their risk. Other studies have suggested reduced risk of prostate cancer that occurs in older men but not aggressive cancer in younger men.
Excessive masturbation could affect one’s refractory period, or time it takes to form an erection again after sex. For some this could last 15 minutes, for others a week. So if a date night is planned for later that evening, one with a long refractory period could have issues.
Chafing and inflammation can also occur but are usually rectified with a change in modality.
The American College of Pediatricians released this statement:
The consumption of pornography is associated with many negative outcomes: increased rates of depression, anxiety, violent behavior, early sexual debut and sexual promiscuity, higher rates of teen pregnancy and a distorted view of relationships. For married adults, pornography also results in an increased likelihood of divorce which, in turn, is harmful to children.
Author, L. David Perry, MD, states, “Pornography glorifies decontextualized sex. Its use by adolescents and young adults often leads to a distorted view of sexuality and its proper role in fostering healthy personal relationships.”
If state governments choose to debate porn being a health risk, I agree with strict restrictions on child and adolescent access. I also agree with education of condom use to protect against unsafe sex practices. Moreover, counseling resources for those addicted to porn should be increased as internet and porn addiction is a growing public health threat. However, does the occasional video view pose serious health risks….no.