Items filtered by date: Wednesday, 24 July 2019

Harvard researchers warn that 30 million Americans are taking aspirin for prevention of heart disease when they could be putting themselves at risk for other serious diseases.

They estimate that 1/5 of these individuals took aspirin on their own without a doctor’s order.

Although aspirin use is recommended for secondary prevention of future heart attacks and ischemic stroke in those at risk of having a future episode, primary prevention (in those who have never had an attack) is still debated.

One study last year found minimal benefit if at all for primary prevention in low risk individuals.  Many experts say the risk of gastrointestinal bleeding, heart disease, hemorrhagic stroke and kidney disease outweigh the benefits.

The latest guidelines from the American College of Cardiology states the following in terms of aspirin for prevention of heart disease:

FOR DECADES, LOW-DOSE ASPIRIN (75-100 MG WITH US 81 MG/DAY) HAS BEEN WIDELY ADMINISTERED FOR ASCVD PREVENTION. BY IRREVERSIBLY INHIBITING PLATELET FUNCTION, ASPIRIN REDUCES RISK OF ATHEROTHROMBOSIS BUT AT THE RISK OF BLEEDING, PARTICULARLY IN THE GASTROINTESTINAL (GI) TRACT. ASPIRIN IS WELL ESTABLISHED FOR SECONDARY PREVENTION OF ASCVD AND IS WIDELY RECOMMENDED FOR THIS INDICATION, BUT RECENT STUDIES HAVE SHOWN THAT IN THE MODERN ERA, ASPIRIN SHOULD NOT BE USED IN THE ROUTINE PRIMARY PREVENTION OF ASCVD DUE TO LACK OF NET BENEFIT. MOST IMPORTANT IS TO AVOID ASPIRIN IN PERSONS WITH INCREASED RISK OF BLEEDING INCLUDING A HISTORY OF GI BLEEDING OR PEPTIC ULCER DISEASE, BLEEDING FROM OTHER SITES, AGE >70 YEARS, THROMBOCYTOPENIA, COAGULOPATHY, CHRONIC KIDNEY DISEASE, AND CONCURRENT USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS, STEROIDS, AND ANTICOAGULANTS. THE FOLLOWING ARE RECOMMENDATIONS BASED ON META-ANALYSIS AND THREE RECENT TRIALS:
  • LOW-DOSE ASPIRIN MIGHT BE CONSIDERED FOR PRIMARY PREVENTION OF ASCVD IN SELECT HIGHER ASCVD ADULTS AGED 40-70 YEARS WHO ARE NOT AT INCREASED BLEEDING RISK.
  • LOW-DOSE ASPIRIN SHOULD NOT BE ADMINISTERED ON A ROUTINE BASIS FOR PRIMARY PREVENTION OF ASCVD AMONG ADULTS >70 YEARS.
  • LOW-DOSE ASPIRIN SHOULD NOT BE ADMINISTERED FOR PRIMARY PREVENTION AMONG ADULTS AT ANY AGE WHO ARE AT INCREASED BLEEDING RISK.

A report published in the American Heart Association’s Heart and Stroke Statistics annual report cited 48% of US adults have some type of cardiovascular disease.

The uptick could be due to rising obesity, and lowering thresholds for diagnosing guidelines such as high blood pressure (now considered high if over 130/80).

Although smoking rates have declined over the years, many still use tobacco and recent research has found E-cigs to increase risk of heart attack and stroke by 70%.

 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 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 bleeding 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.

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. 

Preventing Heart Disease

Firstly, we must know our risk factors. These include:

  • Family history of heart disease
  • Personal history of heart disease
  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Smoking
  • Obesity
  • Inactivity
  • Males over 40
  • Females who are post menopausal
  • High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.  Therefore, secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, 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, 24 July 2019 21:05

Numbering you won't stop the opioid crisis

People are dying all over the country from opioid overdoses. There’s a movement to have the antidote naloxone available in all ambulances and even over the counter. This temporarily reverses the fatal effect of opioids, which stop the patient’s breathing. First responders themselves may need a dose because of contact with a tiny amount of fentanyl, an extremely potent narcotic, while attending a patient.

No, the fentanyl does not come from the patient’s bottle of legal prescription drugs.

Rep. Bill Foster (D-Ill.) introduced a proposal that he claims would “go a long way to fight the practice of doctor shopping for more prescription pain pills amid a deadly opioid crisis.” Doctor shopping “involves visiting multiple doctors.” Hardly new, this proposal, now passed by the House of Representatives as an amendment to a $99.4 billion Health and Human Services appropriations bill, lifts the ban on funding a Unique Patient Identifier (UPI).

The UPI is part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. You don’t have one yet because former congressman Ron Paul, M.D., (R-Tex,) sponsored a prohibition on funding it as part of a 1999 appropriations bill. Rep. Foster’s amendment repeals Dr. Paul’s prohibition.

So how is this 1996 idea supposed to work? And why would it be better than the Prescription Drug Monitoring Programs (PDMPs) now in effect in nearly every state? Every prescription for a controlled substance must be reported to the PDMP, and the doctor must check it before writing a prescription, to be sure the patient is not lying about having prescriptions from other doctors. This costly program that creates time-consuming hassles for doctors has not prevented opioid deaths.

PDMPs are ineffective because doctor shopping is not the cause of the problem. Only 2.5 percent of misused prescription pain medicine was obtained by doctor shopping. And this small percentage apparently increased after PDMPs. More than 97% of misused medications are obtained from a single physician—or from an illicit source. The spike in opioid deaths after 2013 was caused by illicit fentanyl, as Dr. John Lilly concludes from painstaking analysis of official data.

If Rep. Foster’s amendment is not removed, you might have to have a UPI to get legitimate medical care—“no card, no care”—but the drug cartel won’t mind. You can shop drug dealers as much as you like. There is a flood of fentanyl, mostly from Mexico or China, coming across our borders. Rep. Foster is apparently unaware of the armed lookouts protecting the smuggling routes in the Tucson sector. And once here, the drugs go to distributors—such as illegal aliens protected in sanctuary cities.

So, what about the other touted benefits of the UPI? “Specifically, assigning a unique number to a patient would give doctors a way to immediately identify a patient’s medical history,” said Rep. Mike Kelly (R-Pa.). He says it “would lower the cost of medical mix-ups due to misidentification.” His elderly father was nearly given the wrong medication.

To prevent medical errors, you need alert nurses and doctors—and the UPI is not going to fix the hazards of the electronic health record. The EHR, touted as the solution that will bring efficient, quality care, has created its own type of errors.

There is no guarantee that a UPI will improve access to the record, and critical information will still be buried in voluminous, repetitious data of dubious reliability, some of which may have been cut-and-pasted from another patient’s record. There may be critical gaps as patients withhold information they don’t want in a federal database. The new problem that brings the patient to the hospital won’t be in the old record—but may be the result of an old misdiagnosis that should be corrected instead of copied.

Patients need to be able to shop for doctors, especially if the one they have has not solved their problems. Some of them desperately need opioids, which are increasingly difficult to obtain. They do not need a UPI, and neither does their doctor.

The UPI is ideally suited for government tracking and control of all citizens. People like J. Edgar Hoover or Lois Lerner might find it very useful. But it would be the end of privacy, and the foundation for a national health data system.

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

 

 

Published in Opinion

A few years ago, where I live (in rural Nevada), we thought there was going to be a neighborhood tragedy.

 

The 7-11 store which served my rural area started falling on hard times.

 

First, they got out of the gas business.  The powers that be, told the owner that he needed to replace the underground tanks.  He couldn’t justify the expense.  And then, it became public knowledge that Dollar General had purchased the land across the street.

 

The 7-11 franchisee fled.  He was replaced by a remarkably similar independent operator who got a Valero gas franchise and called his store 24-7.

 

And Dollar General built a pretty nice store across the street.

 

The reason for that story is a headline on the CNN Business site:

 

“Dollar stores are everywhere. That’s a problem for poor Americans”

 

That’s right.  The Chicken Noodle News network a/k/a the Trash Trump Net is all of a sudden worried about “poor” Americans.

 

The thrust of the story is that members of a number of city councils are restricting new dollar stores—which can be roughly defined the same way they define “assault weapons”—because many of them only sell fast frozen food thus creating a “food desert”, allegedly because big grocers do not wish to compete.  

 

CNN says, “Advocates of tighter controls on dollar stores say the big chains intentionally cluster multiple stores in low-income areas. That strategy discourages supermarkets from opening and it threatens existing mom-and-pop grocers, critics say.”

 

Of course, that’s also the strategy of McDonalds.

 

““The business model for these stores is built on saturation,” said Julia McCarthy, senior policy associate at the nonprofit Center for Science in the Public Interest and a critic of dollar stores. “When you have so many dollar stores in one neighborhood, there’s no incentive for a full-service grocery store to come in.”

 

“Opponents also express concerns that dollar stores don’t offer fresh produce. Dollar General and its dollar store rivals mostly sell snacks, drinks, canned foods and vegetables, household supplies and personal care products at rock-bottom prices.”

 

Imagine that… snacks, drinks, canned foods and vegetables, household supplies and personal care products at rock-bottom prices.

 

How terrible is that?

 

Hey MORONS! (that’s you CNN).  If you don’t have a lot of money, snacks, drinks, canned foods and vegetables, household supplies and personal care products at rock-bottom prices is a GOOD thing.

 

I’m sorry to tell you that Oklahoma City, where I once owned KOKC and Tulsa where I used to own KTRT passed legislation limiting new dollar store openings.  But only in the “poor” neighborhoods.

 

Ahh, the Nanny State.

 

If you can’t afford to buy a lot, we’ll make you drive to a rich neighborhood to buy it cheap.  Only the oil producers in Oklahoma would like that.

 

The thought in the heads of the libs who lobby for this crap is that if you kill off the dollar stores in the neighborhoods who need them the most, Kroger or Albertsons will take the risks and move right in.

 

Sure they will.  When their shareholders don pink pig suits and fly.  That’s what happens when the Jihad Squad followers get themselves elected to city councils.  Maybe Congress, if we let it continue without opposition.

 

We’ll check into what happened in my former stomping grounds in a few years and see if the libs were right.  Here’s a hint.  Find a bookie who will book a long term future bet.  Bet they won’t.  Make sure that bookie can pay off.

 

Oh…to finish the story about my neighborhood, both stores are doing well, several years later.  Which goes to show the truth of the old saying that the best place to locate a shoe store is across the street from another one.

 

FRED WEINBERG

 

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Fred Weinberg is a columnist and the CEO of USA Radio Network. His views and opinions are his own and do not necessarily reflect the opinions of GCN. Fred's weekly column can be read all over the internet. You can subscribe at www.pennypressnv.com. His column has been reprinted in full, with permission. 

 

Published in Opinion