Multiple states have mobilized their #LocktheClock forces to put an end to biannual time changes.  Last year California passed Proposition 7, making Daylight Saving Time year-round and permanent.  Other states who have proposed legislation include the following:

Some states had put forth legislation to be on Atlantic Standard Time, a time zone one hour ahead of Eastern Standard Time that essentially puts them on year-round Daylight Saving Time.  These include Connecticut, Massachusetts and Rhode Island.

Multiple health risks have been cited in scientific literature during the “Spring Forward” and are cited below, including car accidents, heart attacks and workplace injuries.

Dr. Paul Kalekas, an Internal Medicine and Attending Physician at Valley Hospital Medical Center who has practiced in Nevada for years, states, “It’s time this gets done.”

Nevada’s original bill failed to pass in Congress a few years back so he and other physicians are working to resubmit legislation.

Senator Marco Rubio (R-FL) has introduced the Sunshine Protection Act to make daylight savings time the new, permanent standard time. States with areas exempt from daylight savings time may choose the standard time for those areas.

However, critics worry that states choosing their own time may disrupt the time zone uniformity.

So how did we end up here in the first place?

History of Daylight Saving Time

This ritual began in ancient civilizations, when daily schedules would be adjusted to the change in daylight. Later Benjamin Franklin wrote an essay for Parisians entitled “An Economical Project for Diminishing the Cost of Light” in 1784 explaining how less candles could be used if people woke up earlier, making  more use of natures early light.

 

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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 U.S.
Friday, 15 November 2019 18:23

Smartphones again linked to temporary blindness

Two new cases of “smartphone blindness” has been described in the last month.   One case was a gentleman in China who was playing games on his phone at night and suffered a retinal artery occlusion or “eye stroke.” Another case was a woman in China, who was also playing on her phone at night but she sustained a bleed in her left eye.  Just as those who suffer from cerebral strokes, a “lack of blood flow” to the retina, or layer of the eye that helps create visual images, can be caused by a clot or hemorrhage.  Apparently these can be induced with excessive focusing and eye strain. This may result in temporary or permanent blindness.

UPDATED FROM JUNE 23, 2016

Some people are being evaluated for stroke or transient ischemic attacks when they come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark.  This phenomenon, known as ‘smartphone blindness’, has been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.

 

In 2016, doctors reviewed the cases of two women who experienced episodes of “temporary blindness”; as the ladies put their cell phones down, one eye could not see the cell phone for 15 minutes.  Their vision restored after this length of time.Doctors investigated the cases thoroughly with a variety of medical tests including MRI’s and couldn’t find the cause.

Finally they conclude these transient episodes of “vision loss” were harmless, in that one eye was being used to look at the phone and the other eye needed time to “catch up”.  When the women, as many of us do, check our phones, one eye is snugly closed and resting on a pillow while the other is available to look at the phone.  When the ladies would turn over, the closed eye didn’t have a chance to catch up to the increased brightness of the phone screen, hence having a dimmed view.

If one uses both eyes to look at the screen, this phenomenon does not happen.

Smartphone Blindness Studies Are Cause For Concern

Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment.  In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss.  Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached.  A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurs.

Smartphones have also been linked to myopia, nearsightedness and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.

A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.

Increasing the size of the font helps your eyes since they don’t need to strain as much to read.  Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.

Additionally, avoid using the phone in the dark, but in a lit room. 

Finally its good to use the 20,20,20 rule.  After every 20 minutes of use, look away at something 20 feet away for 20 seconds.  This may help avoid eye strain from excessive smartphone use.

 

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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
Friday, 15 November 2019 18:03

A Stethoscope Is NOT A Prop

Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.

But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.

High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.

The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on.

It may be true, as Dr. James Thomas said, that graduates in internal medicine and emergency medicine miss as many as half of murmurs using a stethoscope. There are several reasons for this. One is not taking enough time to listen in a quiet room, and failing to perform the special maneuvers required to bring out an otherwise inaudible murmur (lean forward and exhale fully, turn onto your left side, squat then stand up, etc.).

The other is inadequate training. There are excellent recordings of heart sounds and murmurs, which of course would take time away from the time-devouring electronic medical record or “systems-based” medicine. And a recording is not the same thing as a live patient. Much of today’s teaching in physical diagnosis may be by “patient instructors”—paid actors pretending to be patients, who are evaluating the students as the students examine them. Rounds may be in a conference room, focused on the electronic record, instead of at the bedside.

In the old days, all the members of the team got to examine a real patient who had an interesting finding, with the patient’s permission and under the supervision of an attending physician. It seemed to me that patients usually enjoyed being the center of attention and the star of the show, and hearing the professor discuss their case. We learned how to help patients to sit up, and about hairy chests, layers of extra insulation, noisy lung sounds, shortness of breath, and other impediments to an easy examination.

The stethoscope is not just for heart murmurs. It’s for finding subtleties in careful, slow measurement of the blood pressure. It’s for extra or abnormal heart sounds. One can sometimes hear evidence of vascular problems inside the skull, or in the arteries supplying the brain, kidneys, or limbs. Or signs of intestinal obstruction. One can check to make sure a breathing tube is in the right place.

I don’t know of any bedside technologic wonders for examining the lungs. The stethoscope can detect sensitive signs of heart failure, pneumonia, fluid in the chest, collapsed lung, or airway obstruction. One can listen frequently to monitor changes in the patient’s status—much more efficiently than bringing the portable x-ray machine around.

The stethoscope works even when the power is off, the batteries are dead, the computer is down, or some circuit in the ultrasound device is malfunctioning. It works in facilities too poor to have the latest technology, or with patients who can’t afford to pay for a more expensive examination.

The stethoscope has tremendous capabilities in trained hands. Patients might want to evaluate whether they have a clinician who knows how to use it or is just carrying around a prop or status symbol. If you have symptoms suggestive of a heart or lung problem, does the doctor listen to all the lung fields—upper, mid, and lower, front and back? To at least four places for heart sounds? Are you asked to cough, say “e,” whisper something, take deep breaths or slow quiet ones, or do other maneuvers if something in the history or examination suggests a possible problem? Is the tv off, and are visitors asked to be quiet?

Everybody including doctors loves fancy technology. But before we toss out the old reliable tools, backed by two centuries of experience, how about some serious comparative studies like those the proponents of evidence-based medicine constantly demand?

 

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 are her own. This is an edited version of her column that originally appeared in pennypress.com. Reprinted with permission. 

Published in Opinion
Wednesday, 13 November 2019 18:35

Tips to help you stop smoking & vaping.

Some of you are trying to get a head start before the family makes you come up with a New Year’s resolution to quit vaping and smoking. So you’ve cut back on tobacco and nicotine and have decided to quit.  Awesome! Within the first half hour of quitting, studies have found your blood pressure and heart rate improve, so your health starts to improve immediately!

So, way to go!!!!  But now what?  It’s not that easy.  You’ve got cravings.

Not being able to manage these cravings can put you at risk of relapsing back into nicotine dependence.

Withdrawal from nicotine can manifest in any of the following:

  • anxiety
  • depression
  • cough
  • sore throat
  • headaches
  • hand tingling
  • increase appetite
  • sleep disturbances
  • constipation
  • mood changes
  • poor concentration
  • memory loss

and more.

Firstly don’t be afraid to get help if you need to.  Nicotine is a powerful, addictive drug and retraining your body to not ask for it is a challenging process.  Smokefree.gov offers multiple resources to help one quit smoking/vaping.

Your medical provider can offer you nicotine replacement therapy to help you wean slowly, or medications such as (brand names) Chantix and Wellbutrin that can help you with your cravings as you cut back or quit.

Therapy and counselling can also be very beneficial while you are weaning off nicotine.

But some of you will want to quit cold turkey.  How do you manage the cravings then?

So we break this down into biological and psychological factors.

Biologically, we can hit this a few ways.  One, is the food choices you make can help with your cravings.

Vegetables like celery and carrots are great quick-to-grab veggies when you’re in a bind. Citrus fruits like oranges work well. Bananas with their vitamin B and potassium melt in your mouth and don’t leave room for a cigarette. Potatoes have potassium and when not loaded up with butter and cheese are….well… not as yummy.

Peppermint is good at curbing cravings, so when you’re walking out of a restaurant don’t forget to grab some of those free candies sitting there. Ginseng and ginger help with cravings as well, and don’t forget fiber.  Stuffing your mouth with oats, bran and fibrous foods keep you so busy trying to pick them out of your teeth that you are too exhausted to smoke.  Top all of this with lots and lots of water, and you’ll find yourself off the nicotine in no time.

Let’s celebrate.  Some one grab me a beer….no wait! No alcohol!  Alcohol fuels your cravings as does meat and caffeine.  Sorry, I never said it would be easy.

Exercise also helps because it will help you keep busy, increase your endorphins and works on the weight gain that might accompany smoking cessation.  Take a nice stroll every time you feel the need to grab a cigarette.

Which transitions nicely into psychological ways to quit.

Distraction is huge.  As the cravings come on, distract yourself by exercise, reading, dancing, or writing about your journey towards a smoke-free life to help others.

Have index cards written out with reasons to quit.

Have a disgusting picture of tobacco-destroyed lung in the kitchen or wherever you get the urge to smoke.

And get your friends and coworkers on board to help. If they vape/smoke in front of you, it will make it that much harder.  Have a friend, family member designated as your support guide who texts you encouraging messages throughout the day as you try to quit. Remind them that the content cannot include chores or reminders to pick things up on the way home.  There……if these tricks don’t help you quit vaping/smoking, at least you can use them to get out of chores…..

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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

A form of diabetes, having features that overlap with both Type 1 and Type 2 diabetes, has been given the name, Type 1.5 Diabetes. Researchers suggest that Latent Autoimmune Diabetes in Adults (LADA), may comprise 10% of the diabetic population, and require insulin treatment be instituted earlier than in those previously diagnosed with Type 2 diabetes, because they may have an autoimmune etiology (seen in Type 1 diabetics)…… hence a Diabetes Type 1.5.

Type I vs. Type II vs. Type 1.5 Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance. This is the fastest growing type of diabetes in both children and adults.

So Type 1.5 Diabetes may develop after childhood, as a working pancreas may, during adulthood, become damaged by the body’s immune system or, suggested by some, a virus.  Those with Type 1.5 diabetes therefore may not be obese, may have had difficulty managing their blood sugar by diet and exercise alone, and may need assistance with insulin supplementation.  If medical providers don’t recognize this early, and appropriate treatment is delayed, a patient may suffer multiple health issues and risks the longer their blood glucose levels are uncontrolled.

What is Diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly. When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the bloodstream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter. Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell. Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want to dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  It’s also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 dmp-blood-sugar-levels-chart

SOURCE DIABETESMEALPLANS.COM

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

 

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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

The FDA has disclosed a new E. coli romaine lettuce outbreak, that has supposedly ended.

23 people from 12 states have become ill due to this recent outbreak of E. coli. 

No deaths have been reported.

The Shiga toxin-producing E. coli O157:H7 sickened 23 people and hospitalized 11 between the dates July 12 and September 8th, with cases occurring in Arizona, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania, and South Carolina, with the majority of cases in California.

The FDA emphasizes that they believe the outbreak is over.  However many wonder why they this wasn’t disclosed earlier.

The CDC did appear to begin its investigation earlier this Fall, and forward their concerns to the FDA, but jointly the disclosure didn’t come until now.

 
 
On their website, the FDA reports the following:
 
TODAY, THE U.S. FOOD AND DRUG ADMINISTRATION IS SHARING NEWS OF A RECENT E. COLI O157:H7 OUTBREAK, INVOLVING 23 ILLNESSES, THAT WAS LIKELY ASSOCIATED WITH ROMAINE LETTUCE. NO DEATHS WERE REPORTED. THE ACTIVE INVESTIGATION HAS REACHED ITS END AND THE OUTBREAK APPEARS TO BE OVER. THE FDA AND THE U.S. CENTERS FOR DISEASE CONTROL DID NOT IDENTIFY ACTIONABLE INFORMATION FOR CONSUMERS DURING THIS INVESTIGATION. ADDITIONALLY, WHEN ROMAINE LETTUCE WAS IDENTIFIED AS THE LIKELY SOURCE OF THE OUTBREAK, THE AVAILABLE DATA AT THE TIME INDICATED THAT THE OUTBREAK WAS NOT ONGOING AND ROMAINE LETTUCE EATEN BY SICK PEOPLE WAS PAST ITS SHELF LIFE AND NO LONGER AVAILABLE FOR SALE. THE FDA IS COMMUNICATING DETAILS ABOUT THE OUTBREAK AT THIS TIME TO HELP ENSURE FULL AWARENESS BY THE PUBLIC AND TO HIGHLIGHT THE ONGOING IMPORTANCE OF INDUSTRY ACTIONS TO HELP ENSURE THE SAFETY OF LEAFY GREENS. FEDERAL HEALTH OFFICIALS DO NOT BELIEVE THERE IS A CURRENT OR ONGOING RISK TO PUBLIC HEALTH.
CDC NOTIFIED THE FDA OF THIS ILLNESS CLUSTER IN MID-SEPTEMBER 2019 AND THE AGENCY PROMPTLY INITIATED A TRACEBACK INVESTIGATION. THE FDA, CDC, ALONG WITH STATE AND LOCAL PARTNERS, INVESTIGATED THE ILLNESSES ASSOCIATED WITH THE OUTBREAK. A TOTAL OF 23 PEOPLE INFECTED WITH THE OUTBREAK STRAIN OF E. COLI O157:H7 WERE REPORTED FROM 12 STATES: ARIZONA (3), CALIFORNIA (8), FLORIDA (1), GEORGIA (1), ILLINOIS (2), MARYLAND (1), NORTH CAROLINA (1), NEVADA (1), NEW YORK (1), OREGON (1), PENNSYLVANIA (2) AND SOUTH CAROLINA (1). ELEVEN PEOPLE WERE HOSPITALIZED AND NO DEATHS WERE REPORTED. ILLNESSES STARTED ON DATES RANGING FROM JULY 12, 2019 TO SEPT. 8, 2019. NO ILLNESSES WERE REPORTED AFTER CDC BEGAN INVESTIGATING THE OUTBREAK ON SEPT. 17, 2019.
INVESTIGATORS WERE SENT TO VISIT FARMS LOCATED IN CALIFORNIA’S CENTRAL COAST REGION WHICH WERE IDENTIFIED THROUGH THE TRACEBACK INVESTIGATION. THEY COLLECTED AND TESTED MANY ENVIRONMENTAL SAMPLES, AND THE OUTBREAK STRAIN WAS NOT IDENTIFIED. WHILE ROMAINE LETTUCE IS THE LIKELY CAUSE OF THE OUTBREAK, THE INVESTIGATION DID NOT IDENTIFY A COMMON SOURCE OR POINT WHERE CONTAMINATION OCCURRED. SINCE THE OUTBREAK STRAIN WAS NOT DETECTED IN SAMPLES COLLECTED FROM FARMS DURING THE TRACEBACK INVESTIGATION, AND THERE HAVE BEEN NO NEW CASES SINCE SEPT. 8, 2019, THE OUTBREAK APPEARS TO BE OVER.
THE FDA REMAINS COMMITTED TO IMPROVING THE SAFETY OF LEAFY GREENS AND TRACEABILITY FROM FARM TO FORK.

Symptoms of E. coli poisoning can occur anywhere from 1-10 days after ingestion.

They include:

  • Nausea
    Vomiting
    Diarrhea, may be bloody
    Fever
    Chills
    Body Aches
    Abdominal Cramps

And if progresses, can cause

  • Shortness of Breath
    Nose bleeds
    Anemia
    Dehydration
    Seizures
    Renal Failure
    Death

Exposure to E. coli may occur from exposure to contaminated foods (from human or animal waste) or undercooked meats.

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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

What if purchasing medical products and services were like buying peanut butter? Grocery stores have several brands and varieties: smooth, chunky, old-fashioned, natural, organic, no added sugar, reduced fat, no-stir, and pre-mixed with jelly with clearly marked prices ranging from $1.75 for the store’s generic brand to $7 for the over-priced Yuppie brand. After carefully examining the labels, our shopper chose a 16-ounce, $5 jar of no-added-sugar peanut butter. She paid the cashier $5 for the peanut butter and went home.

If our shoppers were transported to the universe of medical billing with the $5 jar of peanut butter, the shopper with Medicare would pay $1.00 but her grandchild will be presented with a bill for $4. When the shopper with private health insurance attempts to pay, the cashier becomes unglued. The shopper cannot say whether she met her deductible or has a co-payment, and whether the brand of peanut butter is approved by the network. She really wants the peanut butter so she grabs the generic from the shelf and pays the $1.75. Our privately insured shopper was pleasantly surprised at the generic’s good taste and healthful ingredients, her wallet was happy for the cost savings, and she was glad not to have the middleman hassle.

Comparison shopping is one pillar of bringing sanity to the high cost of medical care, but the opacity of the pricing system for medical costs limits the value of posting list prices to encourage lower costs through shaming, competition, and choice. In addition to research and development, manufacturing, and distribution costs, drug costs are affected by additional layers of middlemen: pharmacy benefit managers (PBMs) and insurers. Using a “trade secret” process, PBMs negotiate discounts and rebates for private and government insurers. The money saved is supposed to go back to the government (taxpayers) or to insurers to lower premiums or otherwise benefit patients. PBMs typically are paid by a percentage of the rebate or discount off the list price. The higher the price, the bigger the rebate. Thus, the rebate system gives an incentive to raise list prices rather than placing the lowest-priced drug on the insurer’s formulary. (This same system is used by Group Purchasing Organizations (GPOs) for hospital product purchases.)

An analysis of the effect of California’s 2-year old drug price transparency law illustrates the complexity of pricing. Despite being compelled to post list prices, pharmaceutical companies raised the list price for wholesalers by a median of 25.8 percent but the data did not indicate the “price” that consumers actually paid. Moreover, with medical services and products the simple What the Market Will Bear (WTMWB) pricing method works because either the medication is essential (e.g., Epi-Pen®), has no alternative, is in short supply, or the medical consumer is not paying directly for the services.

Similarly, publishing hospital the charge description master (“chargemaster”). i.e., the standard industry price does not give consumers enough information to make a rational choice regarding elective medical services. The data necessary to make price comparisons depends on an individual’s circumstances. More relevant than the chargemaster price, a self-pay patient needs to know the lowest possible cash price. A patient with health insurance must know (1) whether the hospital is in the insurance network, (2) the price negotiated between the health care provider and insurer (including Medicare), (3) the amount and method of calculating cost-sharing, (4) the amount Medicare or other insurer will pay for services performed in a physician’s office in contrast to the hospital which tags on a “facility fee.”

Transparency is one tool for lowering costs through choice. As one of many studies on hospital consolidation noted, “The Sky’s the Limit” on prices where there is lack of competition. But the difficulties of achieving useful price transparency must not be a cue for the government to initiate bureaucratic band-aids. As we have seen with Obamacare, forcing insurers to pay more of the costs leads to higher premiums, deductibles, and/or co-pays.

Nor should the government impose price caps. President Nixon’s 1971 wage and price freeze brought product shortages—which we are already facing with certain drugs, including anesthetics and chemotherapy agents. If the government sticks to enforcing anti-trust laws, a competitive market will thrive. The court house door anti-trust settlement by Northern California’s Sutter Health sends a message to big hospital chains to stop using their market share to inflate prices or require insurers to join their networks on an all-or-nothing basis to prevent insurers from negotiating lower prices at individual hospitals.

If we can get to the point of direct exchange of money for goods and services and reserve health insurance for major expenses, we can see costs decrease just as we have seen with the Surgery Center of Oklahoma over the last 10 years.

 

Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the  Association of American Physicians and Surgeons (AAPS). Her opinions, medical or otherwise, are her own. She is a guest columnist and this is an edited version of her article originally written for pennypress.com, reprinted with permission.   

 

Published in Opinion

The CDC reported this week that teen suicide rose 58% over the years 2007-2017 in the age group 10-24.  Although many experts blame social media and teen drug use, one theory may need to be considered:  nicotine withdrawal from vaping.

Millions of middle school and high school students admit to vaping…and many more are assumed who don’t admit to it when surveyed.  So we have an underestimation of how many adolescents take regular hits of their electronic cigarette, exposing them to the powerful, addictive nicotine. One pod, placed in an electronic cigarette to be vaped, contains as much nicotine as a pack of cigarettes.  Hence if a pod is smoked at school, and when the child is home goes hours without, they may “come down” off the nicotine high that they had hours earlier.

In 2002 Picciotto et al discussed how nicotine can affect mood swings, anxiety and depression, where in some cases it can act as an antidepressant but when one withdrawals from it can have increased and anxiety and depression.

The teenage mind and psyche is still developing during this time and a chemical dependency could muddy the mental health waters.

There’s no doubt social media and the misconception teens have that their lives are not as glorious as those who they view online is contributing to lack of confidence, poor self-esteem and depression.  But the decision to commit suicide may also be chemically induced, or a withdrawal of one and should be investigated.

Vaping Linked to Heart Disease and Cancer

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 10mg/ml.  That dose would be commonly consumed by many humans who vape.

 

nicotine.jpg

 

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:

  • 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 mucus 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.

Toxic metals found in vaping liquid

Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.

Last year one study reported 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:

  • lead
  • nickel
  • manganese
  • chromium
  • arsenic

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.

 

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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
Friday, 11 October 2019 19:01

Health risks from wildfire smoke

As thousands of acres burn in Southern California, those residents lucky enough to escape the flames worry what consequences could result in inhaling the smoke.

What is in wildfire smoke?

According to the EPA, smoke emanating from forest and community fires may include any of the following:

  • Carbon monoxide, which competes with oxygen in the blood
  • Carbon dioxide, a respiratory byproduct
  • Wood particles
  • Formaldehyde
  • Acrolein – used as a pesticide
  • Benzene
  • Plastics, and those byproducts after incineration
  • and thousands of different respiratory irritants.

According to the EPA,

Smoke is composed primarily of carbon dioxide, water vapor,
carbon monoxide, particulate matter, hydrocarbons and other
organic chemicals, nitrogen oxides, trace minerals and several
thousand other compounds. The actual composition of smoke
depends on the fuel type, the temperature of the fire, and the
wind conditions. Different types of wood and vegetation are
composed of varying amounts of cellulose, lignin, tannins and
other polyphenolics, oils, fats, resins, waxes and starches, which
produce different compounds when burned.

What symptoms may individuals experience?

Some may have no idea they are breathing in harmful compounds that could affect their lungs and heart.  However, many may experience:

  • Cough
  • Wheeze
  • Difficulty Breathing
  • Chest Pain
  • Mucous Production
  • Dizziness/lightheadedness
  • Fatigue
  • Racing Heart (palpitations)
  • Exacerbation of their lung disease including COPD, asthma, chronic bronchitis
  • Exacerbation of heart conditions such as angina, heart attack, and cardiac arrhythmias.
  • Increased susceptibility to new lung infections as well as flu

What are PM2.5s?

PM2.5 are particles less than 2.5 micrometers in diameter that are present in pollution and wildfire smoke that can penetrate deeply into the lung linings.  Larger, coarse particles 10 micrometers in diameter are called PM10.  Both impair lung function as they inflame the lungs and interfere with the work of alveoli that need to oxygenate the blood.  Moreover the small particles can use this pathway to enter the blood stream. Although the direct health impacts of the fine particulate matter is not clearly defined it is believed that increased PM2.5 levels increase the risk of lung and heart disease as discussed above.

lungs_alveoli-57ffa7fe3df78cbc284e162b

LUNGS AND ALVEOLI (IMAGE FROM THOUGHTCO.)

Symptoms may begin at levels greater than 55 µg/m.

Which individuals are the most at risk?

  • Infants and Children
  • Elderly individuals
  • Those with chronic lung disease, including asthma and emphysema
  • Those at risk for heart disease and stroke
  • Those with diabetes
  • Smokers
  • Pregnant women
  • Those with chronic allergies
  • Pets 

How can residents protect themselves?

Avoiding the area of wildfires is paramount.  Additionally, the following may be considered:

  • Avoid outdoors until air quality reports improve.  Do not rely on how “clear” the air looks.
  • Take heed of wind and air quality advisories.
  • Recirculate the air in your home and car.
  • Keep windows closed.
  • Consult with your medical provider to monitor blood pressure, heart rhythm, lung function and refill any medications you may need BEFORE you feel symptoms.
  • Be wary of facemasks sold as PM2.5 safe as many do not protect against the very small particles. Respirator masks labelled N95 or N100 may provide SOME protection against particulates but not against the toxic fumes such as formaldehyde and acrolein.

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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, 02 October 2019 22:55

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 268,000 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,000 cases of non-invasive breast cancer, a rise from last year. 41,700 women and 500 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 the 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, 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
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