Displaying items by tag: Medicine

Although it's been long known that flight attendants are at higher risk of breast cancer and melanoma, new research has found an increase risk in the following additional cancers:

• non-melanoma (basal cell and squamous cell)
• thyroid
• cervical
• uterine
• gastrointestinal

Researchers from Harvard T. H. Chan School of Public Health, led by research associate, Irina Mordukhovich, surveyed over 5000 flight attendants as part of the Harvard Flight Attendant Health Study (FAHS) and found a four-fold risk in non-melanoma skin cancer, a two-fold risk in melanoma, and a 51% greater risk of breast cancer, among other malignancy risks.

Those flight attendants with three or more children had even a higher risk of breast cancer.

TIME Magazine reported the following:

“Flight attendants are considered a historically understudied occupational group, so there is a lot we don’t know about their health,” says Mordukhovich. “What we do know for sure is the exposures that both pilots and flight attendants have—the main one being high radiation levels because of cosmic radiation at altitude.” That exposure may not be concerning for people taking individual flights, but for people whose jobs involve flying, that risk may have a negative effect on their health, as the study results suggest.

A 2007 study found an increase risk of heart attacks, respiratory illness, poor sleep, depression and anxiety in cabin crew.

What’s surprising is the average flight attendant does not smoke and maintains a healthy weight, hence thought to live a healthier lifestyle, decreasing heart and cancer risk.  So….

Why are flight attendants at increased risk?

Multiple factors can affect those who work high in the skies. These include:

• cosmic ionizing radiation (radiation coming from outer space with higher levels in the upper earth’s atmosphere)
• solar radiation from sun flares
• disruption of their sleep cycle, circadian rhythm (long linked to cancer)
• exposure to chemicals such as jet fuel, flame retardants and other chemicals.
• constant exposure to pathogens and communicable diseases (link to cancer not yet determined)
• not being able to maintain regular hydration and diet

How can flight attendants protect themselves?

It’s difficult for those who staff airlines to alter their schedule, diet or uniform.  But what’s recommended is the following:

• wear sunscreen
• wear long sleeves and skirts/pants
• maintain good hydration and a regular diet
• try to ask for regular shifts that allow one to sleep regular cycles
• if at higher genetic risk for some cancers (BRCA1 and BRCA2 gene mutations) see your medical provider about recommended screening.

The CDC recommends the following:

• Try to reduce your time working on very long flights, flights at high latitudes, or flights which fly over the poles. These are flight conditions or locations that tend to increase the amount of cosmic radiation the crewmembers are exposed to. You can calculate your usual cosmic radiation exposures. The FAA’s CARI program website allows you to enter information to estimate your effective dose from galactic cosmic radiation (not solar particle events) for a flight.

• If you are pregnant or planning a pregnancy, it is important to consider your work exposures, including cosmic radiation. If you are pregnant and aware of an ongoing solar particle event when you are scheduled to fly you may want to consider trip-trading or other rescheduling actions if possible.

• For flight attendants, a NIOSH study found that exposure to 0.36 mSv or more of cosmic radiation in the first trimester may be linked to increased risk of miscarriage.

• Also, although flying through a solar particle event doesn’t happen often, a NIOSH and NASA study found that a pregnant flight attendant who flies through a solar particle event can receive more radiation than is recommended during pregnancy by national and international agencies.

• Regarding solar particle events:

• NIOSH has estimated that pilots fly through about 6 solar particle events in an average 28-year career.

• Avoiding exposure to solar particle events is difficult because they often happen with little warning. You can find out whether a solar particle event is currently active through these sources:

• The National Aeronautics and Space Administration (NASA) Nowcast of Atmospheric Ionizing Radiation System (NAIRAS) is being developed to report potentially harmful flight radiation levels to flight crews and passengers.

• NAIRAS: current radiation dose rate forecast.

• A space weather app for the iPhone offers current information on solar activity

• The National Oceanic and Atmospheric Administration (NOAA) Space Weather Prediction Center’s Aviation Community Dashboard includes a forecast for solar particle events.

Are travelers at risk?

Experts have suggested that those who are frequent fliers are still at low risk of being exposed to “too much radiation”.  Traveller.au.com writes: Overall, the amount “is really inconsequential,” said Dr. Edward Dauer, director of radiology at Florida Medical Center in Fort Lauderdale, adding that medical CT scans result in a much higher dose.

Read more:

Flight risk: how much radiation do planes expose you to?

Therefore medical professionals may suggest flying “in moderation” and checking in for regular check ups.

How can I check my radiation dose?

The American Nuclear Society provides a calculator, based on where one lives, how many x-rays, and how many hours one flies, here.

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

Since 2017 multiple states have declared outbreaks of the Hepatitis A Virus and now the Department of Heath in Ohio (ODH) has declared one as well.

Since the start of 2018, cases in Ohio have risen to 79, double the total number recorded for 2017 in the Buckeye state.

IMAGE FROM CLEVELAND.COM

WTOL reports: Ohio’s hepatitis A outbreak cases appear to be primarily among people who use illegal drugs, those who have been incarcerated, people who have had contact with known cases, those also infected with hepatitis C, men who have sex with men, and people experiencing homelessness.

Per the CDC, the below states have reported the following number of cases:

• California 704  (as of April 11, 2018)
• Indiana 148  (as of June 21, 2018)
• Kentucky 760
• Michigan 846
• Missouri 125
• Utah 109 (2018) and 147 (2017)
• West Virginia  248
• Arkansas 40 since February, 2018

Last year Colorado reported a doubling of Hepatitis A cases since the previous year.

What is Hepatitis A?

Hepatitis A is a disease that affects the liver.  Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits. It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract. Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.

Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.

Those who are immunosuppressed run the risk of dying from the infection.

What are the symptoms of Hepatitis A?

Symptoms of Hepatitis A include:

Jaundice – yellowing of the skin and eyes

Fever

Abdominal Pain

Fatigue

Dark Urine

Joint Pain

Clay – looking stools

Diarrhea

Nausea

Vomiting

Loss of appetite

What is the treatment for Hepatitis A?

There is no specific treatment for hepatitis A.  Most hepatitis A infections resolve on their own.

We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.

For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.

There are vaccines for Hepatitis A included in the childhood vaccination schedule.  Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department.  Many states require all health care and food workers to be vaccinated.

The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.

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

Disney/Pixar may now include a warning for viewers that some scenes in their latest hit, Incredibles 2, may induce seizures at the request of the National Epilepsy Foundation. Some viewers found the strobe and flashing light scenes to be potential seizure triggers.

Veronica Lewis tweeted the following:

‏

HEALTH ALERT I haven’t seen this mentioned in a lot of places, but the new Incredibles 2 movie (#incredibles2) is filled with tons of strobe/flashing lights that can cause issues for people with epilepsy, migraines, and chronic illness.

What is a seizure?

A seizure occurs when there is abnormal electrical activity in the brain.  If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions  (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.

What is Epilepsy?

Epilepsy is a neurological disorder in which a person has recurrent, unprovoked seizures.

Photosensitive epilepsy, in which visual triggers can induce a seizure, occurs in 1 in 4000 of the population.

Can Movies Cause Seizures?

In December of 1997, a Pokemon cartoon aired in Japan resulting in over 700 children to the hospital with ailments ranging from dizziness to epilepsy.  It was determined that the rapidly strobing flashes of red and blue lights induced this “Pokemon Shock.”

A study from Prasad et al in 2012 found no increase risk of seizures with 3D movies than conventional television. They explain why seizures are induced here:

The mechanism in which TV and cinema movies trigger seizures in patients with photosensitive epilepsy is related to several factors including the light intensity, the environment and the frequency of picture frames per second. Normal 2D movies have a frame rate of 24 per second, which may pose a risk for patients with photosensitive epilepsy, but the light intensity in the cinema is very low and there are relatively a few reports of seizures precipitated in cinemas. In contrast, 3D movies project images at 48 frames per second aimed, by the use of colored or polarizing filters, at different eyes and resulting in 24 frames per second per eye. The polarizing effect of 3D films may reduce the light output by around fifty percent leading to a reduced risk to trigger a seizure to people with photosensitive epilepsy. Therefore, the risk of 3D movies to trigger a seizure is around fifty percent less than with conventional 2D movies. However if provocative material such as flashing light is presented the risk can be as high as that for normal 2D movies.

Although there is “insufficient evidence” to connect 3D movies to epilepsy, researchers agree with the need for more study.

Which makes us rely on anecdotal, or testimonial evidence such as the tweet from Veronica Lewis.

“Risky Movies”

The following have been suggested on moviehealthcommunity.tumblr.com to have strobe effects or flashing lights that may affect one’s photosensitivity risk of inducing a seizure:

• Ocean’s 8 – fast-moving trains
• Incredibles 2 - villain weapon
• Solo, A Star Wars Story – laser fire and sparking electrical equipment
• Speed Racer – bright headlines, racing cars
• Deadpool 2 – gunfire, high-speed chase scenes
• Hostiles -flashes from the gunfire
• 300 – lightning scenes
• Avengers, Infinity War – fight scenes, shaking cameras, laser based weapons
• Iron Man series – strobe and flashing lights
• Incredible Hulk, 2008 – strobe lights
• Ready Player One – high-speed chase, shaky camera, flashing lights
• Tomb Raider, 2018 – strobe lights, shaky cameras
• A Wrinkle in Time – lightning storm
• I, Tonya – fast speeds, quick camera shots
• The Cloverfield Paradox – strobe lights

Although one of my favorite franchises, some of my listeners found the Transformer movies to have similar issues with high speed movements and strobe lights.

Many more movies are listed but the common thread are those with high action, high-speed, strobe lighting, storms, horror, and fast-moving race or fall scenes.

More can be found at moviehealthcommunity.tumblr.com.

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

For years, men have voiced frustration when their medical providers insisted on a cardiac workup prior to initiating an ED prescription.  Some thought it was because they’d have a heart attack during sex.  But it’s not.  Erectile dysfunction is a vascular issue, and if the vessels of the penis are compromised, how does one know his heart vessels aren’t as well?

Now in a recent study from John Hopkins School of Medicine found an increase risk of stroke, heart attack and cardiac arrests in those men who suffered from erectile dysfunction.  Study author, Michael Blaha, professor of Medicine, states, “Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors — such as high blood pressure or cholesterol — that much more aggressively.”

Last December, a study published in the Journal of Vascular Medicine, found the same risk factors leading to erectile dysfunction are also culprits in heart disease.

Risk factors shared by both erectile dysfunction and heart disease include:

• High Blood Pressure
• High Cholesterol
• Diabetes
• Smoking
• Men over age 45
• Physical inactivity
• Stress
• Obesity
• Family history of heart disease

Last year, researchers from Mount Sinai Medical Center, Florida International University and Baptist Health South Florida reviewed multiple studies and found a link between erectile dysfunction and compromised blood vessels whose endothelium (lining) demonstrated impaired vessel relaxation. This is necessary for both erections as well as blood flow to the heart and rest of the body.

Moreover carotid media-intima thickness, a marker of atherosclerosis, appeared to be correlated to erectile dysfunction as well.

Both studies remind us that if one bodily function is impaired, other organs may be quietly suffering the same impairment.

I like to credit the pharmaceutical companies that created erectile dysfunction drugs with saving millions of men’s lives as:

1. Men who would refuse to come into any doctor’s office now had an incentive to, resulting in a long-overdue check-up
2. Those who saw providers who required an EKG or diabetic screening, and unknowingly suffered from a serious cardiac risk factor, could now be diagnosed.
3. ED drugs allowed those men who couldn’t enjoy sex to now get some much-needed physical activity

Young men aren’t immune to cardiovascular disease and need to be screened as well if they have issues starting or maintaining erections.

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

Each year 45,000 Americans take their lives. That averages to 123 people a day.  And each suicide affects everyone with whom the  person has regular encounters. So why is it so common?  Here are six reasons people choose to end their life.

They’re Impulsive

Many of us have been trained to act on a whim. We quickly reply to a text, pop some food in the microwave, flick the controller while playing a video game…and these quick, instinctive acts are becoming a part of our daily behavior.  So when one has a fleeting thought of suicide, they may be less likely to slow down and think it through.

They Can’t See Around the Problem

When tragedy strikes, whether it be an accident, break up, job loss, missed opportunity, some can’t see “the light at the end of the tunnel.”  Many think and navigate through life one step at a time, which may be productive when it comes to tackling tasks, but if they feel the obstacle in front of them is insurmountable they may believe their options are far and few between, with death being the only out.

They Fear Death

This is one of the least discussed reasons people commit suicide, but unfortunately more common than we think.  Although most of us fear death and dying, some pathologically can’t handle the thought of it happening out of the blue.  Those who need control and need to plan ahead, may find solace in the fact that they are planning their own death. They can’t control their birth but they can control their death, they believe, and for those who feel they have lost control of their life may find this tragic option welcoming.

They’re Depressed, Really Depressed

Hollywood stereotypes depression as a woman sitting on a couch eating ice cream to combat the tears and loneliness of a breakup.  But many have symptoms of severe depression and don’t know it.

• insomnia
• fatigue
• wanting to avoid others
• poor appetite
• lack of sex drive
• apathy
• anxiety
• sadness
• tearful
• mood swings
• poor memory
• poor concentration
• overeating

So many self medicate either by overeating, drinking alcohol, smoking weed, or taking pills, which when wears off, can sink one into a lower funk. Without psychological or medical intervention, one struggles to recover.

They Feel No One Cares About Them

Since so many people are undiagnosed when it comes to depression, family members and friends are unaware their loved one is struggling. Going about one’s business may be inferred as indifference by someone suffering from a mood disorder.  “They won’t even notice I’m gone,” pervades their thoughts and worsens their loneliness.

They’re Angry

If one feels they’ve been ignored, unheard or wronged, this could incite an “I’ll show ’em” attitude in which their suicide is plotted to be a form of psychological revenge.

Sadly many out there secretly hope they get help but don’t know how to ask for it. It’s up to us to seek them out and guide them to a medical professional who can listen, understand, and work with them.

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

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

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

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

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

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

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

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

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

So what prescription drugs could impair one’s driving?

The obvious ones include the following:

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

Muscle relaxants such as carisoprodol, cyclobenzaprine, methocarbamol……

Sleep aids such as zolpidem, eszopiclone….

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

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

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

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

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

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

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

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

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

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

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

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

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

ABC News cancelled her hit show Roseanne on Tuesday.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But will patients be pleased?

The Robot Is In…

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

Robots Don’t Judge

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

The Doctor Doesn’t Examine Me Anyway

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

They can always answer my questions

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

However, and this is the kicker……

Robots Lack Instinct

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

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

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

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

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

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

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

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

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

What is an “excessive heat warning?”

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

What are Heat Cramps?

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

What is Heat Exhaustion?

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

IMAGE FROM MEDSTAR

What is Heat Stroke?

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

Who is vulnerable to heat related illness?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1995 – Democratic Republic of Congo –  infected 315

2000 – Uganda – infected 425

2007 – Democratic Republic of Congo – infected 264

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

And multiple smaller sporadic cases occurred in the years between.

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

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

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

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

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

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