Displaying items by tag: Medicine

A new study reveals that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.

Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:

• 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.

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

They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

• Formaldehyde (human carcinogen)
• Acetaldehyde (carcinogen related to alcohol drinking)
• Acrolein (highly irritating and toxic)
• Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
• Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children). E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

For more on the study read 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.

Millions of people view porn every day and the Florida House has approved a resolution to protect their constituents from its inherent health risks.

According to the resolution’s sponsor, Republican Rep. Ross Spano, “Research has found a correlation between pornography use and mental and physical illnesses, difficulty forming and maintaining intimate relationships, unhealthy brain development and cognitive function, and deviant, problematic or dangerous sexual behavior.”

So is pornography a public health risk?

What constitutes a “Public Health Risk?”

A public health risk is something that could pose a health threat, injury to humans or could contribute to health risks of other humans.  This could include drunk driving, mosquitos or rats transmitting disease, or even smoking.

So watching pornography would pose a public health risk if not only the “pornee” gets hurt but affects others surrounding him. Now the effect of others could be in the form of missing work, viewing porn at work (considered sexual harassment and/or assault by others not wanting to view it), and unwanted sexual acts with one’s partner.

How does watching pornography affect health?

Although we do not have any definitive studies telling us porn is good or bad for our health, there are many opinions on the matter.

One concern is inactivity and time spent in front of a screen.  Sitting in front of a computer, tablet, or hand-held device watching hours of porn could increase risk of a blood clot, heart disease and (prolonged sitting) has been linked to colon cancer.  However, according to PornHub, the average time spent viewing porn only ranges from 9-13 minutes.

What about lack of sleep? Are people secretly watching porn at night, and not getting their 7-9 hours of uninterrupted rest?

According to PornHub the most common time during the day to watch porn was between 10 pm and 1 am.  If one is only online for 10 minutes and falls asleep afterwards, they may still receive a good amount of sleep.

What about the risks of frequent masturbation?

In 2009 a study found frequent masturbation in young males could increase their risk of prostate cancer, but in older men (>50 years), reduced their risk.  Other studies have suggested reduced risk of prostate cancer that occurs in older men but not aggressive cancer in younger men.

Excessive masturbation could affect one’s refractory period, or time it takes to form an erection again after sex.  For some this could last 15 minutes, for others a week.  So if a date night is planned for later that evening, one with a long refractory period could have issues.

Chafing and inflammation can also occur but are usually rectified with a change in modality.

What about the impact on children?

The American College of Pediatricians released this statement:

The consumption of pornography is associated with many negative outcomes: increased rates of depression, anxiety, violent behavior, early sexual debut and sexual promiscuity, higher rates of teen pregnancy and a distorted view of relationships. For married adults, pornography also results in an increased likelihood of divorce which, in turn, is harmful to children.

Author, L. David Perry, MD, states, “Pornography glorifies decontextualized sex. Its use by adolescents and young adults often leads to a distorted view of sexuality and its proper role in fostering healthy personal relationships.”

If state governments choose to debate porn being a health risk, I agree with strict restrictions on child and adolescent access.  I also agree with education of condom use to protect against unsafe sex practices.  Moreover, counseling resources for those addicted to porn should be increased as internet and porn addiction is a growing public health threat.  However, does the occasional video view pose serious health risks….no.

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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.

Multiple states are reporting “early” allergy seasons.

We still have a month left of winter yet grass is sprouting, leaves are growing and flowers are blooming.  Add warmer than normal temperatures to the mix and this is the perfect recipe for an early allergy season.

Allergy season usually begins with the start of Spring in March.  Yet many may start their symptoms as early as February if they are allergic to what’s blooming.

Tree pollens start first in January and then taper off in April.  Grass pollen starts to rise in February and March.   Finally weed pollens join the party by the Spring and extend through the Summer and Fall.

Here are your questions answered:

What are allergies?

Allergies are the result of the immune response to a foreign particulate that our body senses.  One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder.  Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body.  IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood.  When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.

What are symptoms of seasonal allergies?

Symptoms of allergies could include any or a combination of the following:

• Sneezing
• Coughing
• Wheezing
• Runny nose
• Eye watering
• Red Eyes
• Itchy eyes
• Itchy skin
• Rash
• Itchy throat
• Fatigue
• Congestion….. to name a few.

How do they differ from a cold?

Colds may have very similar symptoms to allergies. However they are different.

The common cold is caused by a virus.  When one gets infected by the virus they may feel malaise, fever, and achy. This does not occur with allergies.

Moreover, nasal secretions from allergies are usually clear. In a cold, the mucous could be thicker and with color.

The same holds true with sputum. During an allergy the cough may have little to no mucous and if so, be light colored. Thick mucus could be a sign of an infection.

An allergic sore throat will seem more dry and scratchy. A sore throat from a cold is more uncomfortable and less easy to soothe.

Allergies may persist or be cyclical. Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.

Can allergies lead to a cold?

Yes and no. Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over. Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.

Are seasonal allergies dangerous?

As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack.  Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.

How can we prevent and treat allergies?

Avoiding, or decreasing exposure to the allergen is key.   We suggest the following:

1. Be aware of your local weather and pollen counts.  If the weather begins to warm and regional vegetation is blooming, allergy season may be upon you sooner than you know.
2. Avoid outside pollen from coming into your house.  Avoid the urge to open all the windows during Springtime as wind will bring the pollen in.
3. Clean your air filters.  Replace air filters frequently and consider using HEPA Filters
4. Wash off pollen from your hair and clothes before you sit on the couch or jump into bed.
5. Close your car windows when you park.
6. “Recirculate” the air in your car
7. Discuss with your medical provider if you are a candidate for medications such as antihistamines, nasal corticosteroids or leukotriene antagonists.  
8. If you suffer from respiratory illnesses or a chronic medical condition, discuss with your medical provider if you need to start your allergy medication before allergy season hits. Some of these medications may take a couple of weeks to reach therapeutic levels.

How can I find my local pollen counts?

Local tree, ragweed and grass pollen counts can be obtained 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.

For centuries, plants and their oils have been used in a variety of therapeutic settings.  Today aromatherapy is a billion dollar industry. Here are your questions answered:

What is aromatherapy?

Aromatherapy is the use of essential oils from plants to treat an ailment.  Oils are extracted from plants through a variety of different methods and then formulated to be used topically or breathed in as an aerosol.

What are the benefits of aromatherapy?

Aromatherapy has been used to treat a variety of conditions including:

• anxiety
• depression
• nausea
• vomiting
• GI upset
• pain
• joint aches
• insomnia
• skin infections
• seizures

to name a few.

In 2014 Azanchi et al described the anticonvulsant activity of neroli oil, finding its biologically active “constituents” may assist in the management of seizures.

The following is a table from Natural Healers describing some uses of essential oils.

What are the risks of aromatherapy?

Many oils may be used alone or mixed with fragrances and/or other chemicals.  These many times have not be tested clinically to see their effects on the respiratory tree lining and skin.  Some risks posed by the use of aromatherapy include:

•  Respiratory issues – could irritate the lung lining causing cough, wheezing, mucus production
• Dermatitis – rashes, hives, itching
• Photosensitivity – use could make one more susceptible to skin reactions when exposed to the sun, causing burning and blistering.
• Interactions with medications, possibly affecting their potency
• Risks to pets ingesting them or absorbing too much in their skin

Who should avoid aromatherapy?

At this time, we recommend avoiding aromatherapy if you have any acute or chronic respiratory conditions, severe allergies, sensitive skin, are pregnant, or are currently taking any medications that could interact with the chemicals being inhaled or absorbed.

If considering using aromatherapy we recommend consulting your medical provider first.

As we see more practitioners integrate aromatherapy into one’s medical plan, more needs to be clinically studied to determine the benefits and risks.

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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 Flu season of 2017 Holidays and early 2018 is different. H3N2, a subtype of influenza A, has been around for years but it mutated in 2014-2015 and during that flu season the mutated strain caused the majority of influenza in the United States. H3N2 is more easily spread by just being beside a person breathing within six feet. The inoculum or, load of virus, needed to infect is small, and it grows rapidly in lung tissue. This process can cause secondary lobar bacterial pneumonia rapidly putting somebody into respiratory failure, ICU, ventilator dependent or quickly become fatal. The vaccine is useless, because the new H3N2 genetics is not tracked by the current vaccine. Vaccines only create antibody to tag the pathogenic virus, and do not kill it.  Only your activated T-Lymphocytes and Granulocytes kill pathogens with singlet free radical oxygen.  

So what is the solution? In public places with high prevalence of influenza, wearing a Niosh N95 mask helps to protect airways. Use antipathogenic wipes that destroy the viral capsids of RNA and DNA viruses and pathogenic bacterial cell walls. Remember to keep the wipes in a Ziploc for protection. Taking natural antipathogenics to prevent viruses from attaching to cell receptors of airways, eyes, and mouth; and killing viruses before they gain a foothold and migrate to your lungs or gastrointestinal tracts.  

If you want more info email me Dr Bill Deagle at This email address is being protected from spambots. You need JavaScript enabled to view it. and This email address is being protected from spambots. You need JavaScript enabled to view it. and listen to my show, the NutriMedical Report on Genesis Communication Network (GCN) M-F from 2:00pm to 5:00pm CST.

Stay Healthy,

Dr. Bill

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Dr. Bill Deagle is a guest contributor to GCN news. His views and opinions, if expressed, are his own. Dr. Bill Deagle, MD is a member of the AAEM (American Academy of Emergency Medicine), ACAM (American College of Sports Medicine) and A4M (American Anti-Aging Association). His radio program, The NutriMedical Report, is nationally syndicated M-F from 2:00 pm -5:00 pm CST here at GCN. Dr. Bills range of nutraceuticals can be found here.  For additional audio and video content with amazing material on health, geopolitics, the military, technology and conservative issues visit Deagle-Network.com. All email consults are FREE.

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.

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 mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

----

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.

A study published in The New England Journal of Medicine reports the flu increases one’s risk for a heart attack by six within the first week.

Study author Dr. Jeff Kwong, a family physician and epidemiologist from the Institute for Clinical Evaluative Sciences and Public Health Ontario, and his colleagues looked at 20,000 adults who were diagnosed (and lab confirmed) with the flu in Ontario from 2009 – 2014.  Of these adults, 332 had a heart attack, either the year before, after or during the flu.   Heart attack risk was 6 times higher the week of the flu and was elevated in those older than 65.

Many of the individuals had cardiac risk factors (diabetes, high blood pressure, high cholesterol) illustrating if one is at risk for a heart attack, a cardiac event may be more likely to occur if they get the flu.

This isn’t the first time a link between heart attack and flu has been suggested. In 2007, Meade et al found a bout with the flu to double the risk of a heart attack and stroke.

Their theory was the flu dislodged fatty deposits sitting along the arteries, allowing them to travel to the coronary arteries or those in the brain resulting in a heart attack and stroke respectively.

Another theory is the cardiac risk factors may worsen during the flu. Blood sugars are difficult to control, hence fats in the blood will follow, and blood pressure may be affected when one is battling an infection.

Inflammation has been linked to heart attack, thus inflammation resulting from the flu may also be a culprit.

The study authors wrote, “Cardiovascular events triggered by influenza are potentially preventable by vaccination.”  The flu shot this year has been projected to only be 30% effective against this season’s active strains but is still being recommended this season as hospitalizations and deaths from the flu are reaching record numbers.

What causes a heart attack?

A heart attack occurs when part of the heart muscle fails to receive the blood and oxygen it needs. This can occur by arteries supplying the heart muscle to become blocked.  Coronary artery disease can be caused by plaque build up from fats, sugars, calcium, fibrin that settle on the blood vessel wall. These plaques can build up and occlude the lumen, obstructing blood flow.

Additionally a heart attack can occur when an unstable plaque rips off, tearing the blood vessel lining causing the body to form an immediate clot. This clot can also be deadly as it obstructs the lumen as well.

Heart disease, however, can be prevented ...

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 postmenopausal

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.

Thirdly, reduce your risk by the following:

Maintain a normal blood pressure

Maintain normal blood sugar

Maintain normal cholesterol and lipid levels

Reduce stress

Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables

Quit smoking

Stay active

Maintain a healthy weight.

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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.

POST-ATHLETIC ACTIVITY DEPRESSION (PAAD) MAY AFFECT MULTIPLE ATHLETES WHEN THEIR SEASON ENDS DUE TO THE HIGH HORMONE LEVELS INDUCED BY THEIR PRIOR RIGOROUS EXERCISE REGIMEN SUDDENLY DROPPING.

Olympic gold medalist Michael Phelps admitted at the The Kennedy Forum in Chicago last week that he had battled depression for years and contemplated suicide.  With his multiple decade athletic career, the most decorated in history, how could an Olympian find life so unlivable?

Other decorated athletes have suffered from depression as well:   Terry Bradshaw, Darryl Strawberry, Larry Sanders, Dwayne “The Rock” Johnson, and Oscar de la Hoya to name a few.

Post-athletic activity depression (PADD) may ensue when the high levels of exercise aren’t maintained and the mind isn’t prepared for losing or being surpassed by another athlete.  As you will see biology as well as psychology play huge factors in the mental health of an athlete.

Exercise wards off depression

Michael Phelps admitted to going into a depression after each Olympics.  His workouts leading up to each of the 2004, 2008, 2012 and 2016 Olympics were illustrated by Arizona State coach Bob Bowman at the American Swimming Coaches Association, and demonstrated thousands of hours and yards swum each week.

Multiple studies have proven that exercise wards off depression. This is in part due to multiple mood enhancing hormones being released during athletic activity such as:

• endorphins
• norepinephrine
• dopamine
• serotonin

So if after a meet, marathon, playoff or Olympic race ends, does the average athlete keep their rigorous training schedule? Probably not.  Hence these hormones that the body has become accustomed to seeing aren’t there at their previous levels, inducing a depression.  If someone is at risk for depression, the drop in these hormone levels could, in theory, depress one to the point that they contemplate suicide.

Being the best puts you psychologically at risk

They say winning is addictive and from a psychological standpoint, that’s correct.  Once you win you reform a new identity.  Those psychologically mature and stable will not find their win their only identifying factor and additionally will understand that you “win some, lose some”.  However those who struggled for years to win, especially if the prize is an Olympic medal, may not deal with “lose some” so easily.

Once you own that Superbowl ring, first place blue ribbon or gold medal others look at you as “one of the best”.  How much higher can you go?  Usually an athlete only has two choices. Maintain their “top” status, difficult to do with aging and younger up and comers vying for their spot, or start losing. Most athletes aren’t preparing for how to lose.  They can’t. They use all their waking hours preparing on how to win.  So when the loss does come, they’re unprepared.

Could some CTE symptoms be related to post-athletic activity depression?

I believe so. Chronic Traumatic Encephalopathy (CTE) is a progressive degeneration of brain tissue and function from multiple hits to the head.  Many who suffer from CTE have mood changes, anxiety, anger and impulsivity.  CTE tau protein build up in the brain contributes to this but hormones can play a role as well.

What needs to be studied are the mood changes incurred by athletes after each season or race to see if a “funk” sets in because their exercise regimen is not being maintained.

Moreover all athletes should have access to counseling to thwart depression and suicidality because losing is inevitable for everyone.

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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.

White House Physician, Navy Rear Adm. Dr. Ronny Jackson, performed President Donald Trump’s annual physical last week are released the following results:

From Politico:

President Donald J. Trump has completed his first periodic physical examination as President of the United States. I performed and supervised the examination with appropriate specialty consultations and diagnostic testing. The exam was conducted January 12, 2018 at the Walter Reed National Military Medical Center.

The purpose of this exam was to provide the public with an update of the President’s current health status and to ensure the President continues to enjoy all the benefits of good health. This examination focused on evidence-based health screening and disease prevention.

With President Trump's consent, I release the following health information:

Vital Statistics

Age: 71 years, 7 months

Height: 75 inches

Weight: 239 pounds

Resting heart rate: 68 bpm

Blood pressure: 122/74 mm

Hg Pulse-oximetry: 99% room air

Temperature: 98.4 degrees F

Physical Examination by System (to include studies)

Eyes: Uncorrected visual acuity was 20/30 bilaterally, with corrected visual acuity of 20/20 bilaterally. Visual fields were normal. Fundoscopic exam was normal bilaterally. Intraocular pressures were normal bilaterally. No ocular pathology was discovered.

Head/Ears/Nose/Throat: Normal exam of the head, ears, nose, mouth, and throat.

Dental: Healthy teeth and gums.

Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of the carotid arteries normal.

Pulmonary: Lungs clear to auscultation. A screening Low Dose CT of the chest demonstrated no pulmonary pathology.

Cardiac: Heart exam normal. Regular rhythm. No murmurs or other abnormal heart sounds noted. ECG with normal sinus rhythm, rate of 71, normal axis, and no other significant findings. Transthoracic Echocardiogram demonstrated normal LV systolic function, EF 60-65%, normal LV chamber size and wall thickness, no wall motion abnormalities. RV normal, atria grossly normal, all valves normal. Exercise Stress Echocardiogram demonstrated above average exercise capacity based on age and sex, and normal heart rate, blood pressure, and cardiac output response to exercise. No evidence of ischemia noted and wall motion was normal in all images.

Gastrointestinal: Normal exam. No masses, hepatomegaly or splenomegaly noted. Normal optical colonoscopy with no polyps or abnormal findings completed June 2013. Repeat colonoscopy not indicated and was deferred until next periodic physical exam.

Genitourinary: Normal exam.

Extremities/Musculoskeletal: Normal throughout. Full range of motion in all joints. Strong distal pulses and good capillary refill in all extremities. No swelling or edema noted.

Neurological: Examination of cranial nerves, cerebellar function, deep tendon reflexes, motor function, and sensory system all normal. Cognitive Screening Exam using the Montreal Cognitive Assessment was normal with a score of 30/30.

Dermatologic: Normal exam. No evidence of melanoma , basal cell carcinoma, squamous cell carcinoma, or any other significant dermatologic disease.

Laboratory Results

Lipid Panel:

Total cholesterol: 223 (mg/dL)

Triglycerides: 129 (mg/dL)

HDL cholesterol: 67 (mg/dL)

LDL cholesterol: 143 (mg/dL)

Cholesterol to HDL ratio: 3.3\

Complete Blood Count:

WBC: 5.5 (K/UL)

HGB: 16.1 (g/dL)

HCT: 48.7 (%)

PLT: 241 (K/UL)

Extended Metabolic Panel:

Fasting Blood Glucose: 89 (mg/dL)

BUN: 19.0 (mg/dL)

CREAT: 0.98 (mg/dL)

ALT: 27 (U/L)

AST: 19 (U/L)

Hemoglobin AlC: 5.0 (%)

Vitamin D: 20.0 (ng/ml)

PSA: 0.12 (ng/ml)

TSH: 1.76 (ulU/ml)

Urinalysis:

Appearance: Clear

Protein: Negative

Ketones: Negative

Glucose: Negative

Blood: Negative

Past Medical History

• Hypercholesterolemia

• Rosacea

Past Surgical History

Appendectomy (age 11)

Social History

• No past or present use of alcohol.

• No past or present use of tobacco.

Medications

Rosuvastatin (Crestor), 10 mg daily to lower cholesterol.

Acetylsalicylic Acid (Aspirin), 81mg daily for cardiac health.

Finasteride (Propecia), 1 mg daily for prevention of male pattern hair loss.

Ivermectin Cream (Soolantra), As needed for treatment of Rosacea

Multivitamin (Centrum Silver), Daily for overall health maintenance.

Immunizations

• • Prevnar 13 (to prevent pneumococcal pneumonia) and Twinrix (to prevent hepatitis A/B) given.
• • Routine vaccinations, to include seasonal influenza, all up to date.
• • All indicated travel vaccinations up to date.

Summary

The President’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. We discussed diet, exercise and weight loss. He would benefit from a diet that is lower in fat and carbohydrates and from a routine exercise regimen. He has a history of elevated cholesterol and is currently on a low dose of Rosuvastatin. In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine screening tests and exams.

All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his Presidency.

President Trump is in “excellent health.”

At the above height and weight, Donald Trump’s BMI is 29.9 placing him in the overweight category just shy of the 30 BMI cut off for obesity.

His blood pressure and heart rate are excellent for his age, especially in the absence of a blood pressure medication.

His pulse oximetry demonstrating the oxygenation of his blood is excellent as well.

An uncorrected vision test of 20/30 means that without glasses, the president has near perfect vision.

A low dose CT of the chest is not routine during annual physicals in non-smokers, but is reassuring that he most likely doesn’t suffer from lung cancer, the number one cancer killer in America.

His EKG, which evaluates electrical abnormalities of the heart secondary to disease or heart attack, confirmed the ideal heart rate.

His echocardiogram, and ultrasound evaluating heart structures and pump activity, demonstrated no heart failure or issues with the filling or pumping of blood, as well as confirming normal anatomy (valves, wall thickness, etc).

A stress test evaluates for cardiac ischemia, or loss of blood flow to heart muscle during rest and exercise, and was normal as well.

A normal colonoscopy in 2013 suggests his next screening colonoscopy wouldn’t be performed until 2023 unless he had pain, rectal bleed, changes in his stool, or any risk factors for colon cancer.

The Montreal Cognitive Assessment was given to evaluate cognitive function and is not routinely done during annual physicals.  This was performed and passed with a 30/30 score.  The test evaluates memory, orientation, visuospatial and executive brain function, recall, concentration and language fluency.  An example is shown here.

His cholesterol is elevated but his good cholesterol is strong and his ratio of cholesterol to HDL is well within goal.

The remaining blood tests looked very good, especially his HBA1C and blood glucose evaluating for diabetes.

Of note is his Vitamin D level which appears low-normal and could put him at risk for osteoporosis.  It does not appear a bone density test, Dexa scan, was performed.

A PSA of 0.12 is reassuring as well although is not recommended as a screening test for prostate cancer.

It's been suggested that President Trump loses 10-15 lbs and increases his exercise activity.

My opinion, for a 71-year-old man with high cholesterol, President Trump is way ahead of the curve.  I’m a fan of Crestor, his cholesterol lowering medication, and credit his lipid profile numbers to his use of the statin.  His weight is an issue but I think the White House has a bowling alley, chefs who could make asparagus taste like meat, and secret service who wear fitbits.  I think he’ll be just fine.

This is a developing story.

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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.

When Hawaii residents Saturday morning received this alert (later retracted):

the rest of the country asked themselves, “What would I have done if I received this alert?”

So I think we can all agree we’re unprepared. Some scoff by saying, “Well we wouldn’t survive anyway!”  Actually, you can survive a nuclear attack.  Here’s how…

It’s never too early to prepare

Firstly, know your shelters. There are two types:

Blast shelters offer some protection against the blast, heat, fire and initial radiation.

Fallout shelters offer some protection against the radiation from the fallout products.

Many public buildings in your city can act as fallout shelters.  These may be schools, hotels, subway tunnels, or below ground pubs.  However if your city doesn’t post or have either, you are more likely to be urged to “Shelter in Place”, which we’ll discuss later.

Secondly, make an “Emergency Kit” that has all your important papers, passports, medications, first aid, pet supplies, food and water.

Ready.gov suggests the following:

• Water – one gallon of water per person per day for at least three days, for drinking and sanitation
• Food – at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert
• Flashlight
• First aid kit
• Extra batteries
• Whistle to signal for help
• Dust mask to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Manual can opener for food
• Local maps
• Cell phone with chargers and a backup battery
• Radio (battery operated) so you can be up to date with what is occurring and be told when it's safe to exit your shelter

Consider adding the following items to your emergency supply kit based on your individual needs:

• Prescription medications
• Non-prescription medications such as pain relievers, anti-diarrhea medication, antacids or laxatives
• Glasses and contact lense solution
• Infant formula, bottles, diapers, wipes, diaper rash cream
• Pet food and extra water for your pet
• Cash or traveler’s checks
• Important family documents such as copies of insurance policies, identification and bank account records saved electronically or in a waterproof, portable container
• Sleeping bag or warm blanket for each person
• Complete change of clothing appropriate for your climate and sturdy shoes
• Household chlorine bleach and medicine dropper to disinfect water
• Fire extinguisher
• Matches in a waterproof container
• Feminine supplies and personal hygiene items
• Mess kits, paper cups, plates, paper towels and plastic utensils
• Paper and pencil
• Books, games, puzzles or other activities for children

Where do I find shelter?

It’s best to get to a building that has a basement. Below ground is obviously safer than above ground. Moreover being surrounded by concrete or even brick is better than stucco.

Mic.com also suggests that the center of a building offers more protection than other rooms as illustrated below:

The farther away you are from the blast the safer, however, you do not want to be in your car in bumper to bumper traffic during an attack either.

Shelter in Place

If you don’t know where to go, than bunker down. If you have a basement go there. If not find an interior room with no windows and start praying.

What if I’m outside?

There is always the possibility that someone may be in the middle of a picnic when a nuclear attack hits.  If that’s the case, and you can’t get indoors, Ready.gov suggests the following:Do not look at the flash or fireball – it can blind you.

• Take cover behind anything that might offer protection.
• Lie flat on the ground and cover your head. If the explosion is some distance away, it could take 30 seconds or more for the blast wave to hit.
• Take shelter as soon as you can, even if you are many miles from ground zero where the attack occurred – radioactive fallout can be carried by the winds for hundreds of miles.
• If you were outside during or after the blast, get clean as soon as possible, to remove radioactive material that may have settled on your body.
• Remove your clothing to keep radioactive material from spreading. Removing the outer layer of clothing can remove up to 90% of radioactive material.
• If practical, place your contaminated clothing in a plastic bag and seal or tie the bag. Place the bag as far away as possible from humans and animals so that the radiation it gives off does not affect others.
• When possible, take a shower with lots of soap and water to help remove radioactive contamination. Do not scrub or scratch the skin.
• Wash your hair with shampoo or soap and water. Do not use conditioner in your hair because it will bind radioactive material to your hair, keeping it from rinsing out easily.
• Gently blow your nose and wipe your eyelids and eyelashes with a clean wet cloth. Gently wipe your ears.
• If you cannot shower, use a wipe or clean wet cloth to wipe your skin that was not covered by clothing.

What about potassium iodide tablets?

These tablets help protect your thyroid from taking up radioactive iodine, as they saturate the organ. It’s an inexpensive pill that will protect one against thyroid cancer but not the other medical sequelae of nuclear exposure such as bone marrow injury and skin irritation.

The false nuclear attack alert Hawaii residents received enlightened the rest of the country on how unprepared the average American is. It’s about time we have a game plan and cities educate their citizens on where and how to protect themselves.

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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.