Displaying items by tag: Medicine

High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg. This will mean close to 103 million more Americans will fall under the “hypertensive” category.

Multiple agencies, including the American Heart Association and American College of Cardiology, redefined the guidelines, in practice for the last 14 years, to lower the threshold for high blood pressure from 140/90 to 130/80.

Under the old guidelines, 1/3 of US Americans were considered to have high blood pressure.  Now 42% of Americans will be “hypertensive.”

In lowering the guidelines, task force members hope to reduce complications associated with high blood pressure and start treatment earlier in those who have not been treated.

What do the blood pressure numbers mean?

The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.

Diastolic pressure is the pressure in your arteries between beats while the heart is “filling.” Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.

What can long term high blood pressure do?

Chronic high blood pressure can be dangerous.  It may cause:

• Heart attacks

• Heart failure

• Stroke

• Kidney disease

• Dementia

• Eye damage – vision loss

• Erectile dysfunction…to name a few.

How do we treat high blood pressure?

The stages of blood pressure are defined in the chart above.  At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:

• Weight loss

• Low salt diet

• Low fat diet

• Good sleep habits

• Regular exercise

• Avoiding tobacco products

• Limiting alcohol consumption

• As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.

• If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.

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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 World Health Organization has reported an outbreak of the Marburg virus, similar to Ebola, has appeared in eastern Uganda on the border of Kenya.

Thus far 5 cases have been reported prompting the WHO to deploy funds to keep the spread contained.

Where did Marburg Originate?

Marburg was originally identified in 1967 when two simultaneous outbreaks occurred in Marburg and Frankfurt, Germany. An outbreak in Serbia also occurred that same time.  Since then rare isolated cases have popped up in Kenya, Angola, South Africa, Uganda and the Democratic Republic of the Congo.

What is Marburg virus and its Symptoms?

Marburg virus is apart of the same family as Ebola, the Filoviridae.  Just like Ebola, it causes a hemorrhagic fever, where victims may bleed, have fever, vomiting, diarrhea, headaches, muscle aches, rash, red eyes, sore throat and abdominal pain to name a few.

Image from KeyWordSuggest

How is Marburg Transmitted?

Marburg virus is transmitted to humans from monkeys and bats such as the African fruit bat and Rousettus bat.  But similarly to Ebola, human to human contact can spread Marburg, especially during body preparation for burial. Saliva, tears, vomit, semen and blood can transmit the Marburg virus from human to human.

Fruit Bat, Image from Dignited

How is Marburg Treated?

There is no treatment currently known for Marburg.  It has an estimated 88% fatality rate.  Its incubation period ranges from 5 days to 2 weeks and those exposed may need to be in isolation for up to 21 days.

RNA interfering treatments are being researched to prevent Marburg virus replication in the host.  Its unclear if Zmapp, a treatment for Ebola, is effective in treating Marburg infection. Between 2014 to 2015, 28,610 people were infected with Ebola resulting in 11,380 deaths.  Local officials are being very diligent to make sure Marburg doesn’t follow a similar epidemic path.

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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.

A new study from the American Medical Association (AMA), the Mayo Clinic and Stanford University finds 1 in 5 physicians plan to cut back their hours next year and 1 in 50 will leave the profession completely within the next 2 years.

Burnout is cited to be the main cause and is one of the biggest threats to health care today. According to AMA President Dr. David Barbe, “An energized, engaged, and resilient physician workforce is essential to achieving national health goals.”

And burnout affects all fields of medicine, surpassing 50%, in those including primary care and specialties such as gynecology, neurology, urology, emergency medicine, anesthesiology, cardiology and critical care to name a few.

Patients are at risk because if doctors aren’t at the top of their game, things get missed.  

Moreover the keen instinct of a clinician is imperative to diagnosing correctly, and this gets blunted when one is emotionally fatigued, or burned out.

Why are Doctors Burning Out?

A variety of factors can lead to physician burnout but the following appear to be the most cited:

1. Electronic medical records – these are time-consuming to learn and implement, take time away from patients and may be financially burdensome due to their cost and lack of revenue for those who struggle to type and work with computers.

2. High patient insurance deductibles – with insurance companies not paying until patients reach their deductible, it forces doctor’s offices to work harder to collect the income needed to run a practice.  Physicians do not want to get into the financial aspect of patient collections and it adds undue stress on an already stressful field.

3. Red tape – ICD 10 code changes, insurance authorizations, referral forms turn the average day of a physician to less patient care and more bureaucracy.

4. Less respect – in the old days, doctors were considered heroes and revered greatly.  Today they are frequently blamed for issues such as rising healthcare costs and the opioid epidemic.

5. Malpractice suit fears – doctors are human and can only combat nature so much.  When one is diagnosed with cancer a physician has to fear that one will accuse him of not diagnosing it “quickly enough”.  When a lab gets ordered, the clinician has to hope that his staff is ensuring that every lab value comes across his desk.  When a prescription is written, he has to hope that the correct medicine is dispensed, works effectively and does not cause an adverse reaction.  And when a referral is made to a specialist, he has to hope all the above issues go well with the second physician or he can be sued for the referral.  And since a doctor sees thousands of patients a year, the odds that he will be sued for something is higher than any other profession.  Moreover, one lawsuit is a enough to bankrupt him.  Pretty darn stressful.

What are the signs of burnout?

In any profession, the following may be signs of burnout:

• Apathy

• Exhaustion

• Poor sleep

• Negative attitude at work

• Absence from work

• Being irritated

• Feeling empty

• Dreading going to work

• Feeling underappreciated

• Feeling you don’t matter

• Blame others for mistakes

• Low energy

• Thinking about quitting

How to prevent burnout?

1. Find the humor – As Milton Berle once said, “Laughter is an instant vacation”.  Watching a comedy or taking a 10 minute break to watch some funny YouTube clips offers immediate relief and energizes you.  A day without laughter is a day wasted. Charlie Chaplin

2. Take care of yourself – how can one heal others when he himself needs healing?  So what can you do?  Try Massage, Meditation, Yoga, Exercise, Stress diary, Sleep, Mini vacations, Staycations but most of all…..Take breaks!!

3. Learn to say “No” – It’s OK to take a day off. Why not take off early on Friday’s?  Or better yet, work a half day on Wednesday to break up the week?  Learn the 4 D’s…..Deflect, Defer, Deter, Delegate…..

4. Make small goals – too many times we burnout because we failed to meet a goal that was unattainable in the first place.  So we toil for years to become “promoted”, or “wealthy”, or “slim”, or “married”, or “see the world”.  Instead, make smaller attainable goals (find a partner, open auxiliary office, lose 10 lbs, take a trip).

5. Quit comparing yourself to others – we watch Shark Tank and then wonder what we are doing wrong, not being millionaires.  It’s unrealistic to think you should be “rich by now”.  We will always be inferior to someone else.  So get over it and love who you are and what you’ve accomplished.

6. Have fun at work – contests, pot luck lunches, lunch room decorating, accent days, dress up days, and end of the week happy hour can spice things up at work.  Plus it increases morale among coworkers and staff.

7. Be charitable – Doing community service is so rewarding and energizing that having a pet project helping out a local charity may be just what this doctor orders.  You can choose a cause, fundraise, attend charity events or walks, or even create a campaign.

8. Get a hobby – tap into your artistic side by writing a book, song, article; paint; cook; build; teach; sing; dance; or even ride.

9. Work on your bucket list- whether its going to a foreign country, learning to speak a new language, buying a vacation property, or even starting a second business, don’t let job burnout deter you.  This may give you the energy and perspective you need.

Finally, be around others and have a Bitch and Moan session – it feels so good to complain and gripe. Find others in similar situations as you and you’ll realize that you may have it better than you think.

Remember you have to come first and doing so will make you more of a help to others.  Feel great and you’ll make others feel great!

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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.

A third type of diabetes has been identified by researchers. Type 3c diabetes may be mistaken for Type 2 diabetes, causing delay of proper treatment.

Researchers from the University of Surrey found Type 3c diabetes to be more common in adults than Type 1 diabetes.  Moreover they found that those with Type 3c were twice as likely to have poor blood sugar control than those with Type 2 diabetes.

They believe, discussed below, that the diabetes occurs years after injury to the pancreas, the organ that produces insulin.  So a person with Type 3c diabetes will most likely need insulin rather than an oral medication that treats insulin resistance

Study author, Andrew McGovern, writes: …our latest study has revealed that most cases of type 3c diabetes are being wrongly diagnosed as type 2 diabetes. Only 3% of the people in our sample – of more than 2m – were correctly identified as having type 3c diabetes.

So if many Type 2 diabetics fail to maintain control with their oral medications that address insulin resistance, they may actually have Type 3c and need insulin instead as low insulin is the cause of their diabetes.  Identifying this early will hopefully prevent some of the complications that occur with long term diabetes.

What is diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, it’s 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 blood stream.   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 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.

Type I vs. Type II vs. Type IIIc 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.

Type IIIc diabetes may occur in individuals who suffered damage to their pancreas.  Inflammation/infection of the pancreas (pancreatitis), a pancreatic tumor, or surgery affecting the pancreas may destroy the beta cells that produce insulin.

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.

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 one's 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 on the study visit 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.

A new study out of Pennsylvania State University College of Medicine links textured breast implants to BIA-ALCL, anaplastic large cell lymphoma.

Although a rare cancer. researchers believe the lifetime risk is 1 out of every 30,000 women with breast implants and if the numbers are underreported, could be as common as 1 out of every 4000 women with implants.

Although the implants are used to augment breast tissue, the malignancy is not a breast cancer but rather a lymphoma.

Lymphomas make up the most common of the blood cancers.  The cancer begins in the lymphocytes, cells crucial for maintaining one’s immune system. Two main types of lymphoma are Hodgkin’s and Non Hodgkin's.  Non Hodgkins is more common, and anaplastic large cell lymphoma is a subset if it.

ANAPLASTIC LARGE CELL LYMPHOMA/PATHPEDIA.COM

In this study, researchers reviewed 115 scientific articles from 1997 – January 2017.  Unlike the report released earlier this year by the FDA, the researchers did not find a link between BIA-ALCL and smooth breast implants.  Of the articles reviewed, 93 cases were cited and the cancer appeared 10 years after the textured implants were placed.

According to the American Society of Plastic Surgeons, there are currently 160 cases in the US and a total of 391 worldwide as of September 2017.

Last March the FDA reported 9 women had died from anaplastic large cell lymphoma (BIA-ALCL) possibly associated with their breast implant use.  The FDA received 359 reports of BIA-ALCL,  a rare type of non-Hodgkin's lymphoma, 9 of whom died as of February 1, 2017.

This is not the first time a link has been suggested.  6 years ago the World Health Organization suggested a link.  Then in 2011, the FDA identified a possible association between the two.  In 2016, the  Australian Therapeutic Goods Administration reported 46 confirmed cases with 3 deaths relating to breast implants.

The report last spring suggested that BIA-ALCL affected both smooth and textured implants. According to the FDA report, 231 of the 359 cancer cases provided information on implant type.   203 were reported to be textured implants and 28 reported to be smooth implants. When it came to silicone vs. saline implants, the FDA said 312 of the 359 reports provided these specifics and of those 186 reported implants filled with silicone gel and 126 reported implants filled with saline.

So neither implant type appeared immune to the risk of BIA-ALCL but it appears the silicone, textured implants carried the most risk.

Now the cancer occurred within the breast and the FDA advises physicians to consider the possibility of BIA-ALCL if there appears to be a seroma (fluid filled cavity around the implant) or a contracture (pulling of the skin and tissue) near the implant.

In most cases the cancer is treatable, with removal of the implant and the surrounding tissue curative.  In some cases however, radiation of the area or chemotherapy is required.

Although 50,000 cases of non-Hodgkin’s lymphoma occurs annually in the US, it is unknown how many cases of BIA-ALCL occur each year.  Moreover, many countries may not have avid reporting systems of breast implant related cancers as we do.  According to the American College of Plastic Surgeons, close to 300,000 women receive breast implants each year, some of which for breast reconstruction after mastectomy for breast cancer.

The FDA reminds us that BIA-ALCL is rare and prophylactic breast implant removal is NOT recommended. However we need to be aware and evaluate if one develops swelling, pain, new lumps or asymmetry in the breasts….just as we do for those without implants.

For more on the study, visit 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.

On Sunday, Green Bay Packers Quarterback Aaron Rodgers suffered a collarbone fracture and may be out for the season.  Here are your questions answered.

What exactly is a collarbone?

The collarbone is another name for the clavicle.  It’s the bone that connects the scapula (shoulder-blade) to the sternum (breastbone).  We have one on each side and it runs horizontally providing shoulder girdle support.  Not only does it provide upper skeletal strength and support but it also protects many major vessels that run underneath it.

Image from AAOS

What’s a collarbone fracture?

The clavicle (collarbone) is one of the most common types of bones to fracture during sports injuries.  There are three major Groups or Types of clavicle fractures.

Type I – is the most common and occurs in the middle third of the clavicle

Type II – is the second most common and occurs distally, or closer to the shoulder.

Type III – is the most rare and occurs the most medially, or closer to the rib cage/sternum.

What are the signs/symptoms of a clavicle fracture?

Before bruising and swelling ensue, one will have sharp pain in the area of the collarbone and have difficulty moving his shoulder.

So signs of a clavicle fracture include:

• Pain

• Loss of range of motion of the shoulder

• A bulge at the fracture site

• Swelling

• Bruising

• Tenderness at the fracture area

• In young children, not wanting to move the arm on the affected side

How are collarbone fractures treated?

If the bone has not shifted too significantly, clavicle fractures can be treated non- surgically. Arm slings will be given to decrease the movement of the shoulder girdle.  Pain medication and antiinflammatories may be prescribed, and physical therapy will be instituted immediately to improve range of motion and strength.

If the clavicle is displaced significantly from the injury then surgery will be needed to reunite the ends using plates, rods and screws.

How long does it take collarbone fractures to heal?

In adults, healing could take anywhere from 6-12 weeks.  For children, clavicle fractures may heal sooner.

How does one prevent a collarbone fracture?

During sports, protective equipment is key to avoiding injuries from falls and tackles.  As in Aaron Rodger’s and Tony Romo’s cases, being sacked by another large player barreling towards them must be avoided at all costs.

Just say NO to sugar.  This will be a hard one for me but if you do it, I will.

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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 World Health Organization (WHO) finds the number of obese children in the world to be 10 times greater than what it was 4 decades ago.

They estimate currently 50 million girls and 74 million boys are obese worldwide.

Back in 1975 only 11 million children worldwide were obese. Now the number sits at 124 million.

True, population has grown since then, but the percentage of children obese is exploding -- 19% of girls and 22.4% of boys in the US are considered obese.

Adult obesity is skyrocketing as well. In 1975 there were 100 million obese adults worldwide. This jumped to 671 million in 2016 and doesn’t include the 1.3 billion “overweight” adults.

The Center for Disease Control and Prevention (CDC) states the following:

Obesity is defined as having excess body fat. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. Body mass index, or BMI, is a widely used screening tool for measuring both overweight and obesity. BMI percentile is preferred for measuring children and young adults (ages 2–20) because it takes into account that they are still growing, and growing at different rates depending on their age and sex. Health professionals use growth charts to see whether a child’s weight falls into a healthy range for the child’s height, age, and sex.

• Children with a BMI at or above the 85th percentile and less than the 95th percentile are considered overweight.

• Children at or above the 95th percentile have obesity.

Why such a rise in obesity?

1. We’re successfully fighting the war on tobacco. Adults especially can’t turn to a stick of nicotine as easily as they once could to curb their appetite.  Teen smoking is down as well, so their appetites may be up.

2. We like fast food.  Its cheap, yummy and convenient.  For 99 cents you can get a small burger that is served to you in a matter of minutes and can be eaten before your next meeting or class.  Fast food contains excess calories, fat and preservatives that our body doesn’t need.

3. We eat too quickly.  The speed at which we eat may affect our metabolism.  Eating too quickly prevents a satiety signal from reaching the brain, hence we will gulp down more food than is needed.  For more on this read here.

4. We don’t move around as much.  We can all agree that children and adults these days don’t play outside as much as we did in previous generations.  And even if we did get some exercise in each day during PE or at the gym, we lose much of the ground gained when we sit on our computers at night for hours on end.

5. More hormones are in our food.  Hormones such as steroids and recombinant bovine growth hormone (rBGH) that enhance food production in our food-producing animals may affect our metabolism.

6. Sugar isn’t a treat anymore, it’s considered a food group.  In the 70’s if you got dessert one night at dinner it would be a rare treat.  Today kids have dessert at lunch and even breakfast has sugar levels over flowing the cereal bowl.  Excess sugar leads to fat storage.

7. Our portions have gotten bigger.  Remember when the Quarter Pounder came out in the early 70’s and we thought it was the biggest burger ever?  Now people will eat two in one sitting.

Below is a table showing the difference in portion sizes today vs. the 1950’s.

Image from Daily Mail

What can we do to combat the obesity epidemic?

1. Make exercise not a choice but a daily necessity. Schools should have English class conducted on walks around the school rather than sitting in desks. A 30 minute workout should be a given every morning without excuses. We brush our teeth, we wash our hair, we gas up our truck, we exercise.

2. Eat fresh, avoid fast food.  The more junk food the more junk in your trunk.  Avoid preservatives and processed foods. Your body was designed to eat the basics. Give it what it needs.

3. Eat slowly.  No need to chow down on the run. If you’re in a hurry then eat half the sandwich as save the rest for later. Which brings us to…

4. Eat smaller portions. Get rid of the platters you call plates these days and eat your dinner off of a saucer dish. You’ll still fill up your tummy.

5. Swap vegetables for carbs. It’s healthier, filling, and helps you poop.

Just say NO to sugar.  This will be a hard one for me but if you do it, I will.

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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.

Investigators believe the Las Vegas Route 91 Harvest Concert shooter, Stephen Paddock, suffered from severe mental illness that was never diagnosed. This seems obvious to us, as anyone who would kill 59 innocent people and wound hundreds more could never be of sound mind.

However, one would think a person this mentally unstable would leave a pattern of behavior footprints that would have been picked up earlier in his life.

Although no motive has been established in the shooting, investigators have interviewed multiple acquaintances who knew the 64-year-old real estate investor and were told he was disconnected, stand-offish, and lacked multiple social interactions. However, he easily flew under the radar as he had a girlfriend, appeared to be close to his mother, and had successful real estate dealings that funded his gambling habits.

Most mass shootings are committed not by those who spent time in mental institutions but by those who dined, shopped, and lived near their victims. And many have been under the care of medical providers, being prescribed medications that address psychological symptoms.  So how do mass shooters evade proper diagnosis?

They don’t fit the stereotype

To the layman, the average person with severe mental illness appears highly erratic, confused, unpredictable.  To a trained medical professional, the same symptoms would trigger their suspicions as well.

But the average killer may be a psychopath, being impulsive, antisocial, and exhibiting violent behavior.  If they don’t act violent or violently impulsive, they can elude the interviewer.

They may hide from the public

A mass shooter will plan their attack, may stake out locations, and but will overall remain isolated to avoid arousing suspicions. And a psychopath, may exhibit antisocial behavior.  So as they stay remain isolated and introverted, they allow less opportunity to be “made.”

They fly under the radar

As in Stephen Paddock’s case, he flew under the radar as he did not avoid the public.  He would drink, gamble, frequent casinos and appear to be very successful in his business/real estate dealings. With lack of a criminal record and violent interactions, the average person wouldn’t deem him suspicious of committing such a heinous act.

They don’t want to be treated medically

Many people with mental illness may have symptoms they wish to control, but will stop short of admitting they have a medical condition that needs treatment.  Those who suffer from delusions or psychosis may believe others are exhibiting the abnormal behavior, so why would they want to undergo treatment themselves?

Moreover, if they fear being “turned in” by the medical provider interviewing them and revealing homicidal ideation, they will be less inclined to seek medical help.

They may not have health insurance

If an individual with severe mental illness has difficulty maintaining a job, he/she most likely will be without employer-paid health insurance.  This limits access to seeking medical help all the more.

The chilling truth is we have killers who live among us who may plot and plan right under our noses.  Let’s pray they leave enough clues that they get caught before they carry out their plans.

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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.

Celebrities such as Julia Louise-Dreyfus, Olivia Newton-John, Christina Applegate and Rita Wilson 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 of the course of their lifetime. According to BreastCancer.org, an estimated 252,710 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,410 cases of non-invasive breast cancer.

40,610 of these women are expected to die this year of breast cancer.

How is breast cancer staged?

Breast cancer is staged based on 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.

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.

3-D MAMMOGRAM IMAGE

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

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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.

Sunday night’s shooting of concert goers at the Route 91 Harvest Music Festival has left 58 dead and wounded hundreds others in the deadliest mass shooting to affect the United States.  Here’s how you can help:

Las Vegas Victim’s Fund

Established by Steve Sisolak, Clark County Commission Chair, this fund is helping to raise funds for victims and their families.  Go Fund Me Page is here.

Blood Donation

Thousands of units of blood are needed and can come from local and out of state donors.

United Blood Services have locations throughout the country that can accept your blood Donation. Contact UBS here.

The American Red Cross is accepting donations. On their website, they ask to visit redcross.org.

Moreover Red Cross is taking donations. Call 1-800-RED CROSS or text the word REDCROSS to 90999 to make a $10 donation.

Petition

We are asking President Trump to help declare a National Blood Donation Week.  Please sign and SHARE the petition below:

Petition

Secret Garden Radio For Las Vegas Fund

R&B icon Al B. Sure, Host of Secret Garden @SlowJams Morning show via iHeart Radio & Host of Secret Garden Radio @ our historic KCEP Power 88.1 FM is raising money for victims and their families here.

National Compassion Fund

Funds will help the immediate and long term needs of victims and their families.  Donate 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.