The CDC reports 3.4 million Americans suffer from epilepsy based on their 2015 data.  This number rose from 2.3 million in 2010.  470,000 of these cases are children.

 

According to their website, the CDC reports 1.2% of the population suffers from “active epilepsy.”  Active epilepsy is defined in adults as those having one or more seizures in the past year and requiring medication daily to control them. In children it means they currently have a seizure disorder.

 

The exact explanation for the rise in cases is unclear, however population growth and improved testing has been cited.

 

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.

 

HGT0066_neurons-seizure-brain_FS.jpg

 

 

Epilepsy and seizures can be caused by a multitude of factors including genetics, brain trauma, tumors, infection, damage during birth, and stroke.

Can cell phones cause seizures?

 

Data has been limited linking seizure activity to cell phone use. However, some studies have found a modest link.

 

In 2016, Kouchaki et al tested mobile phone radiation in mice and concluded “continued and prolonged contact with the mobile phone radiation might increase the risk of seizure attacks and should be limited.”

 

Also in 2016, a study published in Epilepsy and Behavior by Tatum et al found texting to induce a “new type of brain rhythm.”

 

In 2013, Cinar et al examined the effects of electromagnetic waves (EMWs) on humans and suggested the following, “acute exposure to EMW may facilitate epileptic seizures, which may be independent of EMW exposure time. This information might be important for patients with epilepsy. Further studies are needed.”

 

In 2006, Ferreri et al found mobile phone “emissions” to increase human brain excitability, implying this could affect those with epilepsy.

 

More research therefore needs to be done investigating why epilepsy cases are on the rise and if cell phone radiation plays any role.

 

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Daliah Wachs, MD, FAAFP is 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.

 

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Tuberculosis: Your Questions Answered

Tuberculosis (TB), once called “Consumption”, has been one of the deadliest lung infections in history.  With recent advances death rates have drastically dropped, but currently 1/3 of the world’s population is infected with TB and worldwide it ranks in the top 3 causes of death.

What is Tuberculosis?

 

TB was first discovered in 1882 by Robert Koch. It  is caused by the bacteria, Mycobacterium tuberculosis.  It’s an acid-fast staining bacteria (significant for diagnosis purposes) and it needs oxygen to survive, hence the lungs offer the perfect environment for this pathogen to grow.

How is Tuberculosis passed?

 

TB is passed by aerosol/droplet transmission so when someone coughs, sneezes, or passes respiratory fluid they could transmit TB.  It may also grow on contaminated surfaces.

What are symptoms of Tuberculosis infection?

 

Symptoms may include the following:

  • Coughing > 3 weeks

  • Coughing up blood (hemoptysis)

  • Pain with coughing and/or breathing

  • Weight loss

  • Fatigue

  • Fever

  • Night sweats

  • Chills

  • Loss of appetite

How is Tuberculosis diagnosed?

 

If a patient has any of the above symptoms the first test needed is a Chest X Ray.  The chest x ray may show an effusion (fluid), consolidation (area of the lung obscured with fluid/infection infiltrate), and lymphadenopathy (lymph node swelling). Ghon’s lesions (a necrotic, calcified focus of infection) and a Ghon’s complex (a Ghon’s lesion with lymph node involvement) may be seen as well.

Cultures of the sputum/mucous can be done but they take 4-6 weeks.  Acid-fast staining can be done on the sputum which will give a quicker diagnosis.

Can Tuberculosis spread?

 

Yes. 15-20% of the cases can be extrapulmonary. Meaning “beyond the lung”, one could have extrapulmonary TB, with infections affecting the gastrointestinal tract, genitourinary tract, lymph nodes and lining of the brain.

 

Sometimes TB may disseminate throughout the lungs and body, this is called Miliary TB.  Miliary TB can spread to the above areas as well as heart, brain, and bone.

TB may also become “latent” and reactivate at a later date.

How is Tuberculosis treated?

 

Active TB needs to be treated for 6-9 months. The following medications include:

 

  • Isoniazid (INH)

  • Rifampin (Rifadin, Rimactane) (RIF)

  • Ethambutol (Myambutol) (EMB)

  • Pyrazinamide (PZA)

  • Initially we prescribe a 2 month “intensive phase” treatment of the above four drugs.  Then its followed by a “continuation phase” of only INH and RIF.

  • For latent TB cases we prescribe a 9 month regimen of INH.

  • Health care providers watch for liver toxicity and, especially with INH, vitamin B6 deficiency.

 

Is there a vaccine for Tuberculosis?

 

Yes. The BCG Vaccine was created in the 1920’s and it is the most common vaccine given outside of the US. Due to cost and its lack of efficacy (only 50% effective) it's not given during routine vaccination here in the US. Moreover, it may interfere with PPD skin tests used for screening, as one vaccinated will show a positive result.

How do we screen for Tuberculosis?

 

The Mantoux, purified protein derivative (PPD) skin tests are given subcutaneously in the arm and read 48-72 hours later, looking for a red marking.

 

ppd

mar97table1.gif

 

Two steps are done a week apart to ensure against false negatives.

IGRA – Interferon Gamma Release Assay blood tests, such as QuantiFERON®, can be done and provides results within 24 hours.  It is beginning to replace the PPD test for screening in many healthcare settings.

Who is at risk for acquiring TB?

 

High risk populations include the following:

  • Healthcare workers

  • Prisoners

  • Homeless shelters

  • Nursing homes

  • Alcoholics

  • Chronically debilitated

  • Those with HIV

Where is TB the most common?

 

Countries with the highest TB rates include:

  • India

  • Indonesia

  • China

  • Nigeria

  • South Africa

  • Philippines

  • Pakistan

  • Bangladesh

 

50% of all cases in the US are immigrants coming from any of the above countries.

How does one prevent TB?

 

In addition to vaccination, and treating household/close contacts of those infected with TB, prevention includes the following:

  • Education

  • Homes with good ventilation

  • Avoidance of sick household contacts

  • Avoid close quarters with large amounts of people



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Daliah Wachs, MD, FAAFP is 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.

 

 

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A study published this week in Lancet Global Health reveals, without increasing access to treatment, the number of cases of blindness will rise from 36 million cases reported in 2015 to 115 million by 2050.

The cause is the growing aging population, even though the actual percentage of the population with visual impairment is declining.

 

Factors leading to blindness may include diabetes, stroke, macular degeneration, retinal detachment, cataracts, glaucoma, and trauma.

 

In addition to these startling numbers of vision loss, moderate to severe visual impairment cases are set to surpass 550 million by 2050.

 

Study author, Rupert Bourne of Anglia Ruskin University, reviewed population based data from over 188 countries and found currently 200 million people suffer from moderate to severe visual impairment.

Bourne states, “Interventions provide some of the largest returns on investment. They are some of the most easily implemented interventions in developing regions.”

 

He continues, “They are cheap, require little infrastructure and countries recover their costs as people enter back into the workforce.”

 

Even minimal visual impairment can prevent those affected from obtaining a driver’s license or performing many activities, resulting in economic hardship.

 

The study authors hope this news could help shape future public health policies as well as encourage more investment into cataract surgeries and access to eyewear.

 

One is deemed “legally blind” when their central visual acuity falls under 20/200 (in the better eye under the best corrected circumstances) or their visual field is 20 degrees or less.

Childhood Vision Impairment

 

According to Prevent Blindness Northern California, 3% of children under 18 in the US are blind or visually impaired, despite maximum correction efforts.

 

In 2015, the American Community Survey (ACS) reported 455,000 children in the US with vision impairment.  Of these, 62,000 are legally blind, according to the 2015 Annual Report from the American Printing House for the Blind (APH).

 

Sadly, not all states have schools for the blind.

 

Leslie Jones, marketing and special events director of Nevada Blind Children’s Foundation (NBCF), tells us, “Nevada is one of a handful of states without a school for the blind, and what resources are available through the Clark County School District are severely limited (there are just 11 Teachers for the Visually Impaired {TVIs} for more than 500 visually-impaired students needing resources from the Vision Services department).”

 

Foundations such as the NBCF try to fill the gap with services these children need.

 

Jones states, “Nevada Blind Children’s Foundation (NBCF) works alongside CCSD to provide additional after-school educational and adapted recreational programs and services to ensure that these underserved children are given what they need to succeed in the classroom and in life.”

 

A child’s development and windows for learning necessitate early intervention.  Programs slow to enroll or lacking funding burdens blind children more as they fall behind in learning and development.  Building schools for the blind, such as in Nevada, will help thousands of children lessen their disability.

 

To help the Nevada Blind Children’s Foundation, please visit: here.

 

nv blind children

Dr. Daliah Wachs with Children from NBCF – Lady Bug Ball 2017

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The Presidents and Their Medical Issues

It’s been long postulated that JFK could have survived if he wasn’t wearing his back brace the day he was shot.  President Kennedy suffered from many issues including Addison’s disease and multiple back surgeries.  His brace possibly kept him upright when the first shot hit, whereas he could have slumped over and been out of the line of fire during the second shot.

 

The medical issues plaguing our Presidents used to be kept secret, a luxury current politicians can’t fathom in today’s media world.  Each President faced insurmountable tasks on national and global levels.  Let’s now take a look at what our leaders battled personally.

 

George Washington – I cannot tell a lie….

 

It is believed that George Washington suffered from diphtheria, tuberculosis, malaria, smallpox, dysentery, possible sterility, tonsillitis, and epiglottitis.  He appeared to have  many issues with the back of his throat.  Syphilis has been debated but then again many people at the time had syphilis (Abraham Lincoln supposedly had syphilis when he was younger).

 

George Washington had one original tooth left by the time he became president.

His teeth were not made of wood…..instead made of hippopotamus/walrus/elephant ivory or transplanted teeth.

 

The tooth loss could have been from the mercury oxide that was used to treat his smallpox and malaria.

During one of his battles it's been said he had to ride with a pillow on his saddle while being ill with fever.  It is believed that the dysentery left his bottom in so much pain that he required a pillow on which to sit.

 

In 1799, George Washington died of presumed epiglottitis, sore throat, and difficulty breathing.  His end was a painful one as doctors burned and blistered him to draw out the humors.

James Garfield – “Did the doctors kill this President”

 

James Garfield was shot twice (once in the arm and once in the back) on July 2, 1881.  The bullets and wounds supposedly were not lethal but the un-sterile technique used (the practitioners used their fingers to find the bullets while he lay at the train station) caused him to have an infection and his doctors supposedly restricted his eating since they thought the bullet pierced the bowel.

 

They fed James Garfield by rectal enema.   He was fed beef bouillon, egg yolks, milk, whisky and opium through his rectum.  It was considered a “nutritional enema.”

 

Interestingly, Alexander Graham Bell devised a metal detector made of a battery and several metal coils positioned on a wooden platform, connected to an earpiece to help find the bullet. Unfortunately, the attempt was unsuccessful. James Garfield died 80 days later.

Thomas Jefferson – ahead of his time…….

Thomas Jefferson lived until he was 83.  He was not a vegetarian but ate less meat than others and increased his vegetable intake.

 

His sleep habits were also good – 5-8 hours of sleep in a “reclined” position.   “Whether I retire to bed early or late, I rise with the sun.”

 

He was against tobacco, and moderately used alcohol. “…you are not to conclude I am a drinker. My measure is a perfectly sober 3 or 4 glasses at dinner, and not a drop at any other time. But as to those 3 or 4 glasses I am very fond.”

 

Its been postulated he also had Aspergers…….

 

William Taft –  Poster child for sleep apnea and the “Atkins diet”.

 

President Taft weighed over 300 lbs. and supposedly would nod off during the day and during meetings with world leaders. It was therefore presumed he had narcolepsy, most likely a result of his sleep apnea.

His doctor put him on a low carb diet and he lost 60 lbs.

 

Franklin D. Roosevelt –  as if polio wasn’t enough…..

In addition to being a victim to polio, cerebral hemorrhage and very high blood pressure, its been postulated that FDR had malignant melanoma above his left eyebrow….possibly the cause of his hemorrhage when it spread to the brain.

 

fdr

Abraham Lincoln – was he suicidal?

Firstly, let's discuss the myth that Abraham Lincoln had Marfan’s Syndrome.  We now understand he didn’t but actually had a genetic disorder, MEN2B  which gave him a Marfanoid appearance (tall, lanky, long limbs), large lower lip, history of constipation, bumpy lips, “pseudodepression,” and his mother possibly suffered the same disorder.

 

Was Lincoln suicidal?  The poem, Suicide’s Soliloquy was believed to be authored by Abraham Lincoln.

Why did it take Abraham Lincoln 11 hours to die from his fatal wound? ……Doctors actually relieved the intracranial pressure, and appeared to do an amazing job considering the time. Unfortunately he fell unconscious immediately, and they never were able to revive him.

Woodrow Wilson – Was he always in charge?

In October of 1919, Woodrow Wilson suffered a stroke. After his medical incident it's believed his wife Edith ran the country while he was bedridden. He died in 1924, three years after leaving office at the age of 67.

 

Dwight D. Eisenhower – if your heart’s not in it…..

 

In 1955 he suffered a myocardial infarction (heart attack). He originally thought he suffered from indigestion.  Recovery time was much slower than modern day and he was kept on bed rest for months.  He was considering resigning.  Months later he regained his strength and successfully ran for a second term.

 

John F. Kennedy – did his back brace kill him?

Why was JFK so “tan”? He suffered from Addison’s disease and along with this suffered from chronic back problems.  He required  multiple injections and medicines on a routine basis after a series of failed back surgeries.

 

His back brace may have cost him his life……Historians believe he didn’t slump over after the first shot (prevented by the brace) and was therefore sitting upright when the second shot hit his head.

 

jfk-slump

 

JFK appears to be in his back brace that day.  If the first shot caused him to fall over, historians believe he could still be alive today, avoiding the second fatal shot to his head.

 

Other reported maladies affecting some U.S. Presidents include:

 

Ulysses S. Grant – throat cancer

Chester Arthur – Bright’s disease

Teddy Roosevelt – detached retina

Herbert Hoover – GI Cancer and GI bleed

Richard Nixon – phlebitis, blood clots

George HW Bush – hyperthyroidism/Graves disease

In short, Presidents are not always in the finest of health and may suffer the same maladies their constituents do.  Washington has always found a way to keep this from the public and may continue to despite today’s technology.

 

LearnHealthSpanish.com / Medical Spanish made easy.

 

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

 

 

Published in News & Information

Antibiotic resistant strains of the sexually transmitted illness, Neisseria gonorrhea, have been on the rise, and the World Health Organization cites oral sex as a culprit.

 

“Super-Gonorrhea” is a term used for a gonorrhea infection that cannot be treated by conventional antibiotic therapy. Drug resistant strains cause infections that cannot be cured, hence increasing its risk of morbidity and spread to other individuals who think their partner is “cured.”

 

Gonorrhea infection may present with green/yellow discharge emanating from the penile urethra or female vagina or it may be asymptomatic. Additionally the bacteria could colonize or infect the rectum, mouth, or disseminate throughout the body, causing arthritis, rash and multiple other maladies. Untreated gonorrhea can also lead to infertility, pelvic inflammatory disease, and increase one’s risk of acquiring HIV.

 

Oral sex allows an easy route of transmission if condoms aren’t used.  According to Dr. Teodora Wi, WHO Medical Officer, “When you use antibiotics to treat infections like a normal sore throat, this mixes with the Neisseria species in your throat and this results in resistance.”

 

Let me explain. Superbugs develop when a bacteria survives an antibiotic treatment that should have killed it. The surviving bacteria, with its “super genes,” makes offspring that has the same “super genes” capable of withstanding the same antibiotic that didn’t kill its parent. The more exposure a bacteria has to antibiotics that it can withstand, the greater the possibility of it developing antibiotic resistance. Antibiotics used to kill throat infections are not always designed to kill off gonorrhea, hence any gonorrhea sitting in the throat after oral sex can produce resistant progeny.

 

Until recently, gonorrhea would be treated with a single dose of ceftriaxone, ciprofloxacin, or azithromycin. Due to a rise in resistance to these individual medications, the current treatment for gonorrhea infection recommended by the CDC is a single dose of 250 mg of intramuscular ceftriaxone AND 1g of oral azithromycin.

 

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LearnHealthSpanish.com / Medical Spanish made easy.

 

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

 

Published in News & Information

A Houston boy who went swimming at Texas City Dike over Memorial Day Weekend died days later from reportedly “dry drowning,” or possible “secondary drowning.”

 

“Dry Drowning” sometimes gets confused with secondary drowning. The latter occurs when fluid gets into the lungs when one swims and hours, or days later (out of the water), causes respiratory failure.  As will be discussed below, dry drowning causes a spasm of the vocal cords which inhibits breathing.

 

Frankie, 4 years old, appeared fine until a few days later, his father, Francisco Delgado, Jr., said he appeared to be suffering from a minor, stomach ailment. Then one morning the boy woke up with shoulder pain, and “Out of nowhere, he just woke up. He said ahhh.”  His father told KTRK, “He took his last breath and I didn’t know what to do no more.”

 

Despite efforts by paramedics and the parents, Frankie passed. A GoFundMePage has been created for the family to help with funeral expenses.

What is “Dry Drowning” and “Secondary Drowning”?

Dry Drowning occurs when water touches the first pass of the respiratory tree, one’s vocal cords, larynx.  When water touches this area a reflex is triggered, causing a spasm (laryngospasm) such that the vocal cords constrict and close up the airway. It's a defense mechanism designed to prevent water from falling into the lungs. However, laryngospasm causes immediate hypoxia, lack of oxygen, and if not reversed, the victim will die.  In dry drowning, water never officially reaches the lungs.

 

bronchi_lungs.jpg

 

In Secondary Drowning, water gets inhaled and sits in the respiratory tree and if uncleared through coughing, will sit and prevent proper oxygenation. Moreover the water will irritate the lung linings causing more fluid and inflammation, resulting in pulmonary edema. This could occur hours to days after the water activity.

 

According to Florida Hospital Tampa pediatrician, Dr. James Orlowski, these events are very rare, comprising only 1-2% of drowning incidents.

What are the symptoms?

The symptoms for both “Dry” and “Secondary Drowning” are similar in which the victim could have any of the following:

 

  • Cough

  • Chest Pain

  • Difficulty Breathing

  • Shoulder Pain

  • Neck Pain

  • Confusion

  • Irritability

  • Behavior Changes

  • Fatigue

  • Difficulty speaking

 

to name a few…

Prevention

Horse play in water should be avoided. This includes bathtubs, plastic pools, hot tubs, pools, lakes, ocean, etc.

 

Never swim alone.

 

Swim in areas staffed with lifeguards and/or appropriate supervision. If water does get inhaled watch the child or adult to look for any of the above symptoms. If concerned seek medical help immediately.

 

LearnHealthSpanish.com / Medical Spanish made easy.

Daliah Wachs, MD, FAAFP is 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.

 

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For centuries, multiple civilizations have used cannabis to treat various medical conditions, including seizures. This week researchers from NYU Langone’s Comprehensive Epilepsy Center found a chemical in marijuana to do just that.

A study published in the New England Journal of Medicine found that a liquid medication containing cannabidiol, one of the many chemicals in marijuana, reduced convulsive seizures in children by half.

Created by GW Pharmaceuticals, Epidiolex, brand name, was the drug used in this study and has not yet received FDA approval.

As opposed to THC, tetrahydrocannabinol, the psychoactive ingredient in marijuana, cannabidiol does not cause euphoria and has been the subject of many studies for its medicinal applications.

In this study, researchers tested 120 children with Dravet’s syndrome and found those given Epidiolex not only suffered less seizures, but 5% of the children were seizure-free during the 14 week trial.

Side effects, however, were reported such as fatigue, vomiting, diarrhea and anorexia (loss of appetite).

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.

What is Dravet Syndrome?

 

Dravet Syndrome is a rare genetic condition that starts in infancy.  Children can suffer a variety of seizures and may eventually suffer from developmental delay and learning disorders.  What makes Dravet Syndrome so severe is the fact that the seizures are refractory to many anti-seizure medications.

 

 

More research needs to be done in this area, but these preliminary findings give parents and the medical community hope that a pharmaceutical option could exist in the near future for these devastating and potentially fatal seizures.

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Daliah Wachs, MD, FAAFP is 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.

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