Posted in Health, news, Sports

Are Many Athletes at Risk for Depression?

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, Daryl 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.

loss

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.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Advertisements
Posted in Entertainment, Health, news

Opioids Contributed to Tom Petty’s Death

The Los Angeles County Medical Examiner released this week the cause of death of music legend Tom Petty.

According to the report, he died accidentally of “multisystem organ failure due to resuscitated cardiopulmonary arrest due to mixed drug toxicity” of the following medications:

  • Opioids:  fentanyl  and oxycodone (pain killers)
  • Benzodiazepines;  temazepam (br. Restoril) and alprazolam (br. Xanax) (sedatives)
  • and an SSRI antidepressant citalopram (brand name Celexa)

Adding benzodiazepine to a narcotic could accelerate the respiratory depression leading to overdose and death.

There’s been suggestions that SSRI’s and opioids could increase the risk of serotonin syndrome, a toxicity reaction causing dangerous drops in blood pressure, hallucinations, muscle rigidity and low oxygen. This can also induce cardiopulmonary arrest.

Fentanyl was implicated in the overdose death of Prince in April 2016.  Its a powerful narcotic  found to be 50-100 times stronger than morphine and 30-50 times more powerful than heroin.

Petty’s medical issues included a recently fractured hip, emphysema and possible underlying cardiovascular disease.

Emphysema is a lung condition most commonly caused by smoking.  With mild respiratory depression induced by a narcotic, a person with emphysema can easily go into severe respiratory distress.  Those with lung disease are discouraged to regularly use opioids.

 

emphysema.jpg

His family issued the following statement on his facebook page:

Our family sat together this morning with the Medical Examiner – Coroner’s office and we were informed of their final analysis that Tom Petty passed away due to an accidental drug overdose as a result of taking a variety of medications.

Unfortunately Tom’s body suffered from many serious ailments including emphysema, knee problems and most significantly a fractured hip.

Despite this painful injury he insisted on keeping his commitment to his fans and he toured for 53 dates with a fractured hip and, as he did, it worsened to a more serious injury.

On the day he died he was informed his hip had graduated to a full on break and it is our feeling that the pain was simply unbearable and was the cause for his over use of medication.

We knew before the report was shared with us that he was prescribed various pain medications for a multitude of issues including Fentanyl patches and we feel confident that this was, as the coroner found, an unfortunate accident.

As a family we recognize this report may spark a further discussion on the opioid crisis and we feel that it is a healthy and necessary discussion and we hope in some way this report can save lives. Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.

On a positive note we now know for certain he went painlessly and beautifully exhausted after doing what he loved the most, for one last time, performing live with his unmatchable rock band for his loyal fans on the biggest tour of his 40 plus year career. He was extremely proud of that achievement in the days before he passed.

We continue to mourn with you and marvel at Tom Petty and the Heartbreakers’ incredible positive impact on music and the world. And we thank you all for your love and support over the last months.

Thank you also for respecting the memory of a man who was truly great during his time on this planet both publicly and privately.

We would be grateful if you could respect the privacy of the entire Heartbreaker family during this difficult time.

Dana Petty and Adria Petty

This is a developing story.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in flu, Health, news

How to Tell When Your “Flu” is Turning Deadly

IMAGE ABOVE FROM ABC NEWS

 

Once healthy children and young adults are falling victim to this severe flu strain prompting parents to fear the worse when it comes to theirs or their child’s flu symptoms.

Who can blame them. Flu symptoms can last up to 2 weeks, and most patients are told to go home and rest as antibiotics do not help fight the flu and symptoms will usually “resolve on their own.” This is true, but then why are some people..healthy people…dying?

What are the symptoms of the flu?

To understand why people are often misdiagnosed for flu-related illness when something even more serious is occurring, lets first list the common symptoms of the flu.

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

As opposed to a cold, in which symptoms are less severe and come on more slowly, the flu seems to hit you within hours.   The fatigue may be the first symptom, followed by body aches, scratchy throat, cough, runny nose and then fever. The fever could range anywhere from 100 – 106 F.  The fever usually lasts 2 days and the majority of those affected by the flu will average symptoms from 3-5 days.

How can you die from the flu?

There are multiple ways to die from the flu.  The most common cause is pneumonia.  A secondary viral or bacterial infection can affect the already weakened lungs.  Pneumonia can be deadly, especially if untreated.  Symptoms of pneumonia are very similar to the flu:  shortness of breath, cough, fever, fatigue, body aches, etc.

Respiratory failure from inflammation can be fatal as well. The flu virus affects the respiratory tree causing acute inflammation and distress of the tissues whose job is to bring oxygen to the blood.  Additionally, other organs including the heart may become inflamed, impeding their duties.

Flu can increase one’s risk of heart attack and stroke.  A study in 2007 found coming down with the flu doubled one’s risk of heart attack and stroke.

Moreover, having the flu could worsen any disease states already being battled. Hence a diabetic, if suffering from the flu, may struggle to control his blood sugar numbers.

Rarely, some may go into multi-organ failure as a result of septic shock initiated by the flu.  This is what killed 21-year-old body builder Kyler Baughman.

kyler-baughman-1.jpg

21-YEAR-OLD ATHLETIC TRAINER KYLER BAUGHMAN DIED DAYS AFTER FEELING FLU-LIKE SYMPTOMS

But one risk that doesn’t get discussed as much as it should is coming down with an illness during flu season and being mis-diagnosed, a “guilty by association” picture.   Four days before her death, 12-year-old Alyssa Alcaraz was sent home by an urgent care with a flu diagnosis when in fact she had a strep infection in her blood that put her into septic shock.

VTD023579-1_20171226.jpg

12-YEAR-OLD ALYSSA ALCARAZ WAS DIAGNOSED WITH THE FLU WHEN SHE IN FACT HAD A STREPTOCOCCAL INFECTION.

 

How will I know when the flu is turning deadly?

Since symptoms of the flu start to resolve in a couple of days, any symptoms beyond those few days should spark suspicions.   These can include:

  • A fever that does not subside
  • A fever that returns, recurring fever
  • New symptoms forming such as weakness
  • Confusion
  • Delirium
  • Dizziness
  • Unable to keep fluids down
  • Dehydration
  • Chest pain – could signify pneumonia or heart involvement
  • Bluish lips or skin
  • Difficulty breathing
  • Worsening cough

Understanding what the flu virus can affect and not underestimating its severity is paramount in preventing flu fatalities.  If symptoms start improving after 2 days it’s a great sign!!  However, any symptoms that either do not resolve, lag on for days, evolve into something worse, or recur are red flags that something more than the flu could be going on.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, Politics

President Trump’s Physical and Mental Health Exam Results

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
Multi-vitamin (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, recal, 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.

cholesterol-levels-chart

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.

Its been suggested that President Trump loses 10-15 lbs and increases his excercise 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 mediation, 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.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

Posted in Health

If Holding in a Sneeze is Dangerous, What About a Fart?

This week we learned of a 34-year-old British man perforate his throat while trying to hold in a sneeze.  He wanted to avoid spreading germs and apparently taught himself to hold in sneezes to not spread mucous droplets.

The pressure from a sneeze kept in can not only rupture throat musculature, as occurred in this case, but also perforate ear drums.  So if holding air in can damage tissues and organs, what about holding in a fart?

Let’s break this down.

Holding in a fart can be dangerous

In 2013 Dr. Pommergaard and Rosenberg et al published a report encouraging to “let it go” when it comes to flatus on an airplane.  At high altitudes, i.e. on an airplane, air expands. Hence gastrointestinal symptoms could be exacerbated by the intestinal distention.  These include:

  • Abdominal pain
  • Bloating
  • Increased heart rate
  • Increased blood pressure
  • Heartburn

to name a few…  The authors write:

Furthermore the ability to restrain a fart may be impaired by flatus incontinence or falling asleep on the airplane. Persons susceptible to such flatus incontinence may be especially vulnerable to the effect of air holes, turbulence, coughing and sneezing.

On a more serious note, the physiological responses to distended intestine are elevated blood pressure and pulse, and reduced oxygenation of the blood, which can be serious for people already at risk for cardiovascular complications. Furthermore, flatus retention has been suggested as a major factor in the origin of sigmoid diverticular disease.

However, what hasn’t been documented is bowel perforation from holding in gas.  Bowel perforations occur from ulcerations that eat through the lining of the intestine and trauma to the wall.  A direct link to holding gas in has not been documented I believe with any case of bowel perforation.

A sneeze has force and speed that increases the air pressure.  Holding in gas that is not being expelled has significantly less pressure and therefore would be unlikely to directly lacerate tissue.

What about sitting on your farts?

Some will try to lessen the sound of the fart by expelling the gas while seated firmly.  So in this instance, air pressure in increased because the fart is being expelled by sphincter muscles and air is trapped between the anus and the chair.  This may cause damage and some back pressure, but would occur at the level of the rectum and anus and most likely spare the large intestine from injury.

What’s in a fart?

Flatus, or flatulence, is commonly called a “fart”.  Flatus is made up of multiple gases obtained from swallowing and produced by the microbes lining the intestine. These include hydrogen, nitrogen, oxygen, carbon dioxide and methane.

Flatus odor, however, is caused from minor sulfur gas components including hydrogen sulfide, dimethyl sulfide and others.

flatus.jpg

IMAGE FROM PHYSICS STACK EXCHANGE

Can farts make you sick?

Studies have found that bacteria passed from flatus will grow on a petrie dish but that clothes provide a filter.  Reports of pink eye being obtained from a pillow case soiled in flatus are anecdotal.

However, nausea and headaches can happen.  The hydrogen sulfide, depending on the dose, can cause headaches, nausea, skin and eye irritation.  In toxic doses, hydrogen sulfide (which has the characteristic rotten egg odor) can cause convulsions, delirium and death.  But hydrogen sulfide comprises such a minute amount in flatus that no one would become that ill by smelling it.

Can farts be beneficial?

For the farter, yes.  It assists in movement of the stool and passing it can help prevent bloating and constipation.  However for the recipient of the smell, it may be beneficial too.

In 2014, a study from Exeter University, found the hydrogen sulfide in gas to HELP cells recover from mitochondrial damage, allowing their energy powerhouses to continue working. Researchers believe this could help repair the damage in heart disease, stroke, dementia and many other diseases.

In summary, holding in farts, or burps for that matter, may cause uncomfortable gastrointestinal symptoms but in theory should not cause serious injury to the intestines by means of perforation.  Keep in mind, however, that you only have so much control.  The air will need to escape somehow, so the next sneeze, cough or laugh during a board meeting or date may be your gas’s only time to escape.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, nuclear

What to Do In Case of a Nuclear Attack

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

false-alert-message.jpg

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 its 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:

NTVhNGZjZTExMiMvVGdsSTY0MFlLZ0dxczdRTHI4bE9oYXlyaTFnPS83OHgwOjg4N3g3NjYvZml0LWluLzc2MHgwL2ZpbHRlcnM6Zm9ybWF0KGpwZWcpOnF1YWxpdHkoODApOm5vX3Vwc2NhbGUoKTpmb3JtYXQoanBlZykvaHR0cDovL3MzLmFtYXpvbmF3cy5jb20vcG9saWN5bWljLW.jpg

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.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in flu, Health, news

Winter Cold or Flu? How to Quell Your Cough

The FDA is requiring safety labeling changes on cough syrups used for children to limit opioid use in those under 18.  If you or your child can’t get rid of a cough, here’s the breakdown…..

Why do we cough?

Coughs are actually a brilliant defense mechanism designed to spew out unwanted irritants that make it to our respiratory tree. Its lining has sensory neurons, that when triggered, tell the brain to induce a mechanism that will help clear the airway.  This can, simplistically stated, include a cough but also immune cells mobilized to fight possible infection or heal inflammation.  If the act of mechanically coughing irritates the respiratory tree, you may cough more. Likewise, if inflammatory cells produce excess mucous, this could cause a cycle of continued coughing.

What causes a cough?

We’re well aware that infections caused by virusesbacteria and fungi can cause coughs. But the following need to also be considered.

GERD – Gastroesophageal reflux disease – the acid that is refluxing out of the stomach and into the esophagus can, while lying down sleeping, makes its way up into the respiratory tree, irritating the lungs

Medications – such as ACE inhibitors used for high blood pressure – cause accumulation of bradykinin which can induce coughing

Pollution – including dust, pollen, and smoke

Chemicals – such as household products who’s aerosol irritate the lung lining

Mold spores

Cold weather

Exercise

Allergies 

Post nasal drip

Lung conditions – such as asthma, sarcoidosis, emphysema

Heart conditions – such a heart failure

Tumors

Psychological coughing – such as a tic

and more……

What can cure a cough?

We don’t actually “cure” the cough, because remember, it’s a well received defense mechanism.  But to control the cough requires us knowing why you’re coughing in the first place.

If one has pneumoniaantibiotics will be needed to kill the bacteria causing the lung infection.

If one has GERDmedications that decrease acid production and secretion may be required.

If its due to allergiesavoidance of the allergen and medications such as antihistamines, or corticosteroids might be utilized.

If it’s a tumor, then surgery, radiation and/or chemotherapy may be necessary.

But for the common viral nagging cough that many of us are dealing with this season, here is what we recommend:

Steam

Whether its holding your head over a pot on the stove, humidifier, vaporizer or steam shower, the cough reflex subsides and the moisture helps decrease inflammation.

Stay hydrated

Mucous thickens when water content is low, so loosening it up with hydration will make it less irritating.  A dry throat doesn’t do us any good either so keep your fluids up.

Honey

Studies have found this to be an effective cough suppressant. Add it to some warm water, lemon juice or tea and your throat will be soothed as well. Avoid in children under one year of age.

Cough drops

Menthol cough drops work by causing a local anesthetic effect on the back of the throat, temporarily decreasing irritation

Cough suppressants and expectorants

Decrease the cough reflex and thin the mucous respectively.  One, however, should not self treat using these chronically without having their cough evaluated first.

Natural remedies

Natural remedies (without much scientific evidence) such as Peppermint, Thyme, Eucalyptus, Licorice, Ginger may also provide some relief.

Chocolate

Yes chocolate.  This yummy treat has theobromine, which can suppress cough, and a study in late 2015 found it to work better than codeine.

 

What about alcohol and narcotics for cough?

These are not medically recommended, however, many people choose to self-medicate with alcohol and pain pills to control their cough.  Here’s why. Older cough syrups used to contain alcohol, as alcohol may dry up mucous, and induce sleep which may lessen the cough.  Narcotics decrease respiratory drive and provide analgesia which also decreases the cough reflex.  But alcohol is a no no as it can increase acid reflux, worsening cough, and narcotics are a bad idea as they decrease respiratory drive.  However, many prescription cough medications do include codeine and are used when the cough is severe.  However, the FDA does not recommend use of opioid containing cough medicine in those under the age of 18.

 

                                                                                                         LearnHealthSpanish.com

                                                                                                         Medical Spanish made easy

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician