Posted in Health, news, vaping

Viagra Should Not Be Vaped

The FDA is warning e-cigarette companies to stop selling vaping products with claims that they contain erectile dysfunction medications.

Consumers are being urged to avoid vaping products claiming to have ingredients such as sildenafil and tadalafil used in Viagra and Cialis respectively as they can interact with other medications (such as nitrates). Moreover there is no data suggesting one’s respiratory lining to be a safe route of absorption of a phosphodiesterase type-5 (PDE-5) inhibitor.

The primary purpose of the lungs is to oxygenate blood and its highly specialized lining is not necessarily designed to absorb nutrients, as does the small intestine.

On the FDA website it states:

The U.S. Food and Drug Administration announced today it has issued a warning letter to HelloCig Electronic Technology Co. Ltd for various violations of the Federal Food, Drug, and Cosmetic Act, including selling two e-liquids that contain the prescription drugs tadalafil and/or sildenafil, leading the FDA to determine that the products are unapproved new drugs.
Sildenafil and tadalafil are the active pharmaceutical ingredients in FDA-approved prescription drugs used to treat erectile dysfunction. These FDA-approved prescription drugs are not approved for inclusion in e-liquid products sold over the counter and are therefore being sold illegally. In addition, the company is marketing other e-liquids used in e-cigarettes in ways that convey and mislead consumers into believing that the FDA has approved these tobacco products, when it has not.
Laboratory analysis conducted by the FDA confirmed “E-Cialis HelloCig E-Liquid” contains the undeclared drugs sildenafil and tadalafil, and “E-Rimonabant HelloCig E-Liquid” contains the undeclared drug sildenafil. These undeclared ingredients are phosphodiesterase type-5 (PDE-5) inhibitors. These ingredients can be associated with significant safety issues and the risk of serious adverse events.

FDA Commissioner Dr. Scott Gottlieb states, “There are no e-liquids that contain prescription drugs that have been proven safe or effective through this route of administration.”

Those Needing Erectile Dysfunction Drugs Should Have Their Heart Checked

 

Companies are looking to expand their market by enticing consumers to vape vitamins, such as B12, and essential oils.  Last week, however, a professor of nutrition from New York University, Dr. Charles Mueller, warned against it.  He states, “Vitamins need to come with [fat and water] and go through the same gastrointestinal tract to be absorbed.”  Moreover respiratory administration of nutrition has not been actively studied.

 

Vaping linked to heart disease and cancer

A study published by the American Heart Association found nine different E-cig flavors  to impair blood vessel function, which can impair heart health.

Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors.  And at high concentrations of others, exibited cell death.  Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.

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The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:

  • Mint (menthol)
  • Vanilla (vanillin)
  • Clove (eugenol)
  • Cinnamon (cinnamaldehyde)
  • Strawberry (dimethylpyrazine)
  • Banana (isoamyl acetate)
  • Butter (diacetyl)
  • Eucalyptus/spicy cooling (eucalyptol)
  • Burnt flavor (acetylpyridine)

Strawberry flavoring appeared to have the most adverse effect on the cells.

Now many other flavors were not included in this study, so its unknown how safe they may be.

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

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

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

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

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

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

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

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

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Posted in Health, news

Dementia Slowed If We Treat Cataracts and Hearing Loss

A study from the UK reaffirms that helping seniors with their hearing and sight may slow down dementia.

Researchers from the University of Manchester found the correction of one’s cataracts to decrease their risk of dementia by 50%.  If they additionally corrected their hearing with hearing aids, their risk plummeted by 75%.

Study authors looked at participant’s memory and cognitive function and compared them prior to and then after getting cataract surgery or hearing aids.

Dr. Piers Dawes states, “It’s not really certain why hearing and visual problems have an impact on cognitive decline, but I’d guess that isolation, stigma and the resultant lack of physical activity that are linked to hearing and vision problems might have something to do with it.”

Cataracts are a clouding of a person’s lens in the eye, causing decreased vision and, if severe, blindness.

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Hearing loss caused by sensorineural loss can be improved when sounds are amplified by hearing aids.

 

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Previous studies have found hearing loss may precede dementia by 5-10 years.  Elderly individuals who lose their hearing with age (Presbycusis) may actually be demonstrating early dementia.

If repair of the sight by cataract surgery or hearing loss by hearing aids do not slow down or reverse early cognitive issues, dementia may be suspected.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Health, news

Winter Cold or Flu? How to Quell Your Cough

Alcohol and narcotics are not recommended to cure your cough and the FDA has urged children under 2 years of age to not be given any kind of cough and cold product that contains a decongestant or antihistamine.

So if you or your child cannot get rid of a cough, what can you do?  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.

 

Posted in Entertainment, Health, news

Verne Troyer, “Mini-Me”, Death Ruled a Suicide

Verne Troyer, known as “Mini-Me” in the Austin Power movies, died in April at the age of 49.   People reports the coroner from the Los Angeles County Medical Examiner-Coroner’s Office has ruled the death a suicide as a result of alcohol intoxication.

It’s been reported that he battled depression and alcoholism for years and was admitted weeks before his death to a Los Angeles Hospital when he attempted suicide by alcohol as well.

His Instagram page had the following message posted:

 

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The 2 foot 8 inch actor was a hit in multiple films and originally was working in the film industry as a stunt double.  Troyer had achondroplasia, in which cartilage cannot form into large bones resulting in dwarfism.  CNN reports his specific achondroplasia was cartilage-hair hypoplasia, which results in one having little to no hair.

A study in 2015 by Rodriguez-Gomez et al, when studying the medical and psychosocial conditions accompanying achondroplasia, found “31.8% of the sample reported at least one comorbid condition such as, hypertension, diabetes, rheumatoid arthritis, asthma, scoliosis, thyroid problems, neuropathy, psoriasis, gastritis and/or sleep apnea; 32% reported mild to severe depressive symptoms; 55% reported mild to severe symptoms associated to anxiety and 18% reported mild to severe symptoms associated with hopelessness.”

Last Spring Troyer had publicly announced he was returning to rehab to fight his battle with alcohol.

This is a developing story.

Posted in Politics, Health, news

Anthony Weiner to be Released From Prison This Spring

According to the Federal Bureau of Prisons, the former New York Congressman will be set for early release in May of 2019, up from August 2019 due to good behavior.

In 2017, Anthony Weiner was convicted of transferring obscene material to a minor when he sexted a 15-year-old girl.

He was sentenced to 21 months in federal prison, beginning his sentence in November 2017 and is currently at FMC Devens in Massachusetts.

He had unsuccessfully run for Mayor of NYC in 2013 when photos emerged of him in his underwear.

Weiner, 54, had admitted publicly he was “a very sick man for a very long time.”

This is a developing story.

 

Posted in Health, news

Case of PrEP Failure Reported in California Man

A man from San Francisco is apparently the 6th reported case of HIV (Human Immunodeficiency Virus) acquired while taking Truvada, the pre-exposure prophylactic agent.

He’s the third man in the United States who acquired the sexually transmitted virus while taking Truvada as directed.

 

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, meaning a treatment taken prior to becoming exposed.  Truvada is PrEP providing protection for those who may become exposed to HIV.

It is composed of two medications:  200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate.

It is taken once daily in pill form.

 

How does PrEP protect against getting HIV?

HIV infects T-cells, or T-Lymphocytes which help fight infection in the human body.

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Once it infects a healthy T-cell, the virus hijack’s the host’s “machinery” to produce more HIV infected cells using an enzyme called reverse transcriptase.

Truvada’s two medications interfere with this enzyme, preventing HIV from infecting more cells and using their DNA to expand.

 

How effective is PrEP?

Per the CDC, Truvada can provide at least 90% protection and more if combined with condoms and other prevention methods.

 

How does PrEP fail?

If one does not take their prescription regularly it may not provide its full protection.  Moreover PrEP can fail if a strain of HIV shows resistance to the medication.

Those who take PrEP cannot currently have HIV or severe renal disease.  Moreover we screen for liver disease and active hepatitis prior to starting the medication.

PrEP has been groudbreaking in HIV prevention and “failure” cases such as this are extremely rare.  However it does remind us that HIV can develop resistance, hence no medication is 100% effective all of the time.

For more on this story read here.

For more on PrEP read here.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

 

 

Posted in Health, news

Mysterious paralyzing illness on the rise: What is AFM?

A rare polio-like illness is startling health officials as multiple states have reported cases of AFM (Acute Flaccid Myelitis).

Since August 2014, the CDC has received reports on 362 cases, 62 of which were from this year alone.

This week we learn of more children in multiple states who have been diagnosed with AFM, which may manifest initially with cold type symptoms but then progress to sudden muscle weakness, stiffness, slurred speech and facial droop.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.  Although the exact cause is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 362 people affected in currently 16 states (down from 39 states in 2016). CNN reports, however, as of mid October “most” states are affected.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume its a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.