Posted in Health, news, Politics

Using the NFL Injury Report to predict this week’s winners

Here we go! Picks in bold.

Bengals

Browns (will be CLOSE but too many groin injuries for the Steelers)

Cowboys (they’re my team so to heck with the groin injury)

Lions

Titans

Buccaneers (close but Chiefs have a groin injury)

Cardinals

Giants

Dolphins

Patriots

Seahawks

Redskins

We pray that no one gets hurt and those who do recover quickly.  Here’s to a safe season of one of the best sports ever!!  FOOTBALL!!

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

Posted in Health, news

HDL (good cholesterol) may not be so “good” afterall

 

HDL (high-density lipoprotein) has long held the reputation of being “good cholesterol”.  HDL’s role is to pick up LDL (low-density lipoprotein, known as “bad cholesterol”) from cells, blood stream and blood vessels and bring it to the liver.  The liver then breaks down the LDL into bile acids and salts so it could become excreted in the gut.

 

Now LDL is necessary because the body needs cholesterol, just not high amounts. The purpose of LDL is to transport cholesterol made in the liver to the cells.  High LDL levels, however, are associated with atherosclerosis (plaque deposits along the blood vessels) which in turn increases risk of heart disease, stroke and dementia.  High HDL levels appear protective, as the more HDL present, the less LDL remains in its dangerous form.

 

And HDL has an additional benefit…..it lowers inflammation. In a complex system, researchers believe the HDL down-regulates a factor that causes inflammation, hence HDL becomes an anti-inflammatory agent…. a hero in a delicate cardiovascular system.

 

However, this week, a study published in Cell Metabolism finds the HDL may worsen inflammation. Researchers found high levels of inflammation through macrophages (immune cells that help fight infection) in mice with high levels of HDL.  Although the exact mechanism is unclear, the analogy we may be looking at is:  the broom is sweeping away the dirt may be leaving a dust cloud.

 

Now personally, I have never in my 16 years of practice seen a patient with high HDL (greater than 60 mg/dl) suffer heart disease, so I still think its a “hero”. But more needs to be investigated to clarify if it poses risks.

 

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

 

Posted in Health, news

Today’s Health Headlines

 

Yo-Yo dieting increases risk of heart attack
 
We’ve come to learn that the body does not like rapid change, but smooth transitions, and this study found healthy women were 3.5 X more likely to die of a heart attack going up and down in weight. This has nothing to do with eating Yo-Yo’s.

http://www.nydailynews.com/life-style/health/yo-yo-dieting-hurt-heart-study-article-1.2875815

New star-shaped capsule/pill may allow medicine to be dispensed over weeks

This is interesting.  It has 6 arms containing the medication, a polymer matrix ensuring the med is released slowly and evenly and there are prongs holding the capsule in place so it doesn’t pass through the gut.  Hmmm, it sounded cool at first but now I’m scared

Stroke risk increased with high dose Proton Pump Inhibitors

Ischemic stroke risk was found to rise, especially for Protonix, if higher doses were used.  One theory are their affect on gut bacteria.

https://doctordaliah.wordpress.com/2016/11/16/stroke-risk-increased-with-common-heartburn-drugs/
Some Ebola infections may cause no symptoms at all

Last year they found some West African villagers “immune” to Ebola.  This report suggests that Ebola may be asymptomatic in some.

 
Zika could survive for “several hours” on counter tops and hard surfaces

Unlike HIV which can only last a few minutes away from blood, Zika appears to live close to 8 hours on hard, nonporous  surfaces.

https://www.drugs.com/news/zika-can-survive-hard-surfaces-hours-63433.html

Statins cut death risk in patients with serious arthritis conditions
They believe its not only the cholesterol lowering properties but also statin’s anti-inflammatory properties.  The conditions include AS (ankylosing spondylitis) and psoriatic arthritis.

http://www.medicalnewstoday.com/articles/314070.php

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

Posted in Health, news

Stroke risk increased with common heartburn drugs

Millions of Americans suffer from heartburn or GERD (gastroesophageal reflux disease) and self treat with medications now easy to access over the counter.  One group of heartburn medications, the PPIs (Proton Pump Inhibitors) has been found to increase risk of ischemic stroke. These medications include Prevacid, Protonix, Prilosec, and Nexium.

 

nexium-prevacid-prilosec2

 

As opposed to being forms of calcium carbonate, such as Tums, or H2 (Histamine H2 Antagonist) blockers such as Pepcid and Zantac, the PPI’s reduce stomach acid production.  They’re popularity has been skyrocketing over the last two decades and have become a mainstay treatment for multiple gastrointestinal issues including ulcers.

In this Danish study, researchers reviewed the records of 245,000 patients who were suffering from abdominal pain and reflux, and found 9,500 to later suffer from stroke. After adjusting out for other causes of heart disease and stroke they concluded that the Proton Pump Inhibitors increased these patients’ risk of ischemic stroke by 21%.   It varied depending on the brand with Prevacid and Prilosec increasing stroke risk by 33%, Nexium by 50% and Protonix, 79%. They note that these were high doses of PPIs as low doses appeared NOT to increase risk of stroke.

This isn’t the first time, however, that PPIs have been implicated in serious disease.  A few years back, the use of PPIs was found to increase risk of renal failure.  Other risks associated with Proton Pump Inhibitors include increase risk of :

heart attacks

fractures

C. difficile (severe intestinal infections)

pneumonia

low magnesium levels leading to muscle spasms and arrhythmias

dementia

poor absorption of other medications

…to name a few

Researchers do not know why this class of drugs increases stroke risk. They theorize it may have something to do with altering gut bacteria, or prevention of vital nutrients being broken down to become absorbed since stomach acid levels are decreased.

However, those suffering from GERD can be prone to esophageal cancer if the stomach acid bombarding the lower esophagus fails to be subdued.  For this reason, PPIs will still be recommended for severe reflux cases, but maybe lower doses and combinations with other drugs and lifestyle changes should be started first.

 

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

Posted in Health, news, Politics

The New Surgeon General: A choice not to be taken lightly

Daliah Wachs, MD, FAAFP

 

Chief of Staff, Attorney General, Secretary of State….positions of utmost gravity to this new administration.  But should the choice for the head of the Office of Surgeon General be treated lightly?  The Surgeon General advises the Secretary of Health and Human Services and is the main spokesperson for the US when it comes to public health.  Beyond key administration players in economics, national security, environment and healthcare lies a pivotal individual who has the power to affect all of the above.  And we anticipate the upcoming term of the Surgeon General to be a doozey……Here’s why….

hhs-surgeongeneraloffice-logo-bluewhite-250dps

  1.  The repeal of Obamacare – The ACA not only affected insurance premiums and Medicaid access but strikingly, the economy.  Penalties levied on employers for not insuring employees accelerated full-time unemployment and encouraged the formation of millions of part-time positions, not required to be insured.  The economy continued its stagnation and high deductibles thwarted many people from using their health insurance, hence less healthcare dollars being spent.  A Surgeon General’s role in the new healthcare system could obviously affect the economy’s growth and strength.
  2. Zika and other insect-vectored diseases – man cannot control nature and every attempt to risks making the situation worse.  Options to aerial spray with pesticides or release GMO mosquitoes are very controversial. West Nile, Zika, Dengue are just a few of the mosquito born illnesses surging in the US and we haven’t even begun to reach the level of preparedness needed.
  3. Opioid overdose epidemic – prescriptions written and abused are at an all time high, with overdose deaths occurring in record numbers.  However chronic pain is also an epidemic and measures addressing the former are outpacing the latter. Which brings us to…..
  4. Marijuana is becoming legal in many more states – not only will we anticipate recreational use to increase, but individuals suffering from chronic pain will seek cannabis for relief as pain medications become harder to come by.  Logistics of managing drivers under the influence, employee accidents, and teen use have not been ironed out.  Although opportunities to study marijuana and incorporate it into medical management can now be pursued, we’re still lacking research on its safety in inhaled, edible, and second-hand smoke form.
  5. Superbugs are getting stronger – many pharmaceutical companies hampered by ACA restrictions hesitated on the R & D of new drugs and these superbugs, resistant to multiple antibiotics, are gaining speed and strength.  We need treatments (not just antibiotics) to be immediately developed to ward these off.

superbug

And the list goes on so we can agree our new Surgeon General will be busy.  So who should take the job?

Dr. Ben Carson was thought of as a perfect choice….a physician, gets along with Donald Trump, well-spoken…..and additionally it was rumored he was offered Health and Human Services Secretary.  However this week we heard he declined being apart of the Trump administration due to lack of government experience and never having run a government agency.  But are these qualifications necessary to become Surgeon General?

Although its customary for the Surgeon General to be a physician, I believe anyone who has taken care of patients at length, understands the current public health issues, works to get ahead of the curve before something becomes an issue and demonstrates service to their community and country would be a fine choice.  I’ve witnessed so many individuals (nurses, pharmacists, therapists, etc) put their patients and fellow citizens first that when President-Elect Donald Trump does take on the difficult job of vetting the right individual, he has more to choose from than he knows.   A Surgeon General does not need to be a surgeon, nor a general.  But ultimately he/she is the country’s “doctor”.  I wouldn’t take this choice lightly, and I wouldn’t keep the Surgeon General hidden as we’ve seen in previous administrations.  Let them take the lead on what they do best…..care.

 

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

Posted in Health, news

Today’s Health Headlines

Loss of smell may be first sign of Alzheimer’s
This is another study citing how loss of smell could be the first sign of dementia and/or Alzheimer’s, one day being a successful and inexpensive screening test.
 
Zika virus may not be working alone
When mosquitoes carry disease they aren’t picky as to which.  Scientists wonder if dengue and chikungunya could be coinfecting with some bites making neurological symptoms worse.

 

Our cell phones can contain sediments of everything we’re exposed to

Much of what we’re exposed to in every day life apparently can be found in traces on our cell phones.  UCSD scientists were able to make a “lifestyle profile” of the phone owner and this data can later be used for a variety of health applications.

Adolescent depression on the rise, especially in girls


 A significant climb has been observed over the last few years and many aren’t receiving treatment.

http://www.cnn.com/2016/11/14/health/depression-teen-girls/

 

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

 

Posted in Health, news

USPSTF: Most people over 40 need to be on a statin

The US Preventative Services Task Force (USPSTF) has released its final guidelines regarding use of statins in the general population and published these in the Journal of the American Medical Association. They recommend anyone between the age of 40-75 who have at least one risk factor for heart disease, (putting them at a 10 percent or greater risk of having a heart attack or stroke in the next 10 years) be prescribed a statin.

What are statins?

Statins are a class of cholesterol lowering agents that work by inhibiting the enzyme, HMG-CoA reductase, that slows down the production of cholesterol.  Statins come in many brands such as Lipitor, Crestor, Pravachol, Zocor, etc and have “statin” in their generic name (atorvastatin, simvastatin, etc.).  They are one of the most popular medications to treat high cholesterol and are included in the drug cocktail given to anyone who suffers from arteriosclerosis.  They lower total and bad cholesterol significantly and can prevent heart attack.

 

heart-issues-due-to-using-synthetic-marijuana-spice-k2

What are risk factors for heart disease?

These include any of the following:

Male over 40

Female over 55 – post menopausal

Smoking

Diabetes

High cholesterol

High Blood Pressure

Family history of heart disease

Personal history of heart disease

Unhealthy diet

History of preeclampsia during pregnancy

and many others such as lack of exercise, obesity, stress, short stature, and poor hygiene

…..so as you see, so many of us can easily fall under this group of “at risk”

 

gillinov_heartdisease_risks

What are the risks of statins?

These medications work by decreasing cholesterol production in the liver and muscles, so side effects could include these areas.

Elevated liver enzymes – rarely leading to liver failure

Rhabdomyolisis – inflamed muscle – rarely leading to renal failure

muscle cramps

abdominal pain/bloating

memory issues

cataracts

interference with the metabolism of other medications

possible increased risk of diabetes (currently being studied)

 

Despite the risks (that occur very rarely), many medical professionals have been very pleased with statin’s success in improving cardiac status.  I believe this guideline recommendation from the USPSTF will most likely meet little resistance from the medical community.  It will however take more work on the side of the patient as they need to follow up with their medical provider more often so as to be monitored closely for its efficacy and side effects.

 

 

For more information on the USPSTF recommendations click here:  http://jamanetwork.com/journals/jama/fullarticle/2584058

 

 

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

 

Posted in Health, news

Marijuana found to weaken the heart

A study out of St. Luke’s University Hospital Network has found marijuana to cause stress cardiomyopathy.  This is a temporary condition that causes a “ballooning” of a region of the ventricle known as Transient Ventricular Regional Ballooning (TVRB).  We know that many drugs can cause cardiomyopathy (affect the heart muscle) such as cocaine and stimulants causing dilated cardiomyopathy, but this is new in that a sedating type of drug such as cannabis/marijuana, can cause similar effects on the heart.

The condition of TVRB can mimic many different heart conditions because it presents with chest pain, shortness of breath and dizziness.  So many individuals admitted for these symptoms are evaluated for a heart attack, angina, pneumonia, and a variety of other diagnoses.

In this study, the researchers looked at data from 33,000 hospital admissions who had TVRB and saw a link between 210 of these admissions and marijuana use.  They are unsure how marijuana affects the heart, but theorize that it could be an increase in cortisol and stress hormones.  Although none of the marijuana users in this study died, the TVRB can cause cardiac arrest, heart attack.

More questions need to be answered regarding how much marijuana affects the heart and what long-term marijuana use can do from a cardiac standpoint.   But since the drug has become legal in another 5 states, its use will increase and users need to be aware that it is not harmless, especially when it comes to the heart.

 

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

Posted in Health, news

Vietnam War Veterans at risk for deadly cancer

Vietnam soldiers who ingested a parasite (trematode) during their tour appear to be at more risk for a deadly bile duct cancer called cholangiocarcinoma. This is a cancer that starts within the biliary system (liver, bile ducts and gallbladder) and easily spreads if gone unchecked.

These parasites, known as “liver flukes”, are endemic to Vietnam, China, Thailand, South Korea and much of Southeast Asia. Its believed 30-35 million people are infected with these liver flukes. They live in fish and, if not cooked properly, find a home in ones gastrointestinal system upon ingestion.  Many liver fluke illnesses are asymptomatic and if early illness is detected, an antiparasite pill such as praziquantel, tribendimidine,  or albendazole, could treat it.  If not noticed, the fluke settles in and causes chronic inflammation that can cause the delicate biliary tissues to turn cancerous. The exact mechanism for the cancer is unknown.

The parasite not only is ingested by eating raw or undercooked fish, but unwashed vegetables could carry it as well.  Blood and stool tests may be able to pick up the parasite and an ultrasound or CT scan could detect inflammation within the bile ducts.

We currently do not know how many Vietnam veterans are affected, but any symptoms of chronic indigestion, jaundice, bloating, gas, constipation, abdominal pain, hives, nausea, vomiting, fatigue and/or weight loss should be evaluated by a gastroenterologist.

 

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

 

 

Posted in Health, news

Constipation and Kidney Failure linked

Daliah Wachs, MD, FAAFP

As if being constipated isn’t bad enough, a study out of Memphis VA Medical Center and the University of Tennessee found constipation to substantially increase one’s risk of chronic kidney disease and failure.

Researchers studied the medical records of 3.5 million United States military veterans who had normal kidney function and followed them for 7-9 years. The majority of the participants were male and over 60.  They found those with constipation had a 13 percent higher risk of kidney disease and a 9 percent increased risk of kidney failure. Diagnoses of constipation ranged from absent to mild to moderate/severe.  Its not clear what level of constipation and for what time duration was necessary to affect kidney function.

So how do we define constipation?

Constipation is a decrease in frequency of bowel movements or difficulty passing stool that persists longer than one’s normal bowel movement cycle.  In general, less than three bowel movements a week could be considered constipation.20-30% of the US population suffers from constipation and this percentage increases in those who are elderly or confined to medical facilities. Some people have hard stools that are difficult to pass with normal motility, whereas others have soft stool but poor motility.

What causes constipation?

A variety of factors could be the culprit. These include:

Lack of water

Lack of fiber in one’s diet

Certain foods in one’s diet such as cheese, diary, fat, gluten, those high in meat

Caffeine

Hypothyroid

Stress

Lack of exercise

Pregnancy

Hormone fluctuations

Irritable Bowel Syndrome

Inflammatory Bowel Disease

Cancer

Laxative abuse

Eating disorders

Medications such as narcotics, antidepressants, iron supplements

Constipation should never be ignored………

Why would constipation be linked to kidney disease?

In this study the authors theorized that changes in gut bacteria caused slowing of the bowel, leading to constipation, inflammation and factors that could affect the kidney.  An additional theory I have is those with a poor balanced diet, such as one high in fats, can  cause both constipation and kidney disease.

 

What should our stool look like?

When someone is constipated, the stool is not moving through the colon as quickly as it should.  The more hours and days it sits in the colon, the more water is absorbed. So the stool churns and churns becoming dryer, smaller and harder.  So pebbles or rock-like stool is a sign of constipation.  Conversely, as in diarrhea, stool has not been processed by the colon properly, water has not been absorbed and thus it appears very soft or liquid-like. This puts one at risk of dehydration. Therefore healthy stool is a happy medium.

Using the Bristol Stool Chart, the ideal stool would be in the shapes of Type 4 and 5.

 

bristol

What should I do if I’m constipated?

First drink more water. Secondly look at your diet and see if you have any offending agents such as dairy or fried foods.  Thirdly visit your medical provider for an evaluation.  Finally, try and relax.  Many of us have difficulty pooping because we are stressed or on a time crunch.  Your body doesn’t care if you have a meeting in 5 minutes.  The body likes to relax when it relieves itself so grab a magazine, or my bl0g, and take some time out of your day to poop.  Sometimes we need to stop and smell the roses……

 

 

 

spanish book

Learning Medical Spanish is Easy!!!

 

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