Posted in Health, news

Worsening diabetes could be a sign of cancer

Pancreatic cancer and diabetes have been linked once again.  Image from MedScape

 

In practice, usually its been the opposite.  When a person with diabetes becomes “non-diabetic”, our first thought is a hypermetabolic process could be consuming the sugar, making him appear to be non-diabetic.  However, in this study, they found a worsening of the diabetes to suggest a cancerous process was occurring.

As we discussed in previous articles regarding diabetes, https://doctordaliah.wordpress.com/2017/01/26/diabetes-now-the-third-biggest-killer-in-the-united-states/  the pancreas is the organ responsible for producing insulin, a hormone that helps blood sugar transfer to cells to keep them functional.  If the pancreas undergoes any sort of injury, whether it be from an infection, trauma, or even cancer, it won’t function properly.  Less insulin made, means more circulating blood sugar, or a diabetic picture.

In this study a team of researchers evaluated close to a million patients from Italy and Belgium and found 50% of those diagnosed with pancreatic cancer were diagnosed with diabetes previously that year.  Use of stronger diabetic medications such as insulin injections and the incretin mimetics appeared to be associated with a higher incidence of pancreatic cancer.

They do not suggest the medications caused the cancer but rather the deteriorating status of the diabetes (requiring the stronger medications) was the cancer invading the pancreas.

 

One of the study authors,  Ms Koechlin Autier said, “Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex. Incretin therapies reduce diabetic hyperglycemia through stimulating the release of insulin by the pancreas. These drugs are typically prescribed when the oral anti-diabetic drugs can no longer control blood glucose levels. Because of their stimulating effects on the pancreas, it has long been thought that the incretin therapies could promote the occurrence of pancreatic cancer. However, it is known that pancreatic cancer can cause diabetes. Our study shows that incretin therapies are often prescribed to patients whose diabetes is caused by a still undiagnosed pancreatic cancer. Because the pancreatic cancer finally becomes symptomatic and is thus diagnosed, it looks like it is the intake of incretin drugs that could be the trigger of the pancreatic cancer, while in reality, it is the pancreatic cancer that causes a deterioration of diabetes, which is followed by the prescription of incretins. This phenomenon is called ‘reverse causation’. Our study also shows that the reverse causation observed for incretin drugs is also observed for other anti-diabetic therapies, in particular for insulin therapy.”

This “reverse causation” phenomenon can lead providers and patients to feel a medication or treatment is causing a disease when actually the disease is requiring the need for the medication/treatment.

Pancreatic cancer is very lethal and unfortunately it remains asymptomatic until it has progressed to an advanced stage.  So a worsening of diabetes (in the absence of poor diet and lack of compliance with medication) may be the only sign that pancreatic cancer is occurring. The earlier the cancer is caught, the better the prognosis.

 

                                                                                                         LearnHealthSpanish.com

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

 

Posted in Health, news, Politics

Stress Cards and “Time Outs” in the Military

 

Daliah Wachs, MD, FAAFP

 

Its no secret that our enlisted men and women endure stress beyond comprehension…. basic training, time away from home, tours, injuries and witnessing the pain and death suffered by their close comrades.  Then the mental trauma continues for those coming home and either receiving backlash for their duty, facing high unemployment, or suffering alone with their post traumatic stress disorder.

But much discussion has surfaced recently on “stress cards” that the recruits can hold up during times of stress, give to their superior, and in return be given a “time out”.

In 1997 TIME magazine did a piece describing the “Blue Cards” which  Navy recruits receive that give them options if they feel like they’re at their end and want to quit.  At times of stress, the newly enlisted men or women are to hand these over to their trainer or superior when they feel “discouraged”.  Snopes.com provides this image:

 

navy-blues-card

 

US Army Veteran Matthew Wadler wrote a piece in OpsLens discussing the stress cards and time outs offered to privates.  After he witnessed a cadet receive a time out after having a meltdown when he could not provide his bath towel to be aligned with the rest, Wadler said, “To my great distress, he was back in training within hours. He had been issued, by our cadre, a half sheet of paper which stated that if he felt too anxious he could walk away and have a “safe place” to reframe his thoughts and collect himself. At the end of the month he graduated from the course with the rest of us. Worse than that however, was when I saw him several years later as a military intelligence officer while at the National Training Center in California, he had been promoted to captain and had troops under his direction.”

Basic training, depending on the branch of the military, can run from 8-12 weeks.  The military has for years tried to shaken the myth that boot camp was a scene out of Full Metal Jacket. Decades before the recent changes took place, the various branches took the position of “toughening up” their recruits and “weeding out” those who could be a liability in time of war.  However, with the epidemic of anxiety, depression and mood disorders coming from our graduates, the military has had to take a softer approach and offer resources for their mental well being.

So are “stress cards” and “time outs” a good idea?  If not, why such a fuss?  Medical school training is no where near as vigorous as boot camp, however the stressful situations that arise during our training and career leave no time to take a breather.  Students who can’t handle the trauma center will most likely not stay in the trauma center for long.  So if a “natural-selection” type process persists in medical training, many fear these “stress-holidays” prevent selection out of our military.

In the old days, the military made sure you were fit BOTH physically and mentally for battle.  A gamut of resources should be offered to our heros for the sacrifices they are making.  However we need to ensure our new population of recruits won’t freeze up when their life is on the line.  Mental readiness and conditioning is an art.  Therefore, time will tell if the current way of doing things helps/hurts our cadets and national security.

More information can be found:

http://opslens.com/2016/11/10/politically-correct-military-stress-cards-correlation-safe-spaces/

 

                                                                                                         LearnHealthSpanish.com

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

 

Posted in Health, news

Killer Mold from Dirty Hospital Sheets Blamed for Five Deaths

above image from MSU today

 

Five deaths have been blamed on fungal infections caused by linens used at two University of Pittsburgh Medical Center (UPMC) hospitals.  The linens had been supplied by Paris Healthcare Linen’s facility in DuBois, Pennsylvania, and the family of two of the victims filed wrongful death suits against the hospital system.

In 2015, the CDC looked into the first four deaths and could not find the source of the mold.  They reported, “Remediation was performed and there’s no evidence of any ongoing outbreak.”  However the CDC did not investigate the linens or the laundry facility.  It was thought the mold entered the hospital rooms through the ventilation system.

Currently the CDC and Pennsylvania Department of Health have no plans to reopen the investigation.

However, UPMC commissioned environmental specialists to investigate the cause themselves and their findings suggest the mold probably originated from the linen plant’s roof near dryer vents. Unfiltered air was used to dry the linens and could have contaminated them prior to being delivered to the hospitals.

The two molds found on tested linens were mucor and rhizopus. These are common molds that rarely affect healthy individuals. The victims, however, were transplant patients who were in an immunosuppressed state to prevent rejection.  In the lawsuit, Daniel Krieg, 56 suffered from a rhizopus pneumonia, one month after his kindey transplant.  Che DuVall, 70, also suffered from the same mold-induced pneumonia, after undergoing a lung transplant. Both mold infections required the patients to undergo lobectomies (lung lobes removed), but neither patient survived.

 

rhizopus_sporangia_X_40_small[1].jpg                  Rhizopus: BioMedHome

 

 

Two other mold-related deaths were settled out of court by UPMC for $1.3 million each.  One additional case was a transplant patient as well, who was treated at their Montefiore campus.

Hospitals routinely contract out laundry services, but whether the CDC reopens this investigation or not, these deaths highlight the need for all external sources to be diligent in their cleaning practices in case they introduce a pathogen into a delicate hospital environment.

 

 

                                                                                                         LearnHealthSpanish.com

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

 

Posted in Health, news

Flu season: Things are about to get serious

Across the country, flu season is getting ready to peak.  New outlets are reporting this season could be more severe than previous.  Why is this flu season different from others?

We’re about to hit peak season

The October to May season usually sees a peak of flu cases after the Holidays and well into January.  However, warmer weather pushed winter back farther this year and we believe the flu season will peak well into February.  Though many parts of the country see flu subside by March, it has the potential to linger until May.

What strain of flu are we dealing with?

Health officials are reporting the viral strain causing many of the flu cases this year is H3N2.  This is a more virulent strain and can cause a more severe flu, especially in older individuals.

 

This year’s flu vaccine options

Fortunately, this year’s trivalent and quadrivalent flu vaccine included the H3N2 strain as shown below.

  • A/California/7/2009 (H1N1)pdm09-like virus,
  • A/Hong Kong/4801/2014 (H3N2)-like virus and a
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)

with the quadrivalent vaccine adding the B/Phuket/3073/2013-like virus (B/Yamagata lineage).

However, the nasal vaccine, live attenuated virus, was not available this year as the CDC cited earlier in 2016 that it would not provide adequate protection against the flu.  This could imply many children who preferred the nasal administration over injection refused to get vaccinated.

Older individuals were urged to receive a stronger version of the flu shot due to having less of an ability to mount a strong immune response.  The options this year for older individuals were the:

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

If they did not, they could be more vulnerable to this year’s flu.

Less people chose to be vaccinated against the flu

In November the CDC reported that only 2 out of 5 Americans received the flu shot in preparation of this year’s flu season.  The number was similar to last year and unfortunately implies the public’s lack of concern regarding this year’s flu severity.

Its not too late to get the flu shot

Flu vaccines are still available and the CDC encourages those 6 months and older who have not been vaccinated to do so.

For more information on the flu: https://doctordaliah.wordpress.com/2016/10/23/this-years-flu-season-and-flu-vaccine-your-questions-answered/

 

                                                                                                         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

Posted in Health, news

Mumps outbreak in Washington growing. What are the Mumps?

This story was last updated 3/11/17.

Washington health officials have reported 400 cases of presumed Mumps in 8 counties.

Per the CDC, as of February 25, 2017, 1077 Mumps cases have been reported, involving 37 states and the District of Columbia.

 mumps-outbreak-map.jpg CDC.gov

Last year, 5311 cases were reported in all 50 states, including the District of Columbia, with eight states reporting more than 100 cases this year.  These are Arkansas, Iowa, Indiana, Illinois, Massachusetts, New York, Oklahoma and Texas.

Mumps commonly affected individuals prior to the MMR vaccine implementation in the late 1960s. At the time close to 186,000 people were affected each year.  Since vaccination, these numbers have drastically decreased, but outbreaks have sprung up sporadically.

What is “The Mumps”?

Mumps are caused by the virus, paramyxovirus, causing swelling of the parotid (salivary glands).  Other symptoms include fever, malaise, headache, body aches as with many viral illnesses. The facial swelling can occur symmetrically but in 1/4 of the cases only one side may swell.

Its spread by droplet transmission, hence being exposed to someone’s sneeze, cough, saliva and symptoms may appear within a few days to a few weeks.  The illness lasts on average 10-14 days but could last longer.

Complications of the mumps could include meningitis and encephalitis (inflammation of the brain), orchitis (inflammation of the testicle), pancreatitis (inflammation of the pancreas) and others leading to infertility, deafness and in rare cases death.

Prevention

Vaccination and avoiding those who are ill is paramount. The CDC had stated many newer cases of Mumps are occurring in individuals who have been vaccinated.  Two doses are usually given of the vaccine when a child is between 12 and 15 months and then again between   4-6 years old.  Some experts have suggested a possible third booster as the MMR vaccine is 88% effective.  The MMR vaccinates against Measles, Mumps and Rubella.  A newer vaccine, the MMVR also protects against Varicella (chicken pox).

 

                                                                                                         LearnHealthSpanish.com

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

 

 

 

Posted in Health, news

Diabetes now the third biggest killer in the United States

Previously the 7th leading killer of Americans, diabetes affects so many people that its has now become third leading cause of death in the US.  The latest study found 12% of deaths in the US is caused by diabetes, trailing behind heart disease and cancer, ranked at #1 and #2.

What is diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the blood stream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  Its similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter.  Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

Type I vs. Type II Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance.  This is the fastest growing type of diabetes in both children and adults.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  Its also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 

dmp-blood-sugar-levels-chart

Source Diabetesmealplans.com

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

 

                                                                                                         LearnHealthSpanish.com

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

 

 

 

Posted in Health, news, Politics

Patient Freedom Act 2017: Step 1 to replacing Obamacare

Senators Bill Cassidy, R-Louisiana, and Susan Collins, R-Maine unveiled their proposal this week for the initial replacement of the Affordable Care Act.  The outline stirred up quite a bit of controversy as critics, such as Senator Chuck Schumer of New York thought it was an “empty facade” and proponents of an Obamacare repeal thought it was not enough.

Its roots date back to 2015 when then freshman Senator Cassidy drafted a bill that allowed states to opt out of the individual and employer mandates, incentivize coverage, and offer catastrophic medical coverage plans for the uninsured.

Now in 2017, Senator Bill Cassidy, a physician, and cosponsor, Senator Susan Collins, having a long career in politics, proposed a partial replacement of Obamacare, giving more power to the states.  The final language could look very different once Congress debates.  This is what they proposed.

States can choose from three options:

In the Cassidy-Collins proposal, states would have three options summarized here:

Keeping Obamacare

If states wish to continue to operate their health care system under the Affordable Care Act they can.   Federal subsidies, mandates, state run exchanges and medicaid expansion funding would not change.   Dr. and Senator Cassidy stated, “California and New York, you love Obamacare, you can keep it.”

HSA funding option

If a state wishes not to continue operating its healthcare system under the ACA, then the majority of the funding promised by the Obama administration to fund subsidies and Medicaid expansion can be used instead by the state to create tax-free Health Savings Accounts for residents with low income.  In this new “market-based” system, the HSA’s can be used to purchase the insurance and costs of medical care transferring more power to the consumer.

Creating their own system with no federal assistance 

States could opt to reject any federal funding for their health care programs and design their own system.

 

States would choose their option by 2018, work to implement it in 2019 and their system would be up and running by 2020.

Popular ACA provisions that would remain intact include:

Prohibiting insurers from denying coverage due to pre-existing conditions

Children able to stay on parent’s coverage up to age 26

Prohibiting lifetime limits

Additionally, premiums for elderly individuals cannot be more than 3 times that of younger people.

Again, this bill could have a long road ahead in the House and Senate, but highlights the difficulty of replacing the ACA, which created the “Obamacare” healthcare system.  Like cutting the wrong wire when defusing a bomb, the ACA will self destruct, causing millions of Americans to lose their federal subsidizes if any repeal is attempted.  Either path the GOP chooses may be unpopular as there is no national consensus on how to deal with rising health care costs, premiums, medications, and lack of employer enthusiasm in purchasing employee insurance.  Although initial actions by the Trump administration or states to end mandates and penalties could be enacted quickly and prove popular, actual replacement of our healthcare system may take years.

The fact sheet for the PFA 2017 can be viewed here:

http://www.cassidy.senate.gov/imo/media/doc/One%20Pager%20(1.20.17)%20(002).pdf

 

                                                                                                         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