Posted in Entertainment, Health, news

Olivia Newton-John Says Her Breast Cancer Has Returned

The 68 year old singer and actress recently postponed her tour due to back pain.  Unfortunately, Oliva Newton-John discovered the cause: her breast cancer returned and metastasized to her sacrum, a part of the low back.

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In 1992, Newton-John first battled breast cancer by undergoing chemotherapy and by having a modified radical mastectomy (removing the breast and lymph nodes).  She immediately had breast reconstruction and included yoga, acupuncture and massage in her treatment regimen.

In an interview with the Susan G. Komen Foundation, she shared her personal story.  “I meditated every day, did yoga, used homeopathy, ate well—I boosted my inner strength as much as I could. When bad thoughts came in, I pushed them right out. I had what’s called a modified radical mastectomy with reconstruction done to my breast immediately—a woman can be traumatized waking up with nothing there.

She remained cancer free for years.

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Olivia Newton-John in 1978’s Grease

In a statement released on social media, Newton-John said the cancer returned, spread to her sacrum and she was going to undergo a short course of photon radiation therapy, which uses high energy particles to destroy cancer cells.  She stated she would also incorporate “natural wellness therapies”.

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Breast cancer is one of the few cancers that spreads to the bone. Other cancers that may rear its ugly head in the bone include thyroid, kidney, pancreas and the liver.

According to the American Cancer Society Stage 4 Breast Cancer (spreading to other parts of the body) has a 5 year survival rate of 22%, as opposed to Stage 3, who’s 5 year survival rate is 72%.  Treatments today are improving survival rates.

 

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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 Entertainment, Health, news

Tiger Woods DUI – a Possible Reaction to 4 Medications

Image above from (Left) Palm Beach County Sheriff’s Office, (right) AP

Eldrick Tont “Tiger” Woods was arrested Monday am for suspected DUI.  Alcohol was not involved, but the 41 year old pro golfer was allegedly “asleep” at the wheel when he was found by law enforcement near his home in Jupiter, Florida.

He was allegedly taking four medications:  Soloxer, Vicodin, Torix and Vioxx. These medications appear to be a muscle relaxant (may be a medication similar to Skelaxin), opiate, and two types of non steroidal antiinflammatories.

Monday evening he released the following statement, “I want the public to know that alcohol was not involved. What happened was an unexpected reaction to prescribed medications. I didn’t realize the mix of medications had affected me so strongly.

“I would like to apologize with all my heart to my family, friends and the fans. I expect more from myself too. I will do everything in my power to ensure this never happens again.

“I fully cooperated with law enforcement, and I would like to personally thank the representatives of the Jupiter Police Department and the Palm Beach County Sheriff’s office for their professionalism.”

He had recently recovered from spinal fusion surgery on April 20 after he underwent multiple microdiscetomies for various back injuries throughout his career.  Pain medications, such as opioids, can impair a driver, as well as a mixture of medications that may include muscle relaxants and anti-anxiety medications.  Any of the above could make one appear he is driving drunk.

In response to fans asking if he would play soon, on his website Woods wrote, “I can’t twist for another two and a half to three months. Right now, my sole focus is rehab and doing what the doctors tell me. I am concentrating on short-term goals.”

In addition to being plagued with injuries, including an right knee ACL tear in 2008, his personal life left him bruised as well.

Thanksgiving Day, 2009, Tiger Woods crashed his Escalade outside his Florida home when his then wife, model Elin Nordegren , hurled a golf club at the car after learning of her husband’s extra marital affairs.

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At the time Tiger Woods admitted to having a “sex addiction” and admitted himself into rehab.  In an interview in 2010, Woods said, “For 45 days from the end of December to early February, I was in inpatient therapy receiving guidance for the issues I’m facing. I have a long way to go. But I’ve taken my first steps in the right direction.”  He stated he had “repeated irresponsible behavior” and said, “I was unfaithful. I had affairs. I cheated.”

More details have yet to be revealed regarding Monday’s DUI arrest, but the New York Post  reported he was driving his 2015 Mercedes-Benz “erratically, all over the road” before stopped by law enforcement.

Unfortunately, “sex addiction” and alcohol use, or impulse behaviors go hand in hand.

What is Impulse Control Disorder?

Impulse Control Disorder occurs when one hurts themselves or others by not resisting their temptations.  These temptations could include sexual escapades, drinking binges, eating disorders, excessive gambling, stealing (kleptomania), setting fires (pyromania), and addictions to drugs.

A feeling of guilt comes after one acts on his/her impulse and will be seen especially after an intermittent explosive disorder which involves rage and anger.

Many who suffer from impulse control disorder suffer from mood disorders, substance abuse and/or addictions.

Treatment includes behavioral therapy, treating the underlying addiction, and at times, medications.

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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

Medical Students Find and Fix Flaw in Impaired Driver Testing for Marijuana

Multiple states in the US currently allow recreational marijuana or medicinal use of cannabis and multiple more states may be following suit in upcoming elections.

Even those who support the legalization have concerns over driver safety and how to determine if one is impaired.

Breathalyzers are currently being developed and tested but are not ready for roadway spot checks.  Moreover, breathalyzers may have difficulty accurately detecting both inhaled and ingested marijuana.

California law enforcement officers are piloting road-side saliva tests but objective data is still lacking regarding the accuracy of oral fluid tests.

Currently when law enforcement tests an impaired driver for marijuana use, a urine test can be performed which only looks for a metabolite called THC-COOH.    Despite its abbreviation it is a non-psychoactive component of marijuana, as opposed to delta-9-tetrahydrocannabinol (delta-9-THC), which does cause euphoria.  Hence the shortcoming to this testing method are two-fold, as the non active THC-COOH isn’t even the correct metabolite to measure intoxication and it can linger in the body for weeks, hence not allowing an adequate quantitative measure to determining one’s impairment.

Two medical students, however, figured out what needs to be tested and how.  Graham Lambert and Charles Cullison, both entering their third year at Touro University Nevada, performed research for an American College of Legal Medicine (ACLM) poster contest.

One of the lead researchers and osteopathic medical student Graham Lambert said, “This is an issue because it’s non-psychoactive. It stays in the body for long periods of time, long after any psychoactive effects.” Their research lead them to conclude that testing should instead look for an alternate THC metabolite, 11-OH-THC.

Why?  Let’s break this down.  Now both delta-9-THC and 11-OH-THC are psychoactive compounds that can be tested in the blood.  However law enforcement has to determine whether euphoria was present and a factor in one’s unlawful driving.  Both delta-9-THC and 11-OH-THC crosses the blood brain barrier, a semipermeable endothelial cell barrier that helps decide what substances can enter and leave the brain.  But 11-OH-THC’s is more readily active and can bind to the brain’s cannabinoid receptors tighter, lasting longer and causing more of a psychoactive effect.

Additionally, 11-OH-THC is a metabolite also seen in high quantities after ingesting marijuana edibles.

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Image from sapainsoup.com

 

In 2012, Sharma et al found the 11-OH-THC to last twice as long in the blood than delta-9-THC, which would make sense due its strong binding properties.  Yet the psychoactive 11-OH-THC will rapidly be metabolized to an inactive form hence its presence on a test will signify activity rather than just “hanging around”.

Once Lambert and Cullison determined this, they went to Assemblyman Steve Yeager, D-Las Vegas, who is Chair of the Assembly Judiciary Committee.  Yeager helped sponsor a bill, AB135 that would convert marijuana testing for drivers from the inaccurate urine test to a blood test that would look for specifically 11-OH-THC.

Also lead researcher and osteopathic medical student, Charles Cullison said, “Blood alone accurately shows the levels of hydroxy (11-OH-THC) and marijuana.”

In regards to getting the bipartisan law passed through the State Senate with a “Veto-less” majority,  Cullison stated, “We couldn’t have done this without the help of many people.”

After Nevada lawmakers passed AB 135, Governor Brian Sandoval signed it into law. The antiquated urine testing will not be used to test drivers pulled over for possible DUI but a blood test instead.

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Clockwise:  Assemblyman Steve Yeager, DO student Graham Lambert, DO Student Charles Cullison, Governor Brian Sandoval

 

The legal limit of marijuana that is measured in nanograms per milliliter ng/ml would be 2 ng/ml for delta-9-THC and 5 ng/ml for 11 Hydroxy-THC.  This does not change with passage of AB135, nor do the circumstances surrounding when to test, as current protocols are in place once a person fails his sobriety test.

 

 

 

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

 

 

 

Posted in Health, news

E-cigs Should Not be Used to Help Curb the Obesity Epidemic

While we’re winning the war on tobacco, we’re fueling the obesity epidemic.  Americans kept themselves slim for decades puffing on a cigarette, some mistaking the hunger pains as a need for more nicotine.  Some purposely curbing their appetite reaching for a smoke.

In the 1920’s Lucky Strike targeting female consumers by promoting the appetite suppressant effects of their cigarettes.

 

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Over the years, adults have wised up to the risks of heart disease, lung cancer, COPD, and chronic respiratory infections, and tobacco users have fallen to record numbers, 16.8% to be exact.  Last year, however, the CDC reported 36.5 % of Americans are obese, more than doubling since the 1980’s.

 

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Now smoking cessation doesn’t get all the blame for our obesity crisis.  Junk food being cheaper than healthy food, fast food franchises opening up on every street corner, and the average consumer being inundated with plastic products, manipulating one’s metabolism have led to higher weights.  But when someone who used cigarettes to curb their appetite can’t reach for one anymore, weight happens.

So many Americans trying to quit smoking have turned to electronic cigarettes, or e-cigs.  They “vape” a vapor composed of nicotine, propylene glycol, glycerin, water and flavorings.

In 2011, Yale researchers looked into how nicotine can decrease the appetite by studying receptors in the hypothalamus, the part of the brain involved in appetite.  Activation of pro-opiomelanocortin (POMC) cells within the arcuate nucleus region decreased appetite and food intake and additionally increased energy expenditure, according to Mineur et al.

Nicotine patches and gum have been used anecdotally as well for weight loss.  Further research has found nicotine to decrease blood glucose levels, increase insulin resistance and break up stored fat.

Yet nicotine is not without its risks as its one of the most addictive agents out there, equal to that of heroin according to some experts.  Moreover, nicotine has been found to affect the kidneys, heart, and induce cancer in studies involving  the lungs, GI, breast, and pancreas.

The safety of vaping liquid in e-cigs has been debated as well as the chemicals involved may seem benign at room temperature but what happens when the internal e-cig coil turns the liquid into vapor?

So how can we combat the obesity epidemic if we want consumers to avoid tobacco and stay clear of nicotine and vaping liquid?

Going back to 2011, the Yale researchers also looked at cytisine, a plant compound similar to nicotine, and it worked on the POMC cells as well.   According to WebMD, cytisine is found in the seeds of the golden rain tree, and has been used in Eastern Europe for decades to help smokers quit.  In late 2014, a study published in the New England Journal of Medicine found cytisine to trick the brain into thinking it was getting nicotine and was more effective than nicotine replacement therapy in helping smokers stay off cigarettes in the first week, and after two and six months.

Cytisine, a partial agonist of nicotinic acetylcholine receptors, can produce side effects as well such as nausea, vomiting, fast heart rate, but appears to be less toxic than nicotine.

So we have a compound that acts like nicotine and can help stave off the obesity ensuing after smoking cessation.  In the meantime, I would use caution turning to e-cigs.

For more on the harmful effects of nicotine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

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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 Entertainment, Health, news

Earlobe Crease Now Linked to Stroke Risk

Previously suggested to be linked to heart disease, a crease in the earlobe, or “Frank’s sign” has now also been linked to stroke.

Israeli researchers reviewed the records of 241 people who had suffered a stroke and 78.8% of them had Frank’s Sign.

Nazzal et al wrote, “Frank sign could predict ischemic cerebrovascular events. Patients with classical cardiovascular risk factors had Frank sign in a higher frequency.”

In 1973, Dr. Sanders T. Frank first described it in patients with coronary artery disease.

Subsequent studies found a relationship as well to diagonal earlobe crease (DELC) and heart disease.  One study even utilized CT angiography to document the relationship, (Shmilovich, et al. .Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography. Am J Cardiol).

If Frank’s sign predicts heart disease, it would make sense that it could also predict stroke risk.  The diagonal crease in one’s earlobe may hint to underlying atherosclerosis. The vessel damage and cholesterol plaques can affect blood flow to the brain. Hence, both conditions share similar risks.

The more extensive the crease, the higher the “grade” of the crease where a small wrinkling (Grade 1) is less ominous than a deep crease along the whole earlobe (Grade 3). The image above appears to have both a Grade 1 and Grade 3.

 

Multiple theories suggest why the earlobe creases if one has heart disease or stroke risk.

  1.  Those with atherosclerois may have poor vascularization (blood flow), so distal body parts such as earlobes may crease when they don’t have the hydration and vascularization as other ears do.
  2. Collagen and elastic fibers may lose their elasticity from poor vascularization.
  3. Many times the body expresses  a sign dermatologically when pathological processes are beneath the skin.  Frank’s sign could be one of the many dermatological manifestations of internal disease like acanthosis nigracans.

Famous people known to have Frank’s sign include President George W. Bush, Mel Gibson, Steven Spielberg.

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Again, the diagonal earlobe crease does not necessarily mean one has heart disease or will suffer a stroke.  However it may not hurt to be evaluated for cardiac risk factors such as high cholesterol, hypertension, diabetes etc. as many studies hint to its cardiovascular relationship.

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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

Memorial Day Weekend Safety Tips

Memorial Day is this weekend and the country honors those who have sacrificed for our freedom.  Many of us will travel and enjoy the outdoors.  However, according to a study by the National Coalition for Safer Roads, Memorial Day Weekend is the most dangerous holiday for road and highway accidents.  Additionally, water injuries, including drownings may rise this weekend.  Grill injuries can occur, and throughout the US we are seeing record high temperatures.  We need to stay safe out in the sun, by the grill, in the water and on the roads.

Sun Safety

Record heat and extended time outdoors can increase the risk of heat illness.  Hydrate, stay in the shade and protect your skin from damaging UV rays.

Sunscreen with an SPF of 30 or greater should be applied 30 minutes prior to going outside and reapplied every two hours or more often if swimming.

Avoid excessive alcohol as it could accelerate dehydration and put one at greater risk of injuries and heat exhaustion.

For more on heat exhaustion and heat stroke read here:  https://doctordaliah.wordpress.com/?s=heat+stroke

Grill Safety

In 2012, a man caught on fire after spraying sunscreen prior to heading over to the grill. He sustained multiple second degree burns.

Sunscreen may be flammable, so make sure it is dry prior to grilling or use a lotion instead of spray on.

Keep the grill outdoors but away from low roofing, branches, and trees. Watch the little kids and keep them and the pets away from the barbecue.

Assign someone to watch the grill if you need to step a way during grilling.

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Do not add lighter fluid to already ignited coals.

If someone does catch on fire, remember to have them stop, drop and roll on the ground until the flames expire.  Call 9-1-1 and remove any jewelry or tight clothes around the area..

If a minor burn injury does occur, run it under cool (not cold) water for 10-20 minutes. Avoid applying ice to the burn as it can damage the skin.  Also remove nearby jewelry.

Bandage and see a medical provider if concerned with your injury.

Water Safety

Avoid drinking alcohol when swimming or engaging in water sports.

Make sure you are in arm’s reach of your kids in the water.

Use life vests while boating and make sure the kids are wearing appropriate sized vests.

Never swim alone. Always have a buddy.

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Road Safety

Know your route to avoid you checking your GPS app while you drive

Allow extra travel time and don’t rush.  Expect travel delays coming home as well.

Drive the speed limit and avoid tailgating, leaving at least 2 seconds between you and the car ahead of you.

Make sure you have plenty of water, supplies and a first aid kit in the car in case you get stuck on the highway.

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Have a happy and safe Memorial Day Weekend!

 

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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

Marijuana Use Linked to Gum Disease

Image above from Periopeak

While one study this week found a marijuana compound to help combat deadly seizures, another study found it to increase gum disease.

Periodontal, or gum disease, is caused by inflammation of the gum. Contributing factors include bacteria, poor dental hygiene, smoking, diabetes, hormonal changes, medications that decrease saliva, and even genetics.  Gingivitis, an earlier and milder stage, occurs when bacteria and plaque buildup around the teeth causing the gums to become swollen and red.  If this doesn’t resolve, periodontitis can occur leading to recession of the gum, loss of teeth, and damage to the ligaments and bone. Gum disease has additionally been linked to diabetes and heart disease.

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Published in the Journal of Periodontology, the study found recreational smokers of cannabis were twice as likely to have gum disease as opposed to less frequent users.

Dr. Jaffer Sharrif, a postdoctoral resident in periodontology at Columbia University School of Dental Medicine (CDM), and his colleagues examined the data from 1,938 U.S. adults who participated in the CDC’s 2011-2012 National Health and Nutrition Examination Survey.  27% admitted to smoking marijuana in the last year and their gums were evaluated for deep pockets.  Health gums snuggly surround a tooth, hence gums with deep pockets (measured deeper than 3mm) could suggest inflammation or diseased gum.

The frequent marijuana users had more gum sites with deeper pockets.

So the deeper pockets not only signal that gum disease is happening but could also worsen the disease by allowing more food and bacteria to be come trapped around the tooth.

One explanation for this could be saliva secretion decreases when cannabinoid receptors are activated.  This was reported in 2006 when researchers wanted to investigate why saliva decreases with marijuana use.  Less saliva, means less “cleaning” of the gums and teeth.  Moreover, the saliva with its basic pH neutralizes some of the acid produced by bacteria colonizing the gums.

The gum disease-marijuana link could also be due to the poor diet high in sugar that is sometimes associated with the “marijuana munchies”.

Dr. Shariff stated, “While more research is needed to determine if medical marijuana has a similar impact on oral health, our study findings suggest that dental care providers should ask their patients about cannabis habits.”

Signs of periodontitis include:

Bleeding gums

Swollen gums

Tender gums

Gum recession making the teeth look longer

Bad breath

Pus and inflammation

Painful chewing

 

                                                                                                       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