Posted in Health, news

EpiPens Secretly Contain More Than One Dose Used in Emergency Wilderness Settings

The EpiPen® auto-injector contains epinephrine, used during an emergency to treat severe allergic reactions, or anaphylaxis.

If one is allergic to an insect or food, a severe allergic reaction may ensue upon exposure, in which the immune system releases a flood of chemicals that can cause throat tightness, hives, lip and facial swelling, difficulty breathing, nausea, vomiting, low blood pressure, rapid heart rate, cardiac arrest and possibly death.

Epinephrine stimulates the heart to increase cardiac muscle contractility, cardiac output, subsequently raising the blood pressure. Additionally it relaxes the muscles surrounding the airways, allowing one to breathe easier and take in more oxygen. Moreover it helps to stop the release of additional immune chemicals.

The EpiPen® is manufactured by Mylan.  Its cost made headlines when the EpiPen two-pack recently stickered for close to $600. Now generic forms are available costing anywhere from $109-$300 for a dual pack.

The disposable auto-injector, for an adult, delivers 0.3 mg of epinephrine, while the EpiPen Jr., used in pediatric populations, delivers 0.15mg of the medication.  It can be self-administered, through clothing if necessary, into the thigh muscle in one smooth movement once the safety release is removed.

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After 0.3 ml is administered during the single adult dose, the EpiPen® unit is discarded.

However many are not aware that 1.7 ml of solution remains within the cartridge.  This could, in theory, be used for an additional 5 doses if in a remote, “wilderness” setting.

Dr. Arthur (Tony) Islas, Fellow of the Academy of Wilderness Medicine, and professor at the University of Nevada, Reno School of Medicine’s Department of Family Medicine, demonstrated how to extract the remaining doses from the autoinjector at the January Nevada Academy of Family Physicians meeting in Lake Tahoe.

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Although its recommended that all users follow the manufacturer’s labels, those trained in emergency and wilderness medicine may take the used cartridge, cut off the top plastic, and extract the syringe with the remaining fluid.

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Dr. Islas states the initial 0.3 mg dose of epinephrine lasts for 20 minutes.  For most people this allows plenty of time for emergency responders to come to the site of the victim.  However, in a “wilderness” or remote setting, another dose may need to be administered during a very severe case of anaphylaxis.

Please note manipulation, destruction, and off-label use of an EpiPen cartridge could be dangerous and should only be performed by a trained professional.

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

 

 

 

Posted in Health, news

Meningitis from Marijuana?

A 48 year old California woman reportedly acquired life-threatening meningitis from marijuana contaminated with fungus.

Dr. Bryan Shapiro explains in a case study published in the British Medical Journal that she contracted Cryptococcus neoformans from her 3-6 joint-a-day smoking habit.

Crytococcus infections can commonly affect those who are immunosuppressed, but this patient was believed to be relatively healthy.

Her symptoms included feeling fatigued and dizzy but began getting combative, reportedly assaulting a coworker.  She eventually was seen at Cedars of Sinai Medical Center in Los Angeles, where they tested the cerebral spinal fluid surrounding the brain, revealing the life threatening fungus.

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After she was successfully treated, Dr. Shapiro investigated the dispensary in Bakersfield from where she purchased her marijuana.  Nine samples tested positive for the fungus.

Its been established that marijuana leaves are contaminated with pesticides, chemicals and mold.

This is one of the first cases reported of one acquiring meningitis from marijuana use.

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 Entertainment, Health, news

Glee’s “Puck” Mark Salling Reportedly Commits Suicide, age 35

Glee actor, Mark Salling, was found dead in a riverbed near Big Tujunga Creek in Los Angeles.  The exact cause of death is still being investigated.

The 35-year-old had been battling depression and the family had reported him missing Tuesday evening and feared he would hurt himself.

Mark Salling was a registered sex offender and was facing 4-7 years of prison after pleading guilty to possession of child pornography.  His sentencing was slated for March 7th.

It’s been reported that he attempted suicide last summer by slitting his wrists.

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, news

Vaping Found to Raise Cancer and Heart Disease Risk

 

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.   That dose would be commonly consumed by many humans who vape.

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They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

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.

 

For more on the study read here.

 

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

Flu Increases Risk of Heart Attack

A study published in The New England Journal of Medicine reports the flu increases one’s risk for a heart attack by six within the first week.

Study author Dr. Jeff Kwong, a family physician and epidemiologist from the Institute for Clinical Evaluative Sciences and Public Health Ontario, and his colleagues looked at 20,000 adults who were diagnosed (and lab confirmed) with the flu in Ontario from 2009 – 2014.  Of these adults, 332 had a heart attack, either the year before, after or during the flu.   Heart attack risk was 6 times higher the week of the flu and was elevated in those older than 65.

Many of the individuals had cardiac risk factors (diabetes, high blood pressure, high cholesterol) illustrating if one is at risk for a heart attack, a cardiac event may be more likely to occur if they get the flu.

This isn’t the first time a link between heart attack and flu has been suggested.    In 2007, Meade et al found a bout with the flu to double the risk of a heart attack and stroke.

Their theory was the flu dislodged fatty deposits sitting along the arteries, allowing them to travel to the coronary arteries or those in the brain resulting in a heart attack and stroke respectively.

Another theory is the cardiac risk factors may worsen during the flu. Blood sugars are difficult to control, hence fats in the blood will follow, and blood pressure may be affected when one is battling an infection.

Inflammation has been linked to heart attack, thus inflammation resulting from the flu may also be a culprit.

The study authors wrote, “Cardiovascular events triggered by influenza are potentially preventable by vaccination.”  The flu shot this year has been projected to only be 30% effective against this season’s active strains but is still being recommended this season as hospitalizations and deaths from the flu are reaching record numbers.

 

What causes a heart attack?

A heart attack occurs when part of the heart muscle fails to receive the blood and oxygen it needs. This can occur by arteries supplying the heart muscle to become blocked.  Coronary artery disease can be caused by plaque build up from fats, sugars, calcium, fibrin that settle on the blood vessel wall. These plaques can build up and occlude the lumen, obstructing blood flow.

Additionally a heart attack can occur when an unstable plaque rips off, tearing the blood vessel lining causing the body to form an immediate clot. This clot can also be deadly as it obstructs the lumen as well.

Heart disease, however, can be prevented……..

Firstly, we must know our risk factors. These include:

Family history of heart disease

Personal history of heart disease

High Blood Pressure

High Cholesterol

Diabetes

Smoking

Obesity

Inactivity

Males over 40

Females who are post menopausal

High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.  Therefore secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

Thirdly, reduce your risk by the following:

Maintain a normal blood pressure

Maintain normal blood sugar

Maintain normal cholesterol and lipid levels

Reduce stress

Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables

Quit smoking

Stay active

Maintain a healthy weight.

 

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

Posted in flu, Health, news

Flu Deaths: Are We Missing a Severe Pneumonia Season?

This year’s flu season has claimed the lives of at least 30 children and many more adults.  It’s widespread in all states except Hawaii, and we are told its one of most severe flu seasons yet.

However, the number one cause of death when it comes to the flu is pneumonia.  And the respiratory depression that appears to come on with these otherwise healthy individuals, appears to affect them within hours (as we learned with the tragic death of 36-year-old Tandy Harmon). Which brings the question?  Should we be entertaining the possibility that a severe pneumonia strain is affecting us this “flu season”?

Most children are vaccinated against pneumonia

The vaccine schedule for children in the US includes the pneumococcal vaccine (PCV13) given at 2 months, 4 months, 6 months, 12 – 15 months of age.  Over 2 years of a child, one can get the PPSV23 if they did not receive the PCV13.

Not all young adults get the pneumonia vaccine, however if one if over 65, the CDC recommends the pneumococcal vaccines receiving a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.

Now a variety of pathogens can be responsible for pneumonia, including viruses’, fungi, and bacteria other than pneumococcus, but streptococcal pneumonia is the most common cause.  If those affected by pneumonia this year were vaccinated, we need to know the strain, meaning specifically what pathogen was responsible for their pneumonia.

Not all pneumonia presents with a cough

Although pneumonia presents with symptoms such as fever, body aches, cough, shortness of breath and sputum production, some individuals may not present with these symptoms when they have pneumonia. Some of the tragic “flu death” cases this year were in adults who initially had a “mild cough”. Since flu symptoms are similar, some may never know if they have pneumonia.

As a result we are telling patients who have the flu to return immediately to the doctor’s office/urgent care/emergency room if they have any of the below symptoms:

  • Recurring fever
  • Fever that won’t subside after 2 days
  • Shortness of breath
  • Difficulty breathing
  • Confusion
  • Weakness
  • Productive cough
  • Fast breathing
  • Fast heart rate
  • Chest pain

and speak with your medical provider regarding other symptoms he/she may want you to watch out for.

How to tell when your flu is turning deadly

 

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

 

 

 

Posted in food, Health, news

California to Soon Rule if Coffee Causes Cancer

Last September we learned of a legal battle ensuing in California regarding the lack of warnings on coffee products when it comes to a cancer causing chemical that’s produced during the bean roasting process.

This week we learn that in the coming weeks a California state judge will weigh in and most likely be the deciding voice, as opposed to a medical organization, on whether coffee, and its acrylamide byproduct, cause cancer.

 

The Council for Education and Research on Toxics (CERT) wants coffee manufacturers, distributors and retailers to post warnings regarding the acrylamide content.

Proposition 65, The Safe Drinking Water and Toxic Enforcement Act, passed in 1986, requires businesses that expose individuals to toxic chemicals in the course of doing business to first give warnings to such individuals.

If they do not, they can be open to liability.

What is acrylamide?

Acrylamide is a chemical used in many industrial products that produce plastics, adhesives, food packaging and the treatment of drinking water.  It can also be produced when foods are heated, fried, baked, or roasted to above 120 degrees Celsius (248 degrees Fahrenheit).  In 2002 reports came out regarding acrylamide in french fries, and in 2013 the FDA issued guidance to the food industry on how to minimize producing the chemical.

Roasting coffee requires the beans to be heated to close to 450 degrees Fahrenheit.  This heat produces a chemical reaction between the amino acid asparagine and sugars resulting in the formation of acrylamide.

The amounts however are miniscule.  Much smaller than other modes of acrylamide exposure such as cigarette smoking and exposure at work when working in industries that use acrylamide such as plastics, food processing, mining, paper, agriculture and construction.

What can acrylamide do?

In rodents, acrylamide was found to increase several types of cancer. But the doses were 1,000-10,000 times greater than what the average human is exposed to.

According to the American Cancer Society, most of the studies done so far have not found an increased risk of cancer in humans. For some types of cancer, such as kidney, ovarian and endometrial cancer, the results have been mixed, but there are currently no cancer types for which there is clearly an increased risk related to acrylamide intake.

How do I decrease exposure?

As noted earlier, acrylamide can be in a variety of products we use throughout the day.  Large quantities, however, can be consumed through cigarette smoke, hence avoiding smoking is key.  Moreover, avoiding frying foods, especially starches, greater than 120 degrees Celsius/248 degrees Fahrenheit if possible.  Frying and or toasting to a light gold, rather than crispy dark brown color, may limit your exposure as well.

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But keep in mind, numerous studies have found coffee drinkers to lower their risk of cancer, especially liver, uterine, prostate and mouth cancer.  However 4-6 cups had to be consumed in order for researchers to notice a benefit.

More research still needs to be done.  So while we wait for the verdict lets kick back with a cup of …..hot chocolate?

 

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