Posted in Health, news, Politics

Death by Imodium Overdose: Is the Opioid Crisis Getting Worse?

Last year in Pittsburgh, a 29-year-old man died from loperamide poisoning, and officials are warning of a huge spike in Imodium overdose cases.

Loperamide, sold under brand names such as Imodium, is a mu opioid receptor agonist, meaning it can saturate the mu receptors in the brain responsible for quelling pain.  It acts similarly to morphine it its analgesic effect, and in one study by Ray et al, it worked better than morphine.

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Loperamide

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Morphine

Why is loperamide, then, used for diarrhea?

Loperamide slows down the motility of the gut by acting on the smooth muscle lining in the intestine.  Food as it transports down the colon is stripped of much of its water content prior to being expelled as feces.  However in those with diarrhea, the transit time is much shorter and the body does not have a chance to remove the water.  Slowing this pathway down, with loperamide, changes the consistency of the stool and the frequency of stools.

Earlier this year two British citizens died of Imodium overdose and officials are concerned many more non fatal overdoses may be occurring daily.

Loperamide is easy to obtain

First synthesized in the 1960’s, loperamde joined the pharmaceutical industry officially in 1976 when the FDA approved its brand named form, Imodium. Although first introduced as a prescription, Imodium became a widely popular over-the-counter (OTC) remedy by the 1980’s.  Still popular, it remains an OTC, easy to purchase, treatment for diarrhea stocked ubiquitously in stores.

How much Loperamide is too much?

According to drugs.com, dosing is:

4 mg orally after the first loose stool, then 2 mg orally after each unformed stool
Maximum dose: 16 mg per day

However, overdoses can occur based on weight, metabolism and if other medications are being used simultaneously that can interfere with the drug’s bioavailability.  Moreover if one is currently taking narcotics for pain, this could synergistically increase one’s levels of the drug.

What are the side effects of Loperamide?

Regular use of the agent can cause:

  • nausea
  • vomiting
  • fatigue
  • constipation
  • dry mouth
  • dizziness
  • abdominal pain

In training we learned that if one was suffering from an intestinal pathogen resulting in  diarrhea, using loperamide could lengthen the course of the illness as the flushing mechanism during diarrhea is now inhibited.

How can Loperamide kill one using it?

Uniquely, loperamide can cause dangerous heart arrhythmias such as Torsades de points, which can lead to cardiac arrest and death.

So why is Loperamide still used and easily available?

Diarrhea and hyper gut motility cause millions of Americans each year discomfort, time off work and embarrassment.  Moreover, diarrhea can acutely cause dehydration and medicines such as Imodium are widely used in the health care setting for this reason.

But its pharmacological similarity to opiates allows it to be one of the easiest drugs to obtain and abuse.  And with political pressure to decrease access to prescription narcotics becoming more successful, coupled with narcotic withdrawal being so painful and traumatizing, we anticipate more individuals hastily and non-responsibly seeking relief with medications such as Loperamide.

 

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

 

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Posted in Entertainment, Health, news

Arnold Schwarzenegger Stable After Emergency Heart Surgery

The former Governor of California and iconic actor is recovering after a pulmonary valve replacement at a California hospital this week.  According to his publicist, Daniel Ketchel, his artificial valve, placed in 1997 to repair a condition he was born with (congenital) needed to be replaced.

pulmonary vavle

 

The procedure occurred at Cedars-Sinai Los Angeles, and when the Terminator star awoke from surgery, its reported he said none other than “I’m Back.”

Ketchel said in a  statement:

ketchell

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

Can Daily Ibuprofen Prevent Alzheimer’s?

Canadian neuroscientists suggest taking Ibuprofen daily may prevent the onset of Alzheimer’s.

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Image from Alzheimer’s Association

Researchers from the University of British Columbia believe those who take daily ibuprofen, a non-steroidal antiinflammatory (NSAID), can decrease inflammation of the brain caused by the abnormal proteins that cause Alzheimer’s.

In 2004, Dokmeci et al suggested ibuprofen could delay Alzheimer’s onset as it protects neurons (nerve cells) and decreases inflammation of the brain.

In this study, Dr. Patrick McGreer and his team believe they can identify those early on who could benefit from the inexpensive, over the counter treatment.

McGreer is President and CEO of Vancouver-based Aurin Biotech.  He and his team developed a saliva test that measures the protein Abeta42 (amyloid beta protein 42).  In patients at risk of Alzheimer’s, they found levels of Abeta42 to be two to three times higher than normal.  Abeta42 accumulates in the brain, causing inflammation and destroying nerve cells.  Though previously believed Abeta42 is made exclusively in the brain, the saliva test suggests Abeta42 is made elsewhere in the body and can be detected years earlier.  If the protein/peptide is found earlier and known to cause inflammation, McGreer and his team believe preventing the inflammation with ibuprofen could essentially prevent Alzheimer’s onset.

He states, “What we’ve learned through our research is that people who are at risk of developing Alzheimer’s exhibit the same elevated Abeta42 levels as people who already have it; moreover, they exhibit those elevated levels throughout their lifetime so, theoretically, they could get tested anytime.

“Knowing that the prevalence of clinical Alzheimer’s Disease commences at age 65, we recommend that people get tested ten years before, at age 55, when the onset of Alzheimer’s would typically begin. If they exhibit elevated Abeta42 levels then, that is the time to begin taking daily ibuprofen to ward off the disease.”

Daily ibuprofen would not, however, be without its risks.  Gastric upset, ulcers, kidney disease and heart disease could occur with excessive NSAID use.  The authors suggest a “low dose” but did not specify an exact milligram quantity.

Advances in Alzheimer’s treatment have met multiple obstacles as the neurodegenerative disease is difficult to detect early and the few treatments we do have are not very effective at slowing and reversing pathology.  If protein deposition in the brain can be prevented early, we could potentially save the millions of people destined to get the disease. Currently 5.5 million people in the US have Alzheimer’s, and 44 million people are affected worldwide.

alzhemiers

 

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 Season: A Second Wave May Hit

Although flu cases have started to decrease since its peak early this winter, flu season may continue well into late Spring.  The CDC warns a second wave of flu may be upon us as Influenza B is making the rounds.

Although first bombarded with H3N2 “A” strain influenza, Americans appear to be reporting more “B” flu cases this time of year, comprising more than 58% of cases lab-identified.

And young children are especially susceptible to B strain viruses.

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5 pediatric flu-related deaths have been reported this week.  The CDC cites 133 influenza-related pediatric deaths for the current 2017-2018 season.

According to the CDC:

Overall, influenza A(H3) viruses have predominated this season. However, in recent weeks the proportion of influenza A viruses has declined, and during week 11, influenza B viruses were more frequently reported than influenza A viruses.

Week 11 (March 11-17, 2018) has seen the following:

The proportion of outpatient visits for influenza-like illness (ILI) was 2.7%, which is above the national baseline of 2.2%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; nine states experienced moderate ILI activity; New York City, Puerto Rico, the District of Columbia, and 17 states experienced low ILI activity; and 18 states experienced minimal ILI activity.

The trivalent and quadrivalent flu vaccines both protected against Influenza B as well as the A strains of H1N1 and H3N2 this year.  However, flu shot efficacy proved poor for the 2017-18 season, being approximately 30% effective. Moreover, flu viruses can mutate as the season progresses.

It is not uncommon for one to be infected with the flu twice by two different strains circulating during the season.

What’s concerning is allergy season is beginning to overlap with flu season.  Those with allergies may have a temporariy weakness in their immune system, making them more susceptible to catching a cold or flu.

 

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

 

 

Posted in Health, news

Rare Cancer Cases Associated with Breast Implants Rise 15%

 

The FDA reports this week a rise in the number of cases of BIA-ALCL, anaplastic large cell lymphoma, by 15%.

Last March the FDA reported 9 women had died from anaplastic large cell lymphoma (BIA-ALCL) possibly associated with their breast implant use.  At the time, the FDA received 359 reports of BIA-ALCL,  a rare type of non-Hodgkins lymphoma, 9 of whom died as of February 1, 2017. This year the FDA reported 414 cases.

Last year a study out of Pennsylvania State University College of Medicine linked textured breast implants to this malignant cancer.

Although a rare cancer. researchers believe the lifetime risk is 1 out of every 30,000 women with breast implants and if the numbers are underreported, could be as common as 1 out of every 4000 women with implants.

Although the implants are used to augment breast tissue, the malignancy is not a breast cancer but rather a lymphoma.

Lymphomas make up the most common of the blood cancers.  The cancer begins in the lymphocytes, cells crucial for maintaining one’s immune system. Two main types of lymphoma are Hodgkin’s and Non Hodgkins.  Non Hodgkins is more common, and anaplastic large cell lymphoma is a subset if it.

 

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ANAPLASTIC LARGE CELL LYMPHOMA/PATHPEDIA.COM

According to the American Society of Plastic Surgeons , there are currently 195 cases in the US and a total of 521 worldwide as of March 21, 2018.

 

This is not the first time a link has been suggested.  6 years ago the World Health Organization suggested a link.  Then in 2011, the FDA identified a possible association between the two.  In 2016, the  Australian Therapeutic Goods Administration reported 46 confirmed cases with 3 deaths relating to breast implants.

The report last spring suggested that BIA-ALCL affected both smooth and textured implants. According to the FDA report, 231 of the 359 cancer cases provided information on implant type.   203 were reported to be textured implants and 28 reported to be smooth implants. When it came to silicone vs. saline implants, the FDA said 312 of the 359 reports provided these specifics and of those 186 reported implants filled with silicone gel and 126 reported implants filled with saline.

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So neither implant type appeared immune to the risk of BIA-ALCL but it appears the silicone, textured implants carried the most risk.

Now the cancer occurred within the breast and the FDA advises physicians to consider the possibility of BIA-ALCL if there appears to be a seroma (fluid filled cavity around the implant) or a contracture (pulling of the skin and tissue) near the implant.

In most cases the cancer is treatable, with removal of the implant and the surrounding tissue curative.  In some cases however, radiation of the area or chemotherapy is required.

Although 50,000 cases of non-Hodgkins lymphoma occurs annually in the US, it is unknown how many cases of BIA-ALCL occur each year.  Moreover, many countries may not have avid reporting systems of breast implant related cancers as we do.  According to the American College of Plastic Surgeons, close to 300,000 women receive breast implants each year, some of which for breast reconstruction after mastectomy for breast cancer.

The FDA reminds us that BIA-ALCL is rare and prophylactic breast implant removal is NOT recommended. However we need to be aware and evaluate if one develops swelling, pain, new lumps or asymmetry in the breasts….just as we do for those without implants.

 

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

Posted in Health, news

The Latest Trend in Getting High: Bug Spray

Multiple states are reporting an alarming increase in people overdosing on…..bug spray.

Bug spray, such as RAID contain pyrethroids, man-made versions of pyrethrin, a compound made by flowers to repel insects. The compound acts as a neurotoxin, overly exciting the nervous system leading to paralysis and death of the critter that gets exposed.

But humans are spraying the insecticide on their marijuana, tobacco, or spice before smoking it, in an attempt to increase the high. These bug spray-laced drugs, called KD, could cause serious illness.

In December, a Tennessee man went on a violent bender and was arrested after he smoked a mixture of  methamphetamine and bug spray to make “wasp“.

“Hot Shots” are even crazier.  The DenverChannel.com reports one takes a screen, sprays bug spray on it, hooks up a battery charger to  heat it, and once the solution crystallizes, melts it and injects the liquid into their veins.

Health officials are warning using any of the above drug mixtures can produce various symptoms including:

  • nausea
  • vomiting
  • headache
  • dizziness
  • fatigue
  • aggression
  • tremors
  • seizures
  • respiratory failure
  • cardiac arrest
  • coma
  • death

Because of the ubiquity of bug spray, anyone, including a child, can become exposed to toxic doses using it by itself or mixing it with other chemicals and drugs.

As a kid we used to collect bugs and play with them.  Now kids are getting high on bug spray.  What could possibly be next……

 

 

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

 

Posted in Health, news, sex

What To Do If Your Child Catches You in the Act of Sex

One of the most embarrassing, untalked about faux pas that occurs in families is the accidental witness of two parent figures having sex.

Our children see us make dinner, watch TV, argue about the in-laws, blame each other for the last cookie being eaten, drop each other’s toothbrush in the toilet (Ok I did that once!), so seeing and hearing two adults be intimate could potentially leave a mental scar for life.

And the moment the child is being visually and audibly traumatized, what do we do?  We scream…..”GET OUT!!”, or “YOU’RE NOT SUPPOSED TO BE HERE!”

Then once dressed, or finished, we hunt down the child, who’s probably hiding in their room, to try to urgently rectify the situation. My guess is many of us fail at this as well.

Telling them “Mommy and Daddy were just having a conversation”, adulterates any competency in communication skills they might have developed over the past few years.

“Mommy and Daddy were having sex” might work, but the average child who just witnessed it may choose a life of celibacy that instant.

So what should we do?

Assure the child they did NOTHING wrong

I don’t care if you told them a million times not to enter your room, its YOUR fault the door was unlocked.  Blaming the child makes the situation worse and traumatizes them more.  Let them know you’re not mad and want to discuss what happened.

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Understand the child’s point of view

Children of all ages learn by mimicry.  Watching parents have sex may startle not so much because of the sexual nature, but because it’s an act they don’t want to mimic.

In a child’s mind they think that the act they just witnessed is one they need to engage in later if they want to be a grown up like you…..and it scares them. Reassure them that they do not have to do “everything Mommy and Daddy do.”

 

Don’t generalize

If the child thinks “all adults” do what they just witnessed (position, sounds, tools, etc.) they will extrapolate and think their teachers, clergy, and grandparents do the exact same thing.  This could be traumatizing as well.  Let them know that you and your partner were experimenting and having fun and sex is different for everybody. Which brings us to….

It’s OK to call it “Mommy and Daddy time”

Rather than labeling it sex, calling it Mommy and Daddy time is fine.  Let them know that adults need private time and some things or acts may feel good and make them happy.

Set boundaries right away

The child may be more concerned about being yelled at or caught doing something they shouldn’t than actually seeing you have sex.  So their first priority is making sure this doesn’t happen again.  Set boundaries such as, “When our door is closed, knock first”, will give them a concrete instruction to follow.  They may then ask, “But, what happens if there is a fire?”,….so let them know in an emergency, getting your attention is OK.

You don’t have to fix it all right away

If your child says “I got it, I got it, yah I understand”, that doesn’t necessarily mean he/she understands.  It means they want to leave the conversation. That’s fine.  You can always revisit it later.  Sometimes during a drive in the car, topics such as this may be easier to discuss than at home with baby brother/sister giggling nearby.  They’re a captive audience (unless they choose to jump out of the car), and you can smoothly transition to the subject by asking for permission to have a “big boy/big girl” talk.

Kids like two things, being asked permission by a parent and not being talked to like a little kid.  Capturing their attention this way may allow you to then discuss what needs to be discussed.

One more bit of advice …..when the kids are home and you can’t control yourselves, keep it down, avoid loud machinery, and keep it under the covers……

 

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