Posted in Health, Labor Day, news, travel

Labor Day Weekend Safety Tips

Image above from Getty Images

The holiday offers a day of respite for those who labor throughout the week.  But the federal holiday, established in 1894, may come with risks as its one of the most travelled weekends of the year.   Grill injuries can occur, and throughout the US we are seeing record high temperatures. Additionally, water injuries, including drownings may rise this weekend. 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 15-30 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.



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 lotioninstead 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.




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.




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.

Consider leaving a day or two early or a day or two late to avoid congested traffic.

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.




Have a happy and safe Labor Day Weekend!



Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in diabetes, Health, medications, news

Genital Gangrene Linked to Newer Class of Diabetes Medications

The FDA has issued a warning for the class of diabetic medications, the sodium-glucose cotransporter-2 (SGLT2) inhibitors, following reports of Fournier’s gangrene, or necrotizing fasciitis of the perineum.

SGLT2 inhibitors are sometimes used to lower blood sugar in diabetics.  They work by preventing the body from reabsorbing glucose (sugar), forcing it to be excreted in the urine.



Image from Sirona Biochem


Medscape lists the common drugs in this class:

  • Canagliflozin (InvokanaInvokamet, Invokamet XR; Janssen)
  • Dapagliflozin (FarxigaXigduo XRQtern, AstraZeneca)
  • Empagliflozin (JardianceGlyxambi, Synjardy, Synjardy XR; Boehringer Ingelheim/Eli Lilly)
  • Ertugliflozin (Steglatro, Segluromet, Stelujan; Merck)


12 cases had been reported to the FDA, seven of which were men, and five were women, all having had taken an SGLT2 inhibitor. One died, despite treatment.

Last summer, Liu et al published a study in Scientific Reports suggesting an “increased risk of genital infections with SGLT2 inhibitors.”

Symptoms of Fournier’s gangrene may begin with fever, pain, redness or swelling that may occur behind and around the area of the genitalia.  Then necrotizing fasciitis ensues when the infection spreads rapidly across (and killing) the fascia, fibrous tissue that surrounds the muscles and organs.  Anyone experiencing any of the above symptoms must see a medical provider immediately.

The FDA reports the following:

Patients should seek medical attention immediately if you experience any symptoms of tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, and have a fever above 100.4 F or a general feeling of being unwell. These symptoms can worsen quickly, so it is important to seek treatment right away.
Health care professionals should assess patients for Fournier’s gangrene if they present with the symptoms described above. If suspected, start treatment immediately with broad-spectrum antibiotics and surgical debridement if necessary. Discontinue the SGLT2 inhibitor, closely monitor blood glucose levels, and provide appropriate alternative therapy for glycemic control.
Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. The bacteria usually get into the body through a cut or break in the skin, where they quickly spread and destroy the tissue they infect. Having diabetes is a risk factor for developing Fournier’s gangrene; however, this condition is still rare among diabetic patients. Overall published literature about the occurrence of Fournier’s gangrene for men and women is very limited. Publications report that Fournier’s gangrene occurs in 1.6 out of 100,000 males annually in the U.S., and most frequently occurs in males 50-79 years (3.3 out of 100,000).1-3 In our case series, however, we observed events in both women and men.
In the five years from March 2013 to May 2018, we identified 12 cases of Fournier’s gangrene in patients taking an SGLT2 inhibitor. This number includes only reports submitted to FDA* and found in the medical literature,4-6 so there may be additional cases about which we are unaware. In 2017, an estimated 1.7 million patients received a dispensed prescription for an SGLT2 inhibitor from U.S. outpatient retail pharmacies.7Although most cases of Fournier’s gangrene have previously been reported in men, our 12 cases included 7 men and 5 women. Fournier’s gangrene developed within several months of the patients starting an SGLT2 inhibitor and the drug was stopped in most cases. All 12 patients were hospitalized and required surgery. Some patients required multiple disfiguring surgeries, some developed complications, and one patient died. In comparison, only six cases of Fournier’s gangrene (all in men) were identified in review of other antidiabetic drug classes over a period of more than 30 years.

This is a developing story.


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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in food, Health, news

Salmonella Outbreak Linked to a Brand of Kosher Chicken

One person has died and several others hospitalized with Salmonella after consuming a brand of Kosher chicken.

Empire Kosher-brand chicken has been identified as a source of the infection in multiple states including New York, Virginia, Pennsylvania and Maryland.

The CDC stated they isolated the strain in “samples of raw chicken collected from two facilities, including one facility that processes Empire Kosher brand chicken,” but they are NOT urging consumers to avoid “eating kosher chicken or Empire Kosher brand chicken.”

Salmonella is commonly associated with raw poultry, as well as eggs, and cooking thoroughly until the internal temperature reaches 165 degrees is recommended prior to cooling and consuming.  Moreover washing kitchen counters and cookware that touched the raw chicken is paramount to avoiding contamination by Salmonella.



Salmonella:  image from the CDC


Symptoms of salmonella poisoning include fever, chills, rash, diarrhea and stomach cramps within 12-72 hours after exposure. The illness can last 4-7 days, although most people will recover without treatment.

What is Kosher Chicken?


The laws of Kashrut, Jewish dietary laws, are complex. So briefly stated, they entail what can be eaten, what foods can be mixed together, how the animal is slaughtered and how the meat is prepared.

In Jewish law, the animal should not suffer when slaughtered so a clean cut with a clean knife, lack of sawing, etc. is mandated to avoid any endurance of pain. Death must be instantaneous. Then blood vessels, fat and skin are removed from the animal and the meat is soaked and salted to drain excess blood and debris. The soaking and rinsing process is extensive and Rabbis may oversee the process at butcheries or processing plants.  Many offer prayer at this time but a Rabbi’s blessing is not necessary to call a food Kosher.

Some foods, no matter how they are prepared, are not considered Kosher in Jewish law including pork, shellfish and horsemeat.



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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada



Posted in Health, news

High HDL Could Be BAD For You

For decades its been preached that HDL is the “good cholesterol” and protective against cardiovascular disease, while LDL is the “bad cholesterol” and too much could lead to a heart attack.



Now new research suggests too much HDL could be bad for you as well.

Emory School of Medicine researchers performed a study as part of the Emory Cardiovascular BioBank.  They looked at 6000 patients who averaged 63 years of age (2/3 male, 1/3 female) and followed them for four years.  Their HDL ranged from 30 mg/dl – 60 mg/dl (normal is 40-50 mg/dl).  But by the end of the study 13% died from heart-related issues and surprisingly, those who had a “medium” level of HDL appeared to fare the best.

Those with HDL levels below 41 mg/dl or above 60 mg/dl were at higher risk of heart disease in this study. An HDL greater than 60 mg/dl caused a 50% increase risk of dying from heart disease.

Study author, Dr. Allard-Ratick stated, “(one) surprising aspect of the study was that this association between high levels of HDL and increased risk of death or cardiovascular disease was seen more commonly in women compared to men.”

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, but it can be harmful in 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.  Higher HDL levels had appeared to be protective, as the more HDL present, the less LDL remains in its dangerous form.

And HDL has been known to offer an additional benefit… 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.

So what should patients do who have very high HDL?  I recommend to not let your guard down. Many people feel a high HDL is protective, whereas LDL will act independently to clog arteries.  Avoid having a false sense of security and be diligent on having cardiac check ups, avoiding smoking, maintain a healthy diet and weight and participate in regular exercise.


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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in food, Health, news

Grilling Meat with Charcoal May Increase Risk of Heart Attack and Stroke

A study has found those who grill meat on charcoal, wood, or coal have a 12% increase risk of suffering a heart attack, stroke or heart failure.

Researchers from the University of Oxford studied 341,000 people in China, measuring their exposure to cooking mediums and their risk of heart death (8,300 died of heart disease unrelated to smoking and other factors). They additionally found that for every decade after one switched to cooking with gas or electric, their risk factor lowered by 5%.

Study authors suggest if one would switch to a gas or electric grill, the risk could be reversible.  Daily Mail reports the following:

People who had switched 10 or more years ago saw their risk sink back to level with people who had always used ‘clean’ energy.
Professor Zhengming Chen added: ‘Switching to electricity or gas weakened the impact of previous solid fuel use, suggesting that the negative association may be reversible.’




Last Spring, scientists found grilling may increase one’s risk of high blood pressure.  In this study, reported by medicalxpress, they found high blood pressure risk to be:

  • 17 percent higher in those who grilled, broiled, or roasted beef, chicken or and fish more than 15 times/month, compared with less than 4 times a month.
  • 15 percent higher in those who prefer their food well done, compared with those who prefer rarer meats.
  • 17 percent higher in those estimated to have consumed the highest levels of heterocyclic aromatic amines (HAAs) – chemicals formed when meat protein is charred or exposed to  – compared to those with the lowest intake.

Standing NEXT to a Grill Can Increase Cancer Risk

Chinese researchers find the smoke released during grilling to expose one to cancer- causing chemicals.

As we head into the summer, grilling burgers, hotdogs, and steaks are a favorite pastime.  But a small study published in the journal Environmental Science & Technology suggests PAHs (polycyclic aromatic hydrocarbons), produced during grilling, are inhaled and absorbed through the skin, potentially causing genetic mutations that may cause cancer.


The study, out of Guangzhou, China, found those consuming the grilled meat had the highest exposure to PAH’s.  Next came those exposed through skin, and finally those inhaling the smoke to be at next greatest risk.

Clothing provided some protection, but once smoke saturated, should be removed to lessen exposure.

The average person is considered safe if they grill in moderation, but excessive exposure could put them at higher risk of PAH-induced cancers such as lung, bladder and skin cancers.

For more on the study read here.

The heating of foods to high temperatures can cause chemical reactions among the amino acids, fats and sugars in foods, producing toxic substances.  Acrylamide, as discussed below, can be formed when heating starches such as potatoes, to high levels.


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.



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 on all fronts when it comes to grilling mediums, crispiness of our cooking and coffee.  So while we wait for the verdict lets kick back with something safe…..I guess a cup of water??



Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio, KDWN….

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Health, news

Deep Forehead Wrinkles May Suggest Heart Disease Risk

For years we’ve known about Frank’s sign, an earlobe crease that appears to signify increase heart disease risk. Now a study presented this week at the European Society of Cardiology suggest forehead wrinkles may do the same.

Researchers believe that in atherosclerotic disease, blood flow may be impeded, not only affecting the heart but also the skin, making deep wrinkles more inevitable.  Collagen and elastic fibers may also lose their elasticity allowing wrinkles to easily form.



For this study, the authors did the following (according to MedicalXpress):

The authors of the current prospective study investigated a different visible marker of age—horizontal forehead wrinkles—to see if they had any value in assessing cardiovascular risk in a group of 3,200 working adults. Participants, who were all healthy and were aged 32, 42, 52 and 62 at the beginning of the study, were examined by physicians who assigned scores depending on the number and depth of wrinkles on their foreheads. A score of zero meant no wrinkles while a score of three meant “numerous deep wrinkles.”
The study participants were followed for 20 years, during which time 233 died of various causes. Of these, 15.2% had score two and three wrinkles. 6.6% had score one wrinkles and 2.1% had no wrinkles.
The authors found that people with wrinkle score of one had a slightly higher risk of dying of cardiovascular disease than people with no wrinkles. Those who had wrinkle scores of two and three had almost 10 times the risk of dying compared with people who had wrinkle scores of zero, after adjustments for age, gender, education, smoking status, blood pressure, heart rate, diabetes and lipid levels.

Earlobe Crease Now Linked to Stroke Risk

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 deep wrinkles and earlobe creases suggest 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 prominent wrinkles as well as Frank’s sign include President George W. Bush and Mel Gibson.



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Again, the forehead wrinkles or 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, Politics

Senator John McCain Dies After Battling Brain Cancer

After being diagnosed with a brain tumor a little over a year ago, Senator John McCain, 81, has passed after choosing to end treatment for the deadly cancer.

The 81-year-old Vietnam veteran and former POW was diagnosed with a primary glioblastoma in the summer of 2017.  Since then he has bravely fought the malignant brain tumor.  His family reported this week the following:

Last summer, Senator John McCain shared with Americans the news our family already knew: he had been diagnosed with an aggressive glioblastoma, and the prognosis was serious. In the year since, John has surpassed expectations for his survival. But the progress of disease and the inexorable advance of age render their verdict. With his usual strength of will, he has now chosen to discontinue medical treatment.

Our family is immensely grateful for the support and kindness of all his caregivers over the last year, and for the continuing outpouring of concern and affection from John’s many friends and associates, and the many thousands of people who are keeping him in their prayers. God bless and thank you all.

Although still politically vocal, Senator McCain had not been in Washington since December, being at home with his family in Arizona.


What is Primary Glioblastoma?

Primary Glioblastoma Multiforme is a type of brain tumor that arises in the brain and spinal cord and is very aggressive in nature.  “Primary” suggests the tumor is not secondary to another cancer, such as the melanoma Senator McCain successfully battled.

In 1993, 2000 and 2002, McCain had three malignant melonama lesions removed, and the 2000 lesion was close to his left temple.

Those diagnosed with a glioblastoma may have a poorer prognosis  compared to other cancers as the 5-year survival rate is only 10%.  Its median survival is less than 15 months.

In 2017, doctors were optimistic as his lesion had been removed, and chemotherapy and radiation were set to immediately begin once his incision had healed.

However many may choose to end cancer treatment early due to side effects or the desire to spend their remaining weeks with family devoid of medical procedures and hospital trips.  Its understandable and gutsy.  The news broke he made this decision one day prior to dying.  Our prayers are with him and his family during this difficult time.

This is a developing  story.




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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada