Posted in Health, news

High Blood Pressure, the “Silent Killer”, May Have Symptoms

High blood pressure, or hypertension, has long been known as the “silent killer” as many can’t feel when their blood pressure is high, subsequently succumbing to its deleterious effects on the body.

However for some people, it’s not completely “silent.”   High blood pressure could cause some easily recognizable symptoms due to some of the organ damage it is causing.

These include:

  • Headache
  • Chest pain
  • Difficulty breathing
  • Fatigue
  • Dizziness
  • Decreased urine output
  • Blood in the urine
  • Anxiety
  • Confusion
  • Vision changes
  • “Pounding” in the ears
  • Weakness
  • Bubbly, foamy urine

 

urine-foamy-300x162.jpg

 

What do the blood pressure numbers mean?

The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.

Diastolic pressure is the pressure in your arteries between beats while the heart is “filling”.

Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.

 

What blood pressure level is considered “normal” or “abnormal”?

High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg.   Last year it was guestimated that 42% of Americans would soon be considered “hypertensive”.

blood+pressure+chart

 

What can long-term high blood pressure cause?

Chronic high blood pressure can be dangerous.  It may cause:

  • Heart attacks
  • Heart failure
  • Stroke
  • Kidney disease
  • Dementia
  • Eye damage – vision loss
  • Erectile dysfunction…to name a few.

How do we treat high blood pressure?

The stages of blood pressure are defined in the chart above.  At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:

  • Weight loss
  • Low salt diet
  • Low fat diet
  • Good sleep habits
  • Regular exercise
  • Avoiding tobacco products
  • Limiting alcohol consumption

As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.

If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.

 

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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

October is Breast Cancer Awareness Month

ABOVE:  DR. DALIAH UNDERGOING A 3-D MAMMOGRAM TO SCREEN FOR BREAST CANCER

 

Celebrities such as Julia Louise-Dreyfus, Olivia Newton-John, Christina Applegate and Cynthia Nixon have revealed their breast cancer diagnoses, helping raise awareness for the most common cancer to affect women.  It’s the second most common cause of cancer death in females.

#Shirtsoff.jpg

#ShirtsOff #BreastCancerAwarenessMonth

How common is breast cancer?

1 in 8 women will develop invasive breast cancer over the course of their lifetime. According to the American Cancer Society, an estimated 266,120 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,960 cases of non-invasive breast cancer, a rise from last year.

40,920 women and 480 men are expected to die this year of breast cancer.

 

What are the risk factors for breast cancer?

Risk factors for breast cancer include:

  • Age greater than 50
  • Family History
  • BRAC1 and BRAC2 genetic mutations
  • Alcohol use
  • Never been pregnant or becoming pregnant for the first time over 35 years old
  • Early menarche at age 11 or younger
  • Obesity, especially after menopause
  • Dense breasts
  • Lack of physical activity
  • Use of oral contraceptives
  • Previous “precancerous” tumors such as atypical hyperplasia
  • DES exposure
  • Previous radiation therapy

How is breast cancer staged?

Breast cancer is staged based on size of the tumor, if lymph nodes are affected and whether the cancer has spread to distant areas of the body.  Prognosis varies greatly on the stage.

 

Screen-Shot-2012-09-27-at-9.59.51-AM.png

IMAGE ABOVE FROM JOHNSTON HEALTH

 

Is family history a huge factor?

85% of breast cancer cases occur in women with NO family history.

 

Screening of breast cancer

Mammograms are the first line screening tool for breast cancer and are currently recommended biennial for women aged 50-74.  However for those at higher risk, mammogram screening should start earlier, with possible follow-up ultrasound, and be performed more regularly.

 

FullSizeRender (1)

3-D MAMMOGRAM IMAGE

 

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, medications, news

Can Heartburn Drugs Raise the Risk of Osteoporosis?

This week a study revealed the use of Proton Pump Inhibitors (PPI’s) can increase the risk of hip fractures in dialysis patients by 20%.

As opposed to being forms of calcium carbonate, such as acid neutralizers such as Tums, or H2 (Histamine H2 Antagonist) blockers such as Pepcid and Zantac, the PPI’s reduce stomach acid production from the start.  They’re sold under the brand names of Prilosec, Prevacid, Protonix and Nexium.  They’re popularity has been skyrocketing over the last two decades and have become a mainstay treatment for multiple gastrointestinal issues including ulcers.

Researchers from Baylor College of Medicine found in their study, 75% of dialysis patients who suffered a hip fracture, took a PPI within the preceding three years.

Researchers have long debated if PPI’s can cause osteoporosis or thinning of the bones.

A Canadian study done in 2008 found 7 years of proton pump inhibitor use to raise the risk of osteoporosis-related fractures of the hip, wrist and spine.

Anderson et al wrote in the July 2016 issue of Current Opinion in Rheumatology stated the following:

The use of PPIs is a risk factor for development of osteoporosis and osteoporotic fractures. However, as the direct pathogenesis remains unclear, specific points of intervention are lacking, other than being vigilant in regard to the indication for prescribing PPIs and to use the lowest effective dose where PPIs cannot be avoided.

 

Foods that cause reflux

Gastroesophageal reflux disease can be caused by foods difficult to digest such as processed foods, sugars, and those with refined carbohydrates.

acid-reflux-1-1100x700

 

Foods that help relieve acid reflux

The following may help relieve acid reflux symptoms:

  • Oatmeal
  • Banana
  • Salad
  • Aloe vera
  • Parsley
  • Celery
  • Couscous
  • Rice
  • Lean turkey and chicken

 

Here’s another chart that shows foods that may help or trigger reflux:

reflux foods

Elevating the bed 45 degrees at night helps reduce reflux symptoms.

Avoiding drinking lots of water before sleep helps as well.

Eating smaller meals and avoiding a large dinner at bedtime will decrease acid reflux.

Heartburn Medication Found to Double Risk of Stomach Cancer

So why take medication at all?

Those suffering from GERD can be prone to esophageal cancer if the stomach acid bombarding the lower esophagus fails to be subdued.  Acid reflux can also cause chronic sore throat and chronic cough.  For these reasons, PPIs will still be recommended for severe reflux cases, but maybe lower doses and combinations with other drugs and lifestyle changes should be started first.

 

 

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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 flu, Health, news

80,000 Americans Died From Flu-Related Illness Last Year

We knew last year’s flu season was deadly, but we didn’t expect this.    The CDC has this week revealed the following: over 80,000 Americans died last year from flu-related illness. This is double and even triple previous flu seasons.  Thus the 2017-2018 season was one the deadliest in decades, nearly matching the 1976-1977 swine flu outbreak.

Last year’s pandemic was most notably caused by H3N2.  This notorious strain can sneakily avoid being replicated in a vaccine, hence our flu shot efficacy last year was only 16%.

Flu Deaths: Are We Missing a Severe Pneumonia Season?

The most common cause of death was pneumonia.  Which makes us wonder if we are dealing with more severe pneumonia causing strains as well.

 

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

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.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

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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

Don’t Mix Supplements and Herbal Remedies if Taking Medication

Another warning has been issued to adults and seniors who mix herbal remedies, over the counter supplements and prescription medications.

A study from the University of Hertfordshire in the UK found 44% of women and 22% of men surveyed mixed their prescription medications with herbal remedies and over the counter supplements.

Individuals may have changes in their metabolism and medication breakdown as they age causing variances in body absorption and efficacy of medications.  Adding supplements or herbal remedies could cause unpredictable reactions.

These effects could include:

  • Less efficacy of prescription medication causing poor blood pressure, sugar, heart rhythm control, for example)
  • Enhanced active compounds of medications taken (possibly causing overdose)
  • Nausea
  • Vomiting
  • Body aches
  • Jaundice
  • Blood thinning causing easy bleeding
  • Renal failure
  • Liver failure
  • Anemia
  • Mania and other personality changes
  • and  more

For example, St. John’s Wort could interfere with the effectiveness of one’s birth control and ginseng could worsen’s ones hypoglycemia if they are taking insulin.

Grapefruit juice could interfere with the metabolism of a statin, a popular medication used to decrease cholesterol. By raising its levels in the blood, one drink could cause a patient to have increased side effects such as muscle cramps and liver issues.

Iron supplements can interfere with one’s absorption of their thyroid medication, and ginko biloba, if taken with a blood pressure medication, could cause the blood pressure to drop even lower.  Moreover it can increase bleeding if taken with an anticoagulant.

And if alcohol is mixed with any prescription medication, deadly side effects (such as respiratory depression when used with opiates) can ensue.

So the moral is, just because a supplement states is “natural”, or a frequently consumed food appears to be safe, its combination with medication could prove deadly.

Although the interactions are numerous, the AAFP created a table of common ones:

 

Herbal and Dietary Supplement–Drug Interactions

HERBAL OR DIETARY SUPPLEMENT DRUG COMMENT RECOMMENDATION*

Patients taking oral anticoagulants

Cranberry (juice)

Warfarin (Coumadin)

Interaction possible based on seven reports of increased INR, although a clinical study showed no interactions47

Suspect an interaction if INR elevated

Fish oil

Warfarin

Interaction possible, with case reports showing an elevated INR, although a clinical study showed no effect of fish oil on anticoagulation status8,9

Suspect an interaction if INR elevated

Garlic

Warfarin

Interaction unlikely based on a clinical study that found garlic is relatively safe and poses no serious hemorrhagic risk for closely monitored patients taking warfarin oral anticoagulation therapy10

Suspect an interaction if bruising or bleeding occurs despite an appropriate INR

One review found no case reports of interactions with garlic and warfarin11

Ginkgo

Warfarin

Interaction possible, though controlled clinical studies show no effect of ginkgo on the kinetics or dynamics of warfarin12,13

Experts recommend caution, although available research does not support this conclusion

Aspirin

Interaction suspected based on four case reports of spontaneous bleeding14,15

Suspect an interaction if spontaneous bleeding occurs

Ginseng

Warfarin

Interaction possible based on conflicting research findings

Avoid combination if possible

American ginseng (Panax quinquefolius)reduces blood concentrations of warfarin16,17

Coadministration of warfarin with Asian ginseng (Panax ginseng) did not affect the pharmacokinetics or pharmacodynamics of warfarin18

St. John’s wort

Warfarin

Interaction suspected based on decreases in INR in case reports and in a study in 12 healthy volunteers18

Evaluate warfarin response when St. John’s wort is initiated or stopped

Vitamin E (> 400 IU daily)

Warfarin

Interaction suspected based on a single patient (with rechallenge), resulting in an increase in INR19

Evaluate warfarin response when vitamin E is used in combination

One clinical trial showed no interaction20

Patients taking cardiovascular medications

Eleuthero (Eleutherococcus senticosus) [corrected]

Digoxin

Possible increase in digoxin levels without clinical signs (case report)21

Monitor digoxin level when eleuthero is initiated or stopped [corrected]

St. John’s wort

Digoxin

Suspected decrease in digoxin levels without clinical signs in a controlled study22

Monitor digoxin level when St. John’s wort is initiated or stopped

Verapamil (Calan)

Interaction suspected based on decreased bioavailability in a study in eight healthy volunteers23

Increase verapamil dose, if necessary, if diminished response occurs

Statins

Interaction suspected based on decreased plasma blood levels in a clinical study24

Monitor serum lipid levels after St. John’s wort is added

Patients taking psychiatric medications

Ginkgo

Atypical antidepressant (trazodone [Desyrel])

Interaction possible based on one case report of coma25

Evaluate for emotional and/or behavioral changes in patient response after ginkgo is initiated or stopped

Ginseng

Monoamine oxidase inhibitors

Interaction possible based on two case reports of manic-like symptoms, headache, and tremulousness17

Avoid combination if possible

St. John’s wort

SSRIs

Interaction suspected based on case reports of drowsiness or serotonin syndrome26

Taper off St. John’s wort when initiating an SSRI

Benzodiazepines

Interaction suspected based on pharmacokinetic studies showing decreased serum levels (25 to 50 percent) without clinical signs2729

Adjust the dose of benzodiazepine as needed

Tricyclic antidepressants

Interaction possible based on decreased amitriptyline plasma levels but no clinical effects in a study of 12 depressed patients27,30

Monitor patient response after St. John’s wort is initiated or stopped


INR = International Normalized Ratio; SSRI = selective serotonin reuptake inhibitor.

*— All recommendations have a strength of recommendation taxonomy (SORT) evidence rating of C (consensus, disease-oriented evidence, usual practice, expert opinion, or case series). For information about the SORT evidence rating system, see https://www.aafp.org/afpsort.xml.

Information from references 4 through 30.

 

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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

Appendicitis May Be Treated With Antibiotics

For decades, scientists have debated whether surgery was necessary for all appendicitis cases.  Well another study has suggested antibiotics may be a suitable alternative.Finnish researchers found in uncomplicated cases of an inflamed appendix (not ruptured) antibiotics will successfully treat 62% of the time.

Dr. Paulina Salminen and her colleagues looked at 267 patients with appendicitis who were treated with antibiotics and found 167 of them, after 5 years, were still going strong.  100 patients, however, did have their appendixes removed within the follow-up period.

Considering the risks that come with surgery, some patients might prefer to take antibiotics instead.  Moreover, even if surgery may be required down the line, antibiotics may prevent the need for “emergent surgery” allowing at-risk patients who may, for example, have uncontrolled diabetes or blood pressure, have time to stabilize their co-morbid conditions before entering the operating room.

Dr. Salimen states, “It’s a feasible, viable and a safe option.”

CT-Scan-Appendix.jpg

Some patients, or physicians, however, may not be impressed by these numbers as of yet and find surgically removing the appendix a more prudent option if a future surgery appears to be inevitable.

The Appendix: NOT a useless organ

In medical school we learned that nothing in the body is useless.  Well maybe my ovaries have become so, but that will be discussed in my next article on facial hair.

It troubled many of us in the medical profession that an appendage attached to the right sided colon, cecum to be specific, would be useless.   We have to study the appendix profusely in school as an appendicitis attack is not one to be misdiagnosed.  I took out so many appendixes in my training that I could do it blindfolded.  This “vestigial structure” denoting it didn’t have a function, did so as far as I was concerned.  It averaged approximately 10 cm, was about 1 cm in diameter when not swollen and abscessed and was a uniquely hollow tube.

If an organ or body part becomes useless, nature selects it out.  This is why humans don’t have tails. We can pull eachothers hair if we need pull something.  Over 500 animal species have appendixes.  Must be for a darn good reason.

Grammar note.  The plural word for the organ appendix is “appendixes”.  If we were discussing a segment in a book, it would be “appendices”.  

Then in 2007, a team of immunologists from Duke University reported that the appendix has a function:  to produce and harbor healthy bacteria that can help “reboot” the gut when it becomes low in its microbiota.  Makes sense.  But not everyone got the memo and I overheard people in line at Starbucks talk about how the appendix was useless all over again.

In January 2017, scientists at Midwestern University Arizona College of Osteopathic Medicine again confirmed that the dangling worm like tube had a purpose. Not only did they believe the appendix to be a reservoir for good bacteria but also play a role in our immune system with its high level of lymphoid tissue.  Dr. Heather Smith, lead author, stated “In animals that have an appendix, there is a higher concentration of lymphoid tissue in the cecum.”   Moreover she said, “The appendix has a concentration of good gut bacteria that can repopulate the gut.”

The cecum is a pouch like structure that marks the beginning of the large intestine.  It receives the food that was digested in the small intestine and starts its passage through the colon, which will absorb its water content and prepare it to become its dream…..poop.

 

cecum-and-appendix

GRAPHIC FROM HTTPS://WWW.NEWHEALTHADVISOR.COM/PARTS-OF-THE-LARGE-INTESTINE.HTML

We see more and more studies discussing our digestive system’s bacteria and its role in our health.  It would make perfect sense that our colon had a means to repopulate its bacteria inhabitants if stress, antibiotics, or diarrhea washed it away.  As we come to learn that we big organisms rely more and more on microorganisms, we face the fact that the simplest of all creatures deserve credit for our existence.  Its time we appreciate the simplest of organs as well……our friend the appendix.

 

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 diabetes, food, Health, news

Leftover Pasta May Be Better For Diabetics than Freshly Made

Pasta is usually a no-no for those with high blood sugar as it has a high glycemic index. But researchers reveal a trick to allow those with diabetes to enjoy the popular dish:  cooling and then reheating it the next day.

Express.co.uk reports the following:

 ……eating cooled or reheated pasta can help reduce the rise of blood glucose levels, according to an experiment led by the University of Surrey’s Dr Denise Robertson and TV doctor Chris van Tulleken.
This is because when starch is cooked in water and then cooled, it changes shape.
The new structure is resistant to enzymes in the body so can’t be digested, becoming what is known as ‘resistant starch’.
When regular starch becomes resistant starch, most of the sugars it contains aren’t released in the gut, meaning the body will take in fewer calories from the same food.

When study authors tested their theory, they found cooled and reheated pasta did not cause the same spike in blood sugar as freshly made pasta.  There was still a surge in blood sugar, but not as much.

What is resistant starch?

There are four classifications of resistant starch.

resistant starch 1.jpg

Resistant starches get their name by being “resistant” to digestion.  They are carbohydrates that don’t get broken down as easily and act like fiber. The less they are digested, the less their “sugar” can enter the blood stream (diabetes explained below).  Starches that are cooled and then reheated undergo changes in their carbohydrate composition, rendering them less vulnerable to enzymatic breakdown.

Foods with resistant starches are found to be more beneficial when it comes to  insulin sensitivity and gut health.  They include:

  • Legumes
  • Oats
  • Green Bananas
  • Whole grains
  • Cooked and cooled rice and potatoes

 

resistant-starch-1024x986.jpg

 

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.  It’s 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.  It’s 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/.

 

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 dating, football, Health, relationships, sex, Sports

Football Fans May Be More Successful Lovers

For those of us who are football enthusiasts, we may be at an advantage when it comes to relationships.  Makes sense….when things go sour with our partner we turn to football.  When we get sidelined we wait for a signal to get back on the field.  And we instinctively “suit up” before each encounter to protect us from the blows we may incur.  So the question arises, do football fans fare better in relationships?

 

We know the field

Before any play, we need to position ourselves correctly on the field.  Being too close to the “end zone” when you’re supposed to be yards away can give you a severe penalty.

So we start at the line of scrimmage and respect the “neutral zone.”

 

14169268_f496.jpg

 

An infraction of this space could again inflict a costly penalty.  There’s a time and a place when beginning a play and entering this zone is allowed.

 

neutral zone.jpg

 

True our goal is to get to the end zone but it will take some strategy, finesse, and opportunity.  Some good drives will get you a long way, and patience and persistence is key.

 

240_F_128301922_58w07ptHpviYITdXZ5szJXtnSYPAfjqb.jpg

 

We study our competition

Before any play we size up our competition.  Some may block your advance but most you can overcome.  As long as you know your routes and can keep other players at bay, you have a chance of advancing.

ff-routes.png

 

How do we fumble?

Holding a ball loosely and carelessly could cause it to easily fall into another player’s hands.

unsociable-media-man-ignoring-woman-date.jpg

 

But if you hold it too tight it may squeeze out the first opportunity it gets.  A proper cradling, warmth, and protection may be the right recipe.

 

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We need to rely on others during a fumble

Losing the ball is devastating and someone else can pick it up and run with it.  It takes your buddies to help you regain possession so you can start over.

 

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Treat your partner right and don’t lose them to begin with.

 

We are always prepared for an interception

The field is fluid and players are out there watching, waiting to grab your ball and take advantage of the yardage you acquired.

 

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Always be mindful of your position and don’t take your possession for granted.

We adapt when we’re in the red zone

Although the red zone is not officially marked on the field, we understand it to be the 20 yards closest to the end zone, or time during a relationship where you can either advance to your goal or fail miserably, losing all the time and work you put into the relationship.  Being too aggressive may cause a fumble, interception or even injury.  Being too chill could prevent you from ever making a touchdown.

So us football folk know how to stop, huddle, and plan,  hopefully resulting in the ball sailing into the end zone without a hitch.

 

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So if you’re in the dating scene and find yourself getting encroached, needing to scramble, or facing a blitz, watch some football and learn how to treat your date right.  It might get you a whole new set of fresh downs…….

 

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The Baby Boomer’s Guide to Online Dating

 

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

Posted in Alzheimer's, Health, news

Alzheimer’s Cases to Nearly Triple Over the Next Few Decades

Currently 5.7 million people in the US suffer from the debilitating cause of dementia and the CDC estimates close to 14 million will be affected by the year 2060.

As we’re surviving other illnesses that could take our lives sooner, such as heart disease and cancer, we as a population are living to an age where brain changes can occur.

Alzheimer’s is the 5th leading cause of death and scientists still struggle to find a cure or means to stave it off.

 

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The average age of symptom revelation is 65, but researchers believe the disease may set in sooner.  Over 200,000 currently suffer from early onset Alzheimer’s, or onset before age 65.

I believe nightly oxygen or CPAP therapy (Continuous Positive Airway Pressure) might be worth researching as its been postulated that lack of oxygenation can accelerate dementia.

 

What is Alzheimer’s?

Alzheimer’s, a progressive disease in which the brain loses function, is most commonly associated with memory loss. As abnormal proteins build up in the brain (beta-amylaoid and tau), the plaques and neurofibrillary tangles within the nerve cell (neuron), disrupt communication between nerve cells, so memory can easily start to falter.  Many people affected with Alzheimer’s lose newer memories first and then progressively lose old ones.

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However, since the brain is such a dynamic and brilliantly complex organ, a disease that alters its tissue could manifest in a variety of symptoms, beyond memory loss.

These can include:

  • Personality changes
  • Difficulty completing once simple tasks
  • Social withdrawal
  • Labile moods
  • Misplacing commonly used objects
  • Lack of appropriate judgement
  • Issues with problem solving
  • Lack of understanding spatial and timing concepts

 

Hence if a family member appears to lose his way driving home, has difficulty dressing himself appropriately, avoids family gatherings, appears to get angry for no apparent reason, or even offers a young baby an object for a much older individual, these may be signs of a dementia such as Alzheimer’s.

Although Caucasians comprise the majority of cases overall, the CDC found among those over 65, African-Americans have the highest rate at nearly 14%, and Hispanics at 12%.

In a recent study, researchers from Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center found four additional symptoms that may be early signs of Alzheimer’s. These include:

  • Difficulty with speech, vocabulary pool, process and articulating what one wants to say (aphasia)
  • Difficulty writing from a motor and conceptual standpoint
  • Difficulty reading, including comprehension
  • Displaying exaggerated confidence

The study authors state these signs may be overlooked and could be very telling of one’s early disease progression.

To diagnose Alzheimer’s, the medical provider may employ a variety of testing measures including basic history and physical, blood tests to rule out thyroid and vitamin deficiencies, lumbar puncture, CT Scans to rule out bleeds, masses, or stroke, MRI Brain scans, neuropsychological tests, and amyloid PET scans.

Although currently a cure for Alzheimer’s does not exist, there are many  medications being researchered to slow down the progression of the disease and a variety of environmental and behavioral interventions could allow the patient to navigate easier with their challenges.

Can Daily Ibuprofen Prevent Alzheimer’s?

How to prevent Alzheimer’s remains up for debate, but healthy diet, weight, exercise, and control of one’s blood pressure and blood sugar have been suggested.

The earlier Alzheimer’s is diagnosed, the easier it may be to manage, hence family members need to learn and look out for the above symptoms.

 

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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

Sleep Apnea Treatment Can Aid Stroke Recovery

A study out of the Regenstreif Institute and Roudebrush VA Medical Center in Indianapolis suggests giving CPAP to those recovering from a stroke or mini stroke. I have suggested those suffering from concussions in sports to be treated with CPAP to help heal the brain, in hopes to avoid CTE (Chronic Traumatic Encephalopathy), so it makes sense that brain injury from stroke could benefit from the extra oxygenation.

Dr. Dawn Bravata and colleagues studied 252 patients who suffered a stroke or TIA (Transient Ischemic Attack) and found 59% showed improved recovery of their neurological deficits when given CPAP (Continuous Positive Airway Pressure) as opposed to 38% of those who didn’t receive it.

CPAP is commonly used in those who suffer from sleep apnea, or lack of breathing during sleep.  This can prevent oxygenation to the brain and heart throughout the night, severely stressing the body, and I suspect the early morning heart attack or stroke is many times a consequence of a night ridden with sleep apnea.

A study last summer from Sydney University reported loud snoring could be an early warning sign for dementia and memory issues.

Those who have airway obstruction will make noise when they sleep.  Those with obstructive sleep apnea, inability to breath during sleep due to airway obstruction by fat, large tonsils, large posterior tongue and other issues, may in response snore loudly.

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Researchers found those who had sleep apnea had reduced thickness in the temporal lobes, memory centers of the brain which also are integral in speech processing and abstract thinking.  When memory tests were given, those with these changes scored poorly.

Study authors suspect that older people should therefore be screened for obstructive sleep apnea.  Currently we screen those who are overweight, fatigued, or hypertensive, but maybe we should screen all seniors?  Personally, I feel we should intervene sooner, such as middle age, if we want to ward of dementia early.

Could Dementia and CTE be Prevented with Oxygen Therapy?

When brains get deprived of oxygen, during sleep apnea or trauma, dementia and/or neurological sequelae may ensue.

For years I suggested giving oxygen at night to those athletes at risk of CTE, chronic traumatic encephalopathy, and those at high risk for dementia and Alzheimer’s.  Oxygen at high concentrations have been found to help wounds heal, and why should a vulnerable organ fight for oxygen.  Give the brain what it needs.

Last year we learned of a two-year old near-drowning victim, who was submerged for nearly 15 minutes and sustained brain-damaged, surprisingly has “minimal” deficits after given extensive oxygen therapy.

In February 2016, Eden Carlson climbed through a baby gate while her mother was showering and fell into the family pool. Her mother performed CPR and medical personnel worked to revive her for hours. They succeeded, but she had suffered cardiac arrest and brain damage. Upon discharge from the hospital 48 days later, Eden had difficulty speaking, walking and responding to her family.

Her medical team then tried oxygen treatments twice a day in 45 minute sessions.  These were “normobaric” oxygen treatments, or oxygen at the concentration of one atmosphere (sea level). Then three weeks later she was moved to New Orleans for “hyperbaric” oxygen treatments, or breathing 100% oxygen in a chamber greater than atmospheric pressure.

After ten sessions her mother reported “near normal” activity with doctors finding only “minimal damage” on her MRI scan.

An MRI scan 162 days after the incident showed that the child still has mild residual brain injury but the cortical and white matter atrophy she suffered was nearly completely reversed.

AN MRI SCAN 162 DAYS AFTER THE INCIDENT SHOWED THAT THE CHILD STILL HAS MILD RESIDUAL BRAIN INJURY BUT THE CORTICAL AND WHITE MATTER ATROPHY SHE SUFFERED WAS NEARLY COMPLETELY REVERSED.   (MEDICAL GAS RESEARCH)

According to NYDailyNews, the cortical and white matter atrophy (thinning) almost completely reversed.

This raises the question, should oxygen therapy, either normobaric or hyperbaric, be instituted immediately after injury (near drowning, concussion, infection, etc.) and chronically for those at higher risk of dementia (diabetics; those with heart disease, high blood pressure and cholesterol; and stroke victims)?

Athletes who sustain multiple concussions are at high risk of developing CTE, Chronic Traumatic Encephalopathy.  This progressive, degenerative disease of the brain is also found in veterans and those who sustained repeated head trauma.  Symptoms include mood disorders, paranoia, impulse control issues, aggression, and memory loss to name a few.

Many victims of CTE aren’t diagnosed until after they die, upon autopsy and evaluation of brain tissue, hence it may be worth researching early oxygen intervention to those at high risk before symptoms surface.

Now oxygen therapy is not without its risks, as those with COPD, chronic obstructive pulmonary disease, could lose their respiratory drive, and oxygen toxicity could cause bleeding and seizures.  But controlled trials could allow us to investigate if one of the simplest of treatments can help battle some of the most difficult of diseases.

 

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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