Posted in Health, news, vaping

Vaping Creates New Dangerous Chemicals That Become Inhaled

If you remember back in chemistry class, many reactions may transfer heat, or create heat when they combust.  Well the latest study on vaping finds various flavorings in e-cigs, when heated by the heating element, convert to a chemical called acetal.

Yale University Researchers found 2/3 of the time the acetal makes it into the vapor one breaths when they vape.

For years we’ve been trying to warn vapers that the e-cig liquid is not the final product as it can be completely transformed with heat.

Flavors such as “Crème Brulée,” “Fruit Medley,” and “Cool Cucumber” were evaluated for their acetal production.  Vanillin, used in flavoring to make vanilla flavor, has been found to irritate lung linings, and may be one of the biggest culprits when vaping.

According to the National Institutes of Health/National Library of Medicine Database, they report the following in regards to risk factors:

Reported Fatal Dose: 
3= MODERATELY TOXIC: PROBABLE ORAL LETHAL DOSE (HUMAN) 0.5-5 G/KG, BETWEEN 1 OZ & 1 PINT (OR 1 LB) FOR 70 KG PERSON (150 LB).
[Gosselin, R.E., R.P. Smith, H.C. Hodge. Clinical Toxicology of Commercial Products. 5th ed. Baltimore: Williams and Wilkins, 1984., p. II-183] **PEER REVIEWED** 

Now this would be a large amount, but any amount to me is interfering with the one job lungs are designed to do….oxygenate one’s blood.

_____________________________________________________________

Last year a study revealed that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.

Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:

  • lead
  • nickel
  • manganese
  • chromium
  • arsenic

We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).

Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source  low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”

These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure.  Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.

Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.

 

Vaping Linked to Heart Disease and Cancer

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.

nicotine.jpg

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.

 

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

Posted in Health, news, weather

Happy, Horney and Hungry Grasshoppers Are Swarming Las Vegas

 

Las Vegas has seen a swarm of grasshoppers, locusts, in the last few days and residents are asking why….

A rainier season and warm weather may induce migration and mass gathering of grasshoppers, but scientists suggest an additional cause, serotonin.

In 2009, researchers from Oxford and Cambrige Universities revealed that the hormone serotonin may be responsible for desert locusts to swarm.  Anstey et al found elevated serotonin levels 3X higher in those grasshoppers who were swarming as opposed to less sociable, solitary ones.

They also found the stimulation of the hind legs by locusts crawling over eachother as well as the sight and smell of other locusts helped create more of a gathering of the gregarious insects.

In other words, it’s a party.

27xp-grasshopper-videoSixteenByNineJumbo1600

Image from NYTimes

 

Inhibiting serotonin seemed to return the locusts to their solitary grasshopper state.

In the author’s abstract, they write:

We show here that serotonin, an evolutionarily conserved mediator of neuronal plasticity, is responsible for this behavioral transformation, being both necessary if behavioral gregarization is to occur and sufficient to induce it. Our data demonstrate a neurochemical mechanism linking interactions between individuals to large-scale changes in population structure and the onset of mass migration.

Serotonin is a chemical and neurotransmitter that helps affect mood, sex drive, appetite, sleep, growth and even bowel movements.  Low serotonin has been implicated in depression, irritable bowel syndrome and insomnia.  SSRIs (selective serotonin reuptake inhibitors) such Prozac and Zoloft help increase one’s levels of serotonin by blocking receptors that can reabsorb the chemical.

The current swarm of locusts in Las Vegas is not projected to last longer than a few weeks, and no harm should come from the insects.

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

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

 

Posted in disease, Health, news

West Nile Virus Cases in Humans Reported in Multiple States including Nevada

 

Multiple cases of West Nile virus has been confirmed in Clark County, Nevada. The Southern Nevada Health District has declared an “outbreak of mosquito-borne diseases” following new cases of the virus being reported earlier this month.

This summer has been a wetter season in the Southwest, most likely causing an uptick in mosquito activity.

States throughout the country have been reporting cases of West Nile virus as well, with the highest occurring in Arizona (42 cases as of 7/23/19 per CDC).

 

wnv-activity-07092019.jpg

 

West Nile Virus Disease Cases* and Presumptive Viremic Blood Donors by State – United States, 2019 (as of July 23, 2019)

West Nile Virus Disease Cases and Presumptive Viremic Blood Donors by State – United States, 2018 (as of November 27, 2018)
State Neuroinvasive
Disease Cases†
Non–neuroinvasive
Disease Cases
Total
cases
Deaths Presumptive viremic
blood donors‡
Arizona 42 15 57 1 16
Arkansas 1 0 1 1 0
California 2 0 2 1 1
Colorado 0 1 1 0 0
Iowa 0 2 2 0 0
Kentucky 1 0 1 0 0
Maryland 0 1 1 0 0
Missouri 1 0 1 0 0
Nebraska 1 0 1 1 0
Nevada 1 0 1 0 0
New Jersey 1 0 1 0 0
North Dakota 1 0 1 0 0
Oklahoma 1 2 3 0 0
South Dakota 0 1 1 0 0
Virginia 0 1 1 0 0
Wyoming 1 0 1 0 0
Totals 53 23 76 4 17
*Includes confirmed and probable cases.
†Includes cases reported as meningitis, encephalitis, or acute flaccid paralysis.
‡Presumptive viremic blood donors (PVDs) are people who had no symptoms at the time of donating blood through a blood collection agency, but whose blood tested positive when screened for the presence of West Nile virus. Some PVDs develop symptoms after donation.
Please refer to state health department web sites for further details regarding state case totals.

What is West Nile virus?

West Nile virus was originally discovered in the 1930’s in the West Nile district of Uganda.  It is believed to have reached the United States in the late 1990’s.

It’s in the family of Flaviviridae in which the disease is vector transmitted, such as by ticks, or mosquitoes, and can infect mammals as hosts. West Nile is in the same family as Zika, Yellow Fever, Dengue Fever, and Japanese Encephalitis.

Culex genus/species of mosquitoes are the usual culprit.  They feed from evening to morning, hence are more active during those times.

How is West Nile transmitted?

A mosquito contracts the disease while feeding on an infected bird and then can transmit it to humans.

WNV-transmission-cycle.jpg

What are the symptoms of West Nile virus infections?

80% of those infected do not exhibit symptoms.  Some however, may elicit the following if they have mild illness:

  • Fever
  • Body aches
  • Fatigue
  • Nausea
  • Vomiting
  • Joint  pains
  • Weakness
  • Rash

Diffuse-maculopapular-rash-associated-with-West-Nile-virus-infection.png

Image from Reserachgate

Rarely (1 in 150 people) may become seriously ill with neuroinvasive symptoms.  These include:

  • Headache
  • Neck pain/Stiff neck
  • High fever
  • Sensitivity to the light (photophobia)
  • Tremors
  • Weakness
  • Paralysis
  • Confusion
  • Disorientation
  • Seizures
  • Coma
  • Death

Since mosquitoes are the primary vector, avoiding them is paramount to limiting infection.  We recommend the following:

Clean up areas of standing water around the house such as kiddie pools, puddles, buckets as they provide a breeding ground for mosquitoes.

Wear light long sleeve clothing, pants tucked into socks/shoes when outside.

Use DEET or insect repellent that can also be sprayed onto clothes when planning to be outdoors.

Be aware that many mosquitoes are active from dusk till dawn.

If bit by a mosquito, contact your local medical provider if you have any of the aforementioned symptoms.

 

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Great Gift!!!

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

Posted in Health, medical school, news

First Year Medical Student Dilemma….Do I Really Need to Buy the Expensive Diagnostic Equipment for Class?

Medical school is no joke. It’s one of the most expensive degrees out there.  And before one starts, they are asked to purchase equipment for their first year training that can total over $1000.  Most students are expected to purchase at minimum the following:

  • Stethoscope
  • Otoscope/Opthalmascope Set
  • Monofilament
  • Reflex Hammer
  • Light source/Pen light
  • Watch
  • Bag for items

So for year’s I’ve been asked how imperative it is that they spend the money?

Why the debate?  Well many students argue the following:

  • Most clinic settings have equipment on the walls (except for stethscope of course)
  • Most student’s can’t carry all their equipment around on clinical rotations since it’s not practical
  • Most schools train their students in groups so does each one need to purchase the items or can they share amongst a group?
  • They’ll only use the eqiupment once in class and never again in their careers.

However, arguments for purchasing the equipment include the following:

  • Your school may require it
  • Some clinics have broken equipment and you will be the one student who is ready to jump in
  • It’s advantageous to have a set at home later to use for practice on family members
  • Most of us doctors do still have our sets from medical school and its a great momento

What if I can’t afford the new equipment?

Before going online to buy second hand equipment that may not work or have a warrenty, I suggest:

  • Asking your school if there are any student discounts or scholarships to help finance the purchase
  • Ask the school if equipment can be purchased as a small group
  • Borrow (or rent for a nominal fee) from an older medical student
  • Ask your course instructor if all items need to be purchased or if some are elective

Whatever you do, however, do not go cheap on your stethoscope. You will use it thousands of times in your training and cheap ones do not do as good a job. And as a medical student lives will be at stake and your stethoscope is one of your most important tools.

Discounted items can be found here at TheMedicalStudentNetwork.com.

Finally, congrats on getting into medical school!!!!  xoxoxoxo

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

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

 

 

 

Posted in Health, news

Superfungus Cases Continue to Rise

 

The CDC is now reporting 685 confirmed clinical cases of the fungal infection, Candida auris (C. auris), that unfortunately is resistant to multiple types of antifungal drugs. Moreover another 30 cases are being monitored who were in contact with those infected.  This spike is very worrisome.

map

States reporting C. auris infections include:

  • New York
  • New Jersey
  • Indiana
  • Illinois
  • Massachusetts
  • Maryland
  • Oklahoma
  • California
  • Connecticut
  • Florida
  • Texas
  • Virginia

The majority of the cases are in New York, Illinois and New Jersey.  Many of those infected have died but they did have other comorbid conditions, which could have also contributed to their becoming infected with C. auris to begin with.

Please note that this fungus is different from  the species, Candida albicans, which causes common yeast infections.

When investigators first analyzed facilities reporting outbreaks, they found C. auris had colonized mattresses, beds, chairs, counter surfaces, infusion pumps, and window sills.  By this, the superbug demonstrates its resilience outside a human host.

Candida-auris_2016-250px.jpg

IMAGE FROM WIKIPEDIA

The superfungus still has some vulnerability to antifungal medication but its resistance is increasing.

C. auris can cause a variety of infections involving the skin and ear, but most concerning, is sepsis (infection of the bloodstream).  C.  auris was first identified in Japan back in 2009, but upon retrospective review, the CDC states the earliest known strain dates back to 1996. Since then it has been reported in multiple countries including the UK, Israel, South Africa, South Korea, Columbia, Pakistan, Kuwait and Venezuela.

Most hospital disinfectants are currently designed to be antifungal, antibacterial and antiviral.  The CDC has urged healthcare facilities to be diligent in their cleaning practices and to be aware of this “superfungus.”

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

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

 

Posted in diabetes, Health, news

Diabetes Again Linked to Pancreatic Cancer

Another study highlights the risk between high blood sugar and pancreatic cancer.

Researchers from Kangbuk Samsung Hospital in Seoul found as study participants’ blood sugar rose so did their incidence of pancreatic cancer.  Some theories behind one getting cancer could be the following:

  • A virus causes a pancreas to decrease its insulin producing capabilities and this same virus may be culprit in future cancer
  • One with a high sugar diet may be over consuming what the pancreas can handle and the overwork puts one at risk of cancer

According to the CDC, 30.3 million people in the US have diabetes, and at least 100 million Americans suffer from pre-diabetes or diabetes.

Previously the 7th leading killer of Americans, diabetes affects so many people that it has now become third leading cause of death in the US.  A study in 2017 found 12% of deaths in the US is caused by diabetes, trailing behind heart disease and cancer, ranked at #1 and #2.

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/.

What are the risk factors for pancreatic cancer?

Known risk factors for pancreatic cancer include:

  • Older individuals
  • Male (though women are affected as well)
  • Diabetes
  • Alcohol use
  • Chronic pancreatitis
  • Genetics
  • African-American descent
  • Ashkenazi Jewish descent
  • Obesity
  • High fat diet
  • Hepatitis B
  • H. pylori infection
  • BRCA1 or BRCA2 mutations
     

    Can Diet Soda CAUSE Diabetes?

Artificial sweeteners have been linked to diabetes and diabetes is a risk factor for pancreatic cancer.  Their relationship to pancreatic cancer, however, still remains controversial.

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

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

Posted in Education, Health, medical school, students

Creating your MSPE Characteristics for Residency Applications

For those medical students applying for residency, the student needs to provide a short list of “noteworthy characteristics” that are not listed elsewhere in their application.

The Association of American Colleges (AAMC) explains what the “noteworthy characteristics” are:

This section includes information intended to help a residency program selection committee review applicants holistically to achieve a residency class that brings a diverse set of background experiences, characteristics and perspectives.
• Provide a maximum of three characteristics highlighting the most salient noteworthy
characteristics of the student.
• This section should be presented as a bulleted list. Each characteristic should be described in 2 sentences or less. Information about any significant challenges or hardships encountered by the student during medical school may be included.
• Lengthy biographical descriptions are not recommended due to the time required for review and because these details can be found in other sections of the applicant’s portfolio (e.g., ERAS application, personal statement, letters of recommendation, interviews).
• The identification of the noteworthy characteristics can be done by each student in consultation with a designated mentor or advisor, or by the MSPE author.

So in essence, they are no more than 3 short entries highlighting a unique quality and why you possess that quality.  Even though they say a “maximum of 3” do not just write one.  I would suggest writing three.  By the time the program director reads these three short sentences, they have a better picture of you as an individual.

Topics that you can draw your characteristics from include:

  • Missions done
  • Places traveled
  • Raising a family while going to school
  • Creating a charitable/community event
  • Passion, hobby, talent
  • Personal or family challenge
  • Why you chose your research project
  • Life experiences
  • Honors and Awards
  • Leadership positions that you held and what you impressive task you completed

These are usually written in third person.

Examples of these may be:

  1. As an avid traveler (or having completed a mission), Mary is fluent in Spanish, which has helped her communicate with many of her patients during training who were Spanish-speaking only.
  2. Having come to the United States as a small boy, Ti learned English and the American culture at a young age, making new friends and excelling in his school work.
  3. John served as Events Coordinator for the ACOFP and organized a water and sunscreen passout to homeless people at risk of dehydration, heat illness and skin cancer last summer.
  4. Ryan is an avid pianist and has performed at multiple venues including local adult day care centers and charity galas.
  5. Having seen her grandmother battle lung cancer, Jaime worked with other students to put up tobacco hotline numbers on university campuses.
  6. After Breana had a scare with an abnormal skin lesion, that fortunately was not skin cancer, she devoted additional patient education on how to screen for skin cancer with many of her patient interactions as a student.
  7. Lisa participated in multiple marathons, including the Boston Marathon, completing all of them.
  8. Mark lost over 50 lbs when he discovered a plant-based diet, and now educates patients on how inclusion of vegetables is paramount to a healthy diet.
  9. Scott’s academic strength was exemplified by making the Dean’s List during both years of Basic Science, and choosing to tutor other younger students when he moved on to his clinical years.
  10. Maya actively practices yoga and many times has held yoga and meditation workshops for students after school.

So as you see you can be as creative as you wish, and don’t be afraid to “brag.” This is your time to toot your horn and make yourself stand out!  You are applying for the job of your life….prove to them you are exactly what they need for their residency program.

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

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