Posted in Health, Millennials, students, suicide, teens, vaping

Teen Suicide Rates Soaring…Is Vaping and Nicotine Dependency a Cause?

The CDC reported this week that teen suicide rose 58% over the years 2007-2017 in the age group 10-24.  Although many experts blame social media and teen drug use, one theory may need to be considered:  nicotine withdrawal from vaping.

Millions of middle school and high school students admit to vaping…and many more are assumed who don’t admit to it when surveyed.  So we have an underestimation of how many adolescents take regular hits of their electronic cigarette, exposing them to the powerful, addictive nicotine. One pod, placed in an electronic cigarette to be vaped, contains as much nicotine as a pack of cigarettes.  Hence if a pod is smoked at school, and when the child is home goes hours without, they may “come down” off the nicotine high that they had hours earlier.

In 2002 Picciotto et al discussed how nicotine can affect mood swings, anxiety and depression, where in some cases it can act as an antidepressant but when one withdrawals from it can have increased and anxiety and depression.

The teenage mind and psyche is still developing during this time and a chemical dependency could muddy the mental health waters.

There’s no doubt social media and the misconception teens have that their lives are not as glorious as those who they view online is contributing to lack of confidence, poor self-esteem and depression.  But the decision to commit suicide may also be chemically induced, or a withdrawal of one and should be investigated.

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.

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

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

  • Formaldehyde (human carcinogen)
  • Acetaldehyde (carcinogen related to alcohol drinking)
  • Acrolein (highly irritating and toxic)
  • Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
  • Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

For more on the study read here.

Toxic metals found in vaping liquid

Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.

Last year one study reported 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.

 

ultimate book cover final

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 fires, Health, news

Health Risks From Wildfire Smoke

As thousands of acres burn in Southern California, those residents lucky enough to escape the flames worry what consequences could result in inhaling the smoke.

What is in wildfire smoke?

According to the EPA, smoke emanating from forest and community fires may include any of the following:

  • Carbon monoxide, which competes with oxygen in the blood
  • Carbon dioxide, a respiratory byproduct
  • Wood particles
  • Formaldehyde
  • Acrolein – used as a pesticide
  • Benzene
  • Plastics, and those byproducts after incineration
  • and thousands of different respiratory irritants.

According to the EPA,

Smoke is composed primarily of carbon dioxide, water vapor,
carbon monoxide, particulate matter, hydrocarbons and other
organic chemicals, nitrogen oxides, trace minerals and several
thousand other compounds. The actual composition of smoke
depends on the fuel type, the temperature of the fire, and the
wind conditions. Different types of wood and vegetation are
composed of varying amounts of cellulose, lignin, tannins and
other polyphenolics, oils, fats, resins, waxes and starches, which
produce different compounds when burned.

What symptoms may individuals experience?

Some may have no idea they are breathing in harmful compounds that could affect their lungs and heart.  However, many may experience:

  • Cough
  • Wheeze
  • Difficulty Breathing
  • Chest Pain
  • Mucous Production
  • Dizziness/lightheadedness
  • Fatigue
  • Racing Heart (palpitations)
  • Exacerbation of their lung disease including COPD, asthma, chronic bronchitis
  • Exacerbation of heart conditions such as angina, heart attack, and cardiac arrhythmias.
  • Increased susceptibility to new lung infections as well as flu

 

What are PM2.5s?

PM2.5 are particles less than 2.5 micrometers in diameter that are present in pollution and wildfire smoke that can penetrate deeply into the lung linings.  Larger, coarse particles 10 micrometers in diameter are called PM10.  Both impair lung function as they inflame the lungs and interfere with the work of alveoli that need to oxygenate the blood.  Moreover the small particles can use this pathway to enter the blood stream. Although the direct health impacts of the fine particulate matter are not clearly defined it is believed that increased PM2.5 levels increase the risk of lung and heart disease as discussed above.

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LUNGS AND ALVEOLI (IMAGE FROM THOUGHTCO.)

Symptoms may begin at levels greater than 55 µg/m.

Which individuals are the most at risk?

  • Infants and Children
  • Elderly individuals
  • Those with chronic lung disease, including asthma and emphysema
  • Those at risk for heart disease and stroke
  • Those with diabetes
  • Smokers
  • Pregnant women
  • Those with chronic allergies
  • Pets

 

How can residents protect themselves?

Avoiding the area of wildfires is paramount.  Additionally, the following may be considered:

  • Avoid outdoors until air quality reports improve.  Do not rely on how “clear” the air looks.
  • Take heed of wind and air quality advisories.
  • Recirculate the air in your home and car.
  • Keep windows closed.
  • Consult with your medical provider to monitor blood pressure, heart rhythm, lung function and refill any medications you may need BEFORE you feel symptoms.
  • Be wary of facemasks sold as PM2.5 safe as many do not protect against the very small particles. Respirator masks labelled N95 or N100 may provide SOME protection against particulates but not against the toxic fumes such as formaldehyde and acrolein.

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

 

Posted in breast, cancer, 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.

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#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 268,000 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,000 cases of non-invasive breast cancer, a rise from last year.

41,700 women and 500 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.

 

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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.

 

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3-D MAMMOGRAM IMAGE

 

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

Posted in COMLEX 2 PE, Education, Health, medical school, news

COMLEX 2 PE Failures: Your Questions Answered

This is Part II in a series in which we put your mind at ease after you learn you failed one of the most important tests in your training.  We know it’s not easy and lots of emotions are stirring, but since you will need to retake the exam, let’s dissect the most common questions so we can get you ready for the next one.

Why did I fail?

It’s the first question you’ll ask yourself and understandably so because you will want to improve on what you missed.  However, for many students they clearly can’t understand why…..they performed the correct OMT modality, they completed their SOAP notes on time, they made the SP smile….so what happened? We may never know exactly why one fails their PE but it could include some of the following:

HUMANISM

  • Failure to greet the patient and thank them for waiting
  • Failure to make them feel more comfortable if they are in distress
  • Failure to respect their privacy when it comes to gowning and draping
  • Failure to maintain good eye contact and reflectively listen
  • Failure to allow the patient adequate speaking time to answer your questions, (i.e. interrupting or rapid fire questioning)
  • Not “intervening” when they admitted to having a daily habit that could contribute to a health condition (i.e. smoking, alcohol use, poor diet)
  • Not ensuring the patient understood the assessment or reasons for questioning
  • Not appearing confident when one explains the assessment and plan
  • Not suggesting to address the pain or distress in the plan
  • Rattling on and not closing the encounter strongly.
  • Failure to suggest modifications that can help them at work or home

humanism book cover final

Humanism Prep Guide For the Boards

 

DATA GATHERING

  • Failure to address other body systems by only concentrating on the chief complaint (i.e. a left shoulder pain complaint may also need questioning regarding chest pain in addition to musculoskeletal symptoms)
  • Failure to ask associated symptoms or pertinent positives/negatives (i.e. in a patient presenting with back pain, inquiring about lower extremity numbness and tingling, incontinence, hematuria, etc.)
  • Failure to address medical symptoms that may stem from a habit they have (i.e. urethral discharge if they partake in unprotected sex)
  • Failure to address medical symptoms from a medication they may excessively take (i.e. abdominal pain or blood in the stool of a patient who takes NSAIDS often)
  • Failure to examine the appropriate body parts that could be contributing to the illness, (i.e. thyroid and carotids in a patient presenting with dizziness)
  • Asking “why” when they take excessive medication – they may be self treating another medical condition
  • Asking “why” they came in for a physical (family member may have been worried about their memory)

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

SOAP note

  • Failure to complete all four sections (S O A P) consistently in each case
  • Failure to address the chief complaint in all four sections (i.e. if one presents with back pain, did the note address the subjective complaints, an exam of the back, differentials of what the back pain could be, and testing/OMM in the plan that addressed the back pain?)
  • Failure to include associated symptoms (i.e. in a patient presenting with a headache, were they negative or photophobia and neck stiffness)
  • Failure to document appropriate history and physical
  • Failure to list the differentials that the presenting complaint could be (i.e. a patient presenting with fatigue may have depression, anemia, sleep apnea, hypothyroidism, antihistamine overuse)
  • Failure to include OMM, testing, medications, work modifications, follow up in the plan.

OMM

  • Failure to ask permission prior to performing the OMM
  • Failure to explain what OMM is and why one is choosing to perform it
  • Appearing “rough” in technique
  • After performing the OMM, failure to ask how the patient felt and its effect on symptomatology

 

How soon can I retake the PE?

Although most students can go online and register for their retake, most academic institutions will have guidelines on when one should sign up for the retake and prove eligibility to remediating professors.  We suggest you follow your school’s recommendations as retaking the test too soon could lead to an additional failure.

 

Failed Your COMLEX 2 PE/Step 2 CS? Here Are Your Next Steps…..

 

How many times can I take the PE?

According the NBOME website, students are allowed 4 attempts in a single year and 6 total.  However, many academic institutions may have different guidelines, so review your school’s handbook to determine how many attempts they will allow before dismissal.

Is it better to take my retake in a different city than the first one?

We have not seen any data on switching test sites and its effect on passing one’s retake.  For some students the familiarity of the testing city and neighborhood makes the retake easier.  For others a fresh city with fresh SP’s offer the placebo needed to pass. Since the average SP doesn’t remember one student specifically or their score, the effect of seeing a repeating SP is negligible.

Will I not match into residency due to my PE fail?

Most students who retake their PE and pass, go on to match into a residency.  Of course this could be more challenging if one picks a specialty that is highly competitive such as surgery.  However, overcoming a test fail is often times looked upon positively by program directors.  If the question comes up during the interview be honest and humble without blaming anyone or anything for the failure.

Will a PE failure prevent me for applying to residency this year?

Most schools have a timeline on what needs to be completed before entering the match and better yet, some have a fail-safe built into the curriculum to allow some time off for board remediation if needed.  Most schools however, want all board scores passed before entering the match, and since test scores may take 6-8 weeks to comeback after taking the exam, discuss with your school on your time needed to remediate and when to schedule your retake.

Should I take a leave of absence (LOA) to study for the PE?

If you feel you need to concentrate your efforts on passing the exam, an LOA may be of huge benefit. However, other students use their clinical rotations to help them hone in on their PE skills and prefer to keep learning while preparing for their retake.  This decision will be based on your school’s recommendations and the degree of your PE failure (i.e. one section vs multiple sections.)

Will I still be able to get letters of recommendation (LOR) from faculty if I failed my PE?

Yes….but make wise choices in choosing the faculty. Those with whom you closely worked during clinical rotations, research, or community service are good choices, especially if they liked you and you performed well around them.

 

Again, hang in there. We know you just received devastating news with your first failure,  but remember most students who study, retake their PE and pass, go on to residency.  It’s a bump in your long academic road but a small one and one that can be easily overcome.  You got this!!

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

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