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.

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.

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!!!

The Ultimate Medical Student HandBook

 

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

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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 is not clearly defined it is believed that increased PM2.5 levels increase the risk of lung and heart disease as discussed above.

lungs_alveoli-57ffa7fe3df78cbc284e162b

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.

#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 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.

 

FullSizeRender (1)

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.

 

 

 

 

Posted in disease, flu, Health, news

This Year’s Flu Season Has Begun

Although flu season officially starts in October, public health officials in Riverside, California have already reported the first “flu-related” death this year, a 4 year-old child.

And being that Australia’s flu season began a couple weeks early and was more “severe” than previous years, US health experts are bracing for a rough one of our own.

We still, however, cannot predict how “severe” this year’s flu season will be, but here are answers to the most commonly asked questions about the flu.

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 a flu-related death.  As the season unfolds, more cases will be 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/Brisbane/02/2018 (H1N1)pdm09-like virus
  • A/Kansas/14/2017 (H3N2)-like virus
  • B/Colorado/06/2017-like (Victoria lineage) virus

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.

How long does it take the flu shot to “kick in”?

The average immune system takes a couple weeks of to prime, so we suggest getting the flu shot before the season starts…or peaks.  However, experts recommend to still get the flu vaccine to anyone who missed early vaccination.

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!!

 

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.

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

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

Image above from Riverside Community College District

 

Failing an exam is not easy, especially if it’s one of your boards.  However, these tests have been failed many times before by multiple students who go on and become very successful in their field.  So what do you do when you get the crushing news?  We take it step by step…..

COMLEX 2 PE Failures: Your Questions Answered

 

Know You’re Not Alone

Considering the countless exams you’ve taken throughout your schooling, you’re sure to wind up stumbling on a few.  And none of the boards have a 100% pass rate. So there are numerous students right now in your same shoes.  The majority of them succeed on their next attempt so odds are in your favor.  Failing a set of boards should never stop your path of becoming a physician, because odds are you will succeed next time around.

 

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

 

Expect to Go Through the Five Stages of Grief

As soon as you receive the failing grade you will immediately be in a state of denial.  As described above you will also feel isolated, but remember, you’re not alone.  Then you’ll become angry that a testing service or grader thought you were not worthy to become a doctor.  You’ll learn that’s not the case but it will still ruin your day, week, or month nonetheless.

Next you may go through a period of bargaining, thinking you could reach out to the testing center to appeal the grade, or pray the grade away, and when the score doesn’t change, you may fall into a depression. Finally you realize the grade is here to stay and you reach acceptance, which is a good sign and necessary to recover and eventually succeed.  Once you’ve accepted what has happened you can start planning how to rectify the situation.

Many students feel they shouldn’t go through the above stages, but how else will you begin to heal from a such a traumatizing incident?  Which brings us to….

 

Take a Moment for Yourself

Being told you fail a test hurts, and you’ll want to scream or cry. That’s normal, being you busted your butt in school for years and an exam is trying to get in your way of you reaching your goal.  But when we fall we need to get back up and brush ourselves off.   The most satisfying thing you can do at this stage is prove the testing centers wrong by passing it the next time around.  Remember you are in your final years of medical school and you overcame much bigger obstacles than this.   You got this. So now what do you do next…..

 

Notify Your School Immediately

Some programs are made aware of a time frame in which test scores come out but may not know what exact day scores are released.  So if you failed and are expecting to hear from them checking in on you, don’t. Reach out to them first but realize that not hearing from your medical school is not a sign of indifference.  Once they know you failed they can start setting up a remediation program if they have one or get you in touch with valuable resources.

 

humanism book cover final

Humanism Prep Guide For the Boards

 

Be Open To Criticism and New Instruction

Medical students are told their whole life how “smart” they are so we sometimes persist in the disbelief that we failed a test. However, if you failed, chances are you did something wrong.  So take instruction and learn from it.  Even if other doctors in your clinical rotations have taught you differently, those professors in your institution who understand the boards will have insight to help you pass the boards, which is your primary goal.

If you failed humanism/communications – practice bedside manner, confidence building, questions patient’s commonly ask their doctor, as well as making sure the patient understands what you’re thinking and about to order for them.

If you failed SOAP notes – practice typing speed, write out notes for multiple cases, have others grade your work to see what you’re missing.

If you failed data gathering, practice coming up with differentials or body systems and common questions to ask, and review cases of all chief complaints offered in study guides.

Passing a test is a game..it always has been. We learned how to play the game early on in our grade, middle and high school years but now we’re playing pro and the stakes are higher when it comes to medical boards.  Realize you need help and be open to it.

Phone a Friend

You will need support from those you love and have your back.  Don’t be embarrassed discussing this one stumble in a long line of schooling successes.  No one makes it through medical school alone, so leaning on someone is par for the course.  Plus you feel better opening up.  I’ve heard from countless students who failed their PE and CS and am here as well.

Medical students and professionals aren’t perfect and shouldn’t be expected to be.  But we are strong, resilient, and hard working.  So approach your board failure as you’d do anything in medicine.  Evaluate, assess and treat…….You got this!

 

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

 

 

Posted in cancer, Health, medications, news

Ranitidine Being Evaluated For Cancer Causing Chemical

The FDA has announced that samples of ranitidine, an H2 Blocker used for stomach upset, reflux and ulcers sold generically and under the brand name of Zantac, were found to have the contaminant N-nitrosodimethylamine (NDMA).  This is one of the chemicals that prompted the generic ARB blood pressure medication recalls last year.

There have been no reports of users becoming ill and no recall has been suggested at this time. In animals, NDMA is known to cause liver and lung cancer.  In humans its carcinogenic risk is unknown, however the CDC states it may cause liver function impairment and cirrhosis.

The FDA writes:

The FDA is not calling for individuals to stop taking ranitidine at this time; however, patients taking prescription ranitidine who wish to discontinue use should talk to their health care professional about other treatment options. People taking OTC ranitidine could consider using other OTC medicines approved for their condition. There are multiple drugs on the market that are approved for the same or similar uses as ranitidine.
Consumers and health care professionals should report any adverse reactions with ranitidine to the FDA’s MedWatch program to help the agency better understand the scope of the problem:

The investigation is ongoing and more needs to be looked at when it comes to this manufacturing process suspected to result in these “impurities” being made.

Last year NDEA was also found in the generic  blood pressure medications that were the subject of recall, however has not yet been suggested as being being present in ranitidine.

N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) was the third chemical detected resulting in the latest two recalls of losartan, an angiotensin receptor blocker commonly used to treat hypertension (high blood pressure).  It is believed to have been created during the manufacturing process of the generic drug.

pills.jpg

NMBA, according to Toronto Research Chemicals, is a known carcinogen in a wide range of animal species.

Last Fall, ScieGen Pharmaceuticals, Inc. recalled certain lots of irbesartan, a similar angiotensin receptor blocker used in blood pressure management.

The recalls initially began last summer when FDA recalled a number of lots of valsartan due to an “impurity”, N-nitrosodimethylamine (NDMA) that is known to cause cancer in animals.  Weeks later they additionally found traces of N-nitrosodiethylamine (NDEA).

According to Reuters, earlier last summer, the MHRA, Medicines and Healthcare Products Regulatory Agency, located in the UK, said the appearance of the impurity, N-nitrosodimethylamine (NDMA), came after a change in the process for making valsartan at one facility owned by Zhejiang Huahai Pharmaceuticals, a company in Linhai, China.

With NDEA, data is limited, but due to its classification as a nitrosamine and its prevalence in tobacco smoke it is classified as a probable human carcinogen.

According to New Jersey Department of Health’s website, NDEA has been linked to liver, lung and gastrointestinal tract cancer in animals.

Losartan, valsartan and irbesartan are medications in the class of angiotensin receptor blockers (ARBs) used for high blood pressure and congestive heart failure.

Those taking either tablet for their blood pressure are urged to not abruptly stop their medication but rather check with their medical provider and pharmacy to see if their particular prescription is involved in the recall.

I suspect more recalls will follow as processes may be similar across multiple pharmaceutical facilities and NMBA, NDMA and NDEA are byproducts that may not be individually unique to just one “brand” of medication manufacturing.

 

ultimate book cover final

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