Posted in Health, news

Orthopedic Injuries We May Sustain With Our Bathroom Habits

Have you ever been told you have carpal tunnel syndrome or a rotator cuff tear?  When you question the diagnosis, citing no history of trauma, you’re told “it can stem from repeated, recurrent use of a joint.”  So what do we do repeatedly each day? Well we eat, sleep and potty.  Unbeknownst however to the pottier, is there is a method by which we can avoid many injuries including the aforementioned. So let’s dive in.

Some of the following orthopedic injuries that could be sustained from poor potty habits include:

Carpal Tunnel Syndrome – numbness and tingling that arise from an “entrapment” of the median nerve between the wrist and carpal bones.

arthritis_carpel_tunnel_syndrome_carpal_tunnel_syndrome

 

De Quervain’s Tenosynovitis – inflammation of the tendons in the wrist and lower thumb

 

de-quervains-tenosynovitis-8col-3746063-001-0

 

Trigger Finger – a locking or snapping of a finger, preventing smooth movement caused by inflammation and scar tissue surrounding the tendons

 

ds00155_im01852_mcdc7_trigger_fingerthu_jpg

 

Rotator Cuff Tear – injury, inflammation or tear of the muscle or tendons surrounding the shoulder

a-medical-illustration-of-rotator-cuff-tears-original

and more…..

If a “clean break” occurs, minimal wiping is needed.  However, if stool is mushy, or if one is constipated or has diarrhea and soils themselves more with stool passage, multiple wiping attempts are needed.  Hence repetitive use of one’s upper extremity and its joints can put one at risk for any of the above ailments.

Is Toilet Paper BAD For Your Tush?

So firstly one might consider a bidet.   It requires very little joint movement and the spray of water seems to do the majority of the the work, unless you need to use your hands to help.

On one hand, bidets are a less aggravating means to clean an anus.  Warm water can rinse off sediment that paper cannot. And those with anal fissures or hemorrhoids will be less inflamed, since they didn’t have to rub dry paper along the cuts/swelling.

However, a 2010 study found bidets to aggravate vaginal microflora, or natural occurring bacteria.  Oquino et al writes, “Habitual use of bidet toilets aggravates vaginal microflora, either by depriving normal microflora or facilitating opportunistic infection of fecal bacteria and other microorganisms.”

Another issue with bidets is many require you to use your hands while cleaning your butt.  This potentially allows fecal matter to be transmitted elsewhere as it gets on your hands. Toilet paper offers a barrier to this.

However what would be ideal is some wet toilet paper.  Not chemical laden wet wipes but wet toilet paper to help lessen the number of passes necessary to clean one’s tushee.

When one says “the knee bone is connected the thigh bone” well they’re not too far off. As you see the tushee can be very much connected to upper extremity joint health.

 

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

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Posted in Health, news

Sepsis is NOT a Single Disease but has Subtypes

One of the leading causes of death in hospitalized patients is much more complex than once thought.

Septicemia is an infection that enters one’s blood stream.  This can result in Sepsis, a life threatening condition that occurs in response to the blood infection. Its definition has been fluid over the years as more research reveals it’s a disease process.

Sepsis-Awareness-web

Image from Tristatehospital.org

Now researchers in a study published in JAMA describe 4 separate subtypes of Sepsis. These include:

α phenotype had fewer abnormal laboratory values and less organ dysfunction;

those with the β phenotype were older, had greater chronic illness, and were more likely to present with renal dysfunction;

those with the γ phenotype were more likely to have elevated measures of inflammation (eg, white blood cell count, premature neutrophil count [bands], erythrocyte sedimentation rate, or C-reactive protein), lower albumin level, and higher temperature;

and those with the δ phenotype had elevated serum lactate levels, elevated levels of transaminases, and hypotension.

Dr. Christopher Seymour of the University of Pittsburgh School of Medicine, states in Medical Express, “Right now, our treatment approach to sepsis is basically ‘one size fits all,’ whether you are a 40-year-old with influenza complicated by [a] staff infection or an 80-year-old with multiple comorbidities and biliary sepsis,” he said, adding that international sepsis practice guidelines recommend the same bundle of care for everyone.”

23-04Sepsis-signs-and-symptoms-01

Current goals in medicine aim to treat the patient rather than the disease, and as we need to individualize treatment for those with high blood pressure, cancer and diabetes, we need to as well with acute, deadly diseases such as sepsis.

 

 

 

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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, Politics

Ending Surprise Medical Bills…Not So Easy

The Trump Administration has vowed to put an end to “surprise medical bills.”  But this may be easier said than done.

Reports of “sticker shock” have exponentially grown over the years and consumers want transparency of what their health care visit is going to cost.  However, the average physician, nurse practitioner, physician assistant, hospital, medical center, etc. don’t know themselves until the insurance company sends an EOB “Explanation of Benefits” delineating what is discounted, what is covered, and what is the patient responsibility.

So to start, President Trump is asking Congress to address those charges incurred by “out of network” facilities to which patients go to in an emergency setting.  Wanting to hold “insurance companies and hospitals accountable,” President Trump wants to put an end to patients getting charged for “services they did not know anything about, and sometimes services they did not have any information on.”

Can he do it?  Politicians on both sides of the aisle want to help curb health care costs, but both sides want to get the credit.  There’s race to see who could do more for healthcare before the 2020 election.

Why can’t health costs be predictable/fixed?

There’s a few reasons why cost transparency in an emergency medical setting is challenging.

Firstly, insurance companies aren’t transparent to hospitals. They only inform the medical facility of the out of pocket costs once they take weeks to review the claim.  This can be streamlined and cut down in time with software, but same day pricing by an insurance company is impeded by the need to see if the patient paid (or will pay) their premiums that month, or if they are still employed and have the same active insurance.

Secondly, patients don’t always know what their diagnosis is when they walk up to the front counter. Some may think they have a “cold,” but actually end up having a bout of pneumonia. Some may think they have a “stomach bug,” but after CT confirmation, learn they have appendicitis. Hence until the medical provider performs the evaluation and testing, a diagnosis and then “cost to treat”, cannot be given.

Finally, patients may not prefer the “cost factor” added into their facilities’ decision making.  If they pay a certain amount for a visit and end up needing more pain control, a repeat breathing treatment, or some extra bandages, they may not want to have to take out their wallet, sort of speak, each time they need more services.

As a physician who, for years, pleaded with insurance companies to give us an idea of what they would want a patient to pay, I’m for any campaign to increase price transparency and offer patient’s more choice.  However, since medicine and health can be unpredictable, coming up with predictable “costs” may prove difficult.

 

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Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

 

 

 

Posted in Health, news

Parkinson Risk Tied to Appendix Removal

Those who have had their appendix removed may be at 3X greater risk of later developing Parkinson’s.

Researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center looked at 62 million health records from 26 institutions throughout the US and found that those who had an appendectomy, surgical removal of the appendix, had a 3-fold risk of developing Parkinson’s later in life.

Internal medicine second year resident and study author, Dr. Mohammed Z. Sheriff, states,

“Recent research into the cause of Parkinson’s has centered around alpha synuclein, a protein found in the gastrointestinal tract early in the onset of Parkinson’s.”
“This is why scientists around the world have been looking into the gastrointestinal tract, including the appendix, for evidence about the development of Parkinson’s.”

Researchers suggest more research to be done, with investigational focus on gut health as it relates to neurological health.

The Appendix: NOT a useless organ

 

What is Parkinson’s Disease?

Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year.  It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.

 

substantia nigra

IMAGE FROM THE SCIENCE OF PARKINSON’S DISEASE

 

It was first described in 1817 by James Parkinson as a “shaking palsy.”

What are the Symptoms of Parkinson’s?

Common symptoms of Parkinson’s include:

  • Stiffness and rigidity
  • Poor balance
  • Tremor at rest, especially a pill-rolling tremor
  • Slow movement
  • Inability to move
  • Shuffling steps, gait

and patients may later develop…

  • Depression
  • Anxiety
  • Memory loss
  • Constipation
  • Decrease ability to smell
  • Difficulty swallowing
  • Erectile dysfunction
  • Pneumonia
  • Fractures from falling
  • Hallucinations
  • Delusions
  • Dementia

Who is at Risk for Parkinson’s?

Most cases are idiopathic, meaning the disease arises with no specific cause.  However some cases are genetic and multiple genes have been identified that are associated with the disease.

The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.

Men appear to be more affected than women at twice the rate.

Risk may be enhanced with a history of head trauma.

Exposure to herbicides and pesticides has been linked to an increase risk of Parkinson’s as well.

 

How Quickly do Parkinson’s Symptoms Progress?

Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.

The stages of Parkinson’s are illustrated below:

What-Are-the-Stages-of-Parkinson_s-Disease

How is Parkinson’s treated?

Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.

  • Levadopa – converts to dopamine in the brain, helping replace the deficient hormone.
  • Carbidopa (Sinemet) – if given with levadopa prevents the latter from being broken down before it reaches the brain.
  • Dopamine agonists – mimic dopamine
  • MAO-B inhibitors – helps block the enzyme MAO-B, which breaks down natural dopamine
  • Other medications including COMT inhibitors, amantadine and anticholinergics
  • Medications to treat anxiety and depression
  • Deep brain stimulation – a surgeon implants electrodes into the brain, allowing stimulation of parts that help regulate movement.
  • Stem cell therapy – being investigated as a means to create dopamine-producing cells
  • Physical and occupational therapy

 

Famous People Diagnosed with Parkinson’s

  • Michael J. Fox
  • Janet Reno
  • Robin Williams
  • Muhammad Ali
  • Casey Kasem
  • Johnny Cash
  • Linda Ronstadt
  • Pope John Paul II
  • Peanut’s creator Charles Schulz
  • Rev. Jesse Jackson
  • Neil Diamond

It’s been postulated Adolf Hitler suffered from Parkinson’s as well.

 

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Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, pornography, sex

Watching Porn Declared a “Public Health Risk”

Millions of people view porn every day and this week Arizona declared pornography to be an “epidemic” and a “public health risk.”

Citing its role in the rise of underage sex, sexually transmitted diseases, and unplanned pregnancies, the bill states pornography,  “perpetuates a sexually toxic environment that damages all areas of our society,” including the ability to build intimate relationships.”

Last year the Florida House approved a resolution to protect their constituents from its inherent health risks, joining other states with similar declarations including: Utah, Tennessee, South Dakota, Pennsylvania, Kentucky, Louisiana, Kansas and Idaho.

According to the Florida resolution’s sponsor, Republican Rep. Ross Spano, “Research has found a correlation between pornography use and mental and physical illnesses, difficulty forming and maintaining intimate relationships, unhealthy brain development and cognitive function, and deviant, problematic or dangerous sexual behavior.”

Criminal penalties will not be levied, but this bill serves as a “gesture” to bring awareness to a growing “health risk” and denounce pornography as a “growing health crisis.”

So is pornography a public health risk?

What constitutes a “Public Health Risk?”

A public health risk is something that could pose a health threat, injury to humans or could contribute to health risks of other humans.  This could include drunk driving, mosquitos or rats transmitting disease, or even smoking.

So watching pornography would pose a public health risk if not only the “pornee” gets hurt but affects others surrounding him. Now the effect of others could be in the form of missing work, viewing porn at work (considered sexual harassment and/or assault by others not wanting to view it), and unwanted sexual acts with one’s partner.

How does watching pornography affect health?

Although we do not have any definitive studies telling us porn is good or bad for our health, there are many opinions on the matter.

One concern is inactivity and time spent in front of a screen.  Sitting in front of a computer, tablet, or hand-held device watching hours of porn could increase risk of a blood clot, heart disease and (prolonged sitting) has been linked to colon cancer.  However, according to PornHub, the average time spent viewing porn only ranges from 9-13 minutes.

pornhub.png

 

What about lack of sleep? Are people secretly watching porn at night, and not getting their 7-9 hours of uninterrupted rest?

According to PornHub the most common time during the day to watch porn was between 10 pm and 1 am.  If one is only online for 10 minutes and falls asleep afterwards, they may still receive a good amount of sleep.

 

porn times

 

What about the risks of frequent masturbation?

In 2009 a study found frequent masturbation in young males could increase their risk of prostate cancer, but in older men (>50 years), reduced their risk.  Other studies have suggested reduced risk of prostate cancer that occurs in older men but not aggressive cancer in younger men.

Excessive masturbation could affect one’s refractory period, or time it takes to form an erection again after sex.  For some this could last 15 minutes, for others a week.  So if a date night is planned for later that evening, one with a long refractory period could have issues.

Chafing and inflammation can also occur but are usually rectified with a change in modality.

What about the impact on children?

The American College of Pediatricians released this statement:

The consumption of pornography is associated with many negative outcomes: increased rates of depression, anxiety, violent behavior, early sexual debut and sexual promiscuity, higher rates of teen pregnancy and a distorted view of relationships. For married adults, pornography also results in an increased likelihood of divorce which, in turn, is harmful to children.

Author, L. David Perry, MD, states, “Pornography glorifies decontextualized sex. Its use by adolescents and young adults often leads to a distorted view of sexuality and its proper role in fostering healthy personal relationships.”

If state governments choose to debate porn being a health risk, I agree with strict restrictions on child and adolescent access.  I also agree with education of condom use to protect against unsafe sex practices.  Moreover, counseling resources for those addicted to porn should be increased as internet and porn addiction is a growing public health threat.  However, does the occasional video view pose serious health risks….no.

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Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in Health, news, sunscreen

Sunscreen Chemicals DO Get Absorbed in the Blood

Many of us moms who hesitated lathering our kids up in perfumed sunscreen for fear of chemical absorption may have some evidence on our side.

The FDA and EWG (Environmental Working Group) looked at 24 volunteers who applied sunscreen (spray/lotion) 4 times a day for 4 days to 75% of their body.  They found levels of avobenzone, oxybenzone, octocrylene and ecamsule elevated in the blood samples of the men and women tested in the following days.

They results of this study were:

Among 24 participants randomized (mean age, 35.5 [SD, 1.5] years; 12 (50%] women; 14 [58%] black or African American; 14 [58%]), 23 (96%) completed the trial. For avobenzone, geometric mean maximum plasma concentrations were 4.0 ng/mL (coefficient of variation, 6.9%) for spray 1; 3.4 ng/mL (coefficient of variation, 77.3%) for spray 2; 4.3 ng/mL (coefficient of variation, 46.1%) for lotion; and 1.8 ng/mL (coefficient of variation, 32.1%). For oxybenzone, the corresponding values were 209.6 ng/mL (66.8%) for spray 1, 194.9 ng/mL (52.4%) for spray 2, and 169.3 ng/mL (44.5%) for lotion; for octocrylene, 2.9 ng/mL (102%) for spray 1, 7.8 ng/mL (113.3%) for spray 2, 5.7 ng/mL (66.3%) for lotion, and 5.7 ng/mL (47.1%) for cream; and for ecamsule, 1.5 ng/mL (166.1%) for cream. Systemic concentrations greater than 0.5 ng/mL were reached for all 4 products after 4 applications on day 1. The most common adverse event was rash, which developed in 1 participant with each sunscreen.
Conclusions and Relevance  In this preliminary study involving healthy volunteers, application of 4 commercially available sunscreens under maximal use conditions resulted in plasma concentrations that exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens. The systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings. These results do not indicate that individuals should refrain from the use of sunscreen.

…with oxybenzone having the highest persisting levels.

However, due to the alarming rates of skin cancer worldwide, no one is suggesting using less sunscreen. The purpose of this study is to encourage more safety studies by manufacturers.

Most People Apply Sunscreen Incorrectly

A new study has found the majority of people miss the most vulnerable parts of their face when applying sunscreen.

Published in PLOS One, researchers from the University of Liverpool looked at the sunscreen application habits of 84 men and women with the majority avoiding areas of the face around the eyes.

However, study authors cite the skin around the eyes is the most vulnerable to sun damage and skin cancer.  SPF containing moisturizers were used even less around the eyes.

The Sun reports:

AUSTIN MCCORMICK, STUDY AUTHOR AND CONSULTANT OPHTHALMIC AND OCULOPLASTIC SURGEON, FROM AINTREE UNIVERSITY HOSPITAL TRUST, SAID: “THE EYELID SKIN IS VERY THIN AND THIS PUTS IT AT RISK OF UV DAMAGE.
“THE AREA AROUND THE EYELASHES AND BETWEEN THE EYELIDS AND THE NOSE IS LEAST LIKELY TO BE COVERED.”
MR MCCORMICK SAID THAT EYELID CANCERS ACCOUNTED FOR 10 PER CENT OF ALL BASAL CELL CARCINOMAS IN THE UK – THE MOST COMMON TYPE OF SKIN CANCER.
HE ADDED THAT MOISTURISER MAY BE USED MORE SPARINGLY BECAUSE IT IS OFTEN EXPENSIVE AND SOLD IN SMALLER AMOUNTS.

My theory:  We’ve been told since we were kids to keep things away from our eyes, especially lotions.

How do sunscreens work?

Sunscreens use chemicals to disperse or absorb UV rays.  Inorganic compounds in sunscreen such a titanium dioxide or zinc oxide attempt to scatter the UV rays.  Organic compounds such as PABA and oxybenzone attempt to absorb UV rays so they can’t damage the skin.

 

What’s the difference between UVA and UVB radiation?

UVA rays penetrate deeply into both the epidermis and dermis.  They can cause premature aging of the skin, wrinkles, and skin cancer.

UVB rays are shorter and primarily affect the epidermis. They are responsible for causing sunburns as well as skin cancer.

8ce0498bca5aac49d757b683088b7d4a.jpg

What is SPF?

SPF stands for Sun Protection Factor.  The higher the SPF, the less sun photons enter the skin and cause damage.  SPF primarily measures the protection against UVB rays. We multiply the SPF factor by how long it takes one’s skin to burn by the SPF number to determine the protection factor.

In theory, an SPF of 30 suggests your skin, if it burns within 10 minutes without protection, will not burn until 300 minutes has lapsed (30 times 10).  However, we find this isn’t always the case.  People sweat or swim and the sunscreen dissipates.  Moreover many don’t put on the proper amounts (see below.)

So instead we use SPF as a grade to how much protection the product can offer.

An SPF of 15 blocks 93% of UVB rays

An SPF of 30 blocks 97% of UVB rays

An SPF of 50 blocks 98% of UVB rays

As we see, the relationship is not linear, however the higher the SPF, the more protection we have against UV rays..

what-is-spf-sunsreen-sun-protection-factor.JPG

IMAGE FROM BADGERBALM

 

Although the SPF alludes to protection against burning, hence UVB rays, a sunscreen may still protect against both UVA rays and UVB rays if it’s a broad spectrum sunscreen.

 

image-4@1-5.jpg.d3f15e8b9561ed8c3b2dd3679e8e79cb.jpg

How to apply sunscreen

Most people apply sunscreen incorrectly or unevenly.   Lotion needs to be applied at an amount of 2mg/cm2 of skin or 1 teaspoon per body part (chest, arm, leg, face and neck).  It should be applied 15 minutes prior to going out into the sun and needs to be reapplied every 2 hours, or more often if swimming or sweating.

CRM_Page_41_Important_Sunscreen_Spots_07-15 (1)

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Employment, Health, news

Stand-Up Desks Help You Poop

Image from Officesupply.com

Most of us who work standing up or use a stand-up desk can attest to the fact that we seem to get a thumbs up from our colon.  In fact some of us will even admit we suffer from less constipation than our 90 degree angle sitt’n brethren.

Why?

Sitting may impede flow, flow that occurs hours before one needs to empty his bowels.  And not only do angles play a part in this but when one sits, their abdominal cavity shrinks, as opposed to stretching when standing up.  An individual who is standing allows more volume of abdominal room for the colon to work.

Additionally, pressure from sitting and the chair may cause undue pressure on the lower colon.  If you think back to high school physics, pressure has to be less at the destination of flow.  True, mass and density can vary based on poop amount but even NASA gets it (see below).

 

nasa.gif

….where “choke” is the act of sitting.

Even in basic terms, our caveman forefathers and mothers realized that standing made an easier bowel evacuation, (standing and squatting even easier).  So 2019 humans may need to go old school, doing less sitting and more standing.

 

Stools Help You Stool

 

A study from Ohio State University reinforces the theory that putting your feet up when you poop helps passage.

Studies have long suggested that standing or squatting when we poop is more natural and easier on our bowels.  When we sit angled with our legs at a 90 degree angle to our torso, we may worsen constipation.  (you see why we needed to learn geometry in school…)

 

squatty potty.jpg

 

Dr. Peter Stanich and colleagues used a sample size of 52 people and of those who used a stool when they pottied, 71% reported faster bowel movements and 90% reported less straining.

They cite these “defecation posture modification devices” are a natural way to help one evacuate their bowels without relying always on medication.

 

So how do we define constipation?

Constipation is a decrease in frequency of bowel movements or difficulty passing stool that persists longer than one’s normal bowel movement cycle.  In general, less than three bowel movements a week could be considered constipation.20-30% of the US population suffers from constipation and this percentage increases in those who are elderly or confined to medical facilities. Some people have hard stools that are difficult to pass with normal motility, whereas others have soft stool but poor motility.

 

What causes constipation?

A variety of factors could be the culprit. These include:

  • Lack of water
  • Lack of fiber in one’s diet
  • Certain foods in one’s diet such as cheese, diary, fat, gluten, those high in meat
  • Caffeine
  • Hypothyroid
  • Stress
  • Lack of exercise
  • Pregnancy
  • Hormone fluctuations
  • Irritable Bowel Syndrome
  • Inflammatory Bowel Disease
  • Cancer
  • Laxative abuse
  • Eating disorders
  • Medications such as narcotics, antidepressants, iron supplements
  • Constipation should never be ignored………

 

What should our stool look like?

When someone is constipated, the stool is not moving through the colon as quickly as it should.  The more hours and days it sits in the colon, the more water is absorbed. So the stool churns and churns becoming dryer, smaller and harder.  So pebbles or rock-like stool is a sign of constipation.  Conversely, as in diarrhea, stool has not been processed by the colon properly, water has not been absorbed and thus it appears very soft or liquid-like. This puts one at risk of dehydration. Therefore healthy stool is a happy medium.

Using the Bristol Stool Chart, the ideal stool would be in the shapes of Type 4 and 5.

 

bristol

 

What should I do if I’m constipated?

First drink more water. Secondly look at your diet and see if you have any offending agents such as dairy or fried foods.  Thirdly visit your medical provider for an evaluation.  Finally, try and relax.  Many of us have difficulty pooping because we are stressed or on a time crunch.  Your body doesn’t care if you have a meeting in 5 minutes.  The body likes to relax when it relieves itself so grab a magazine, or my blog, and take some time out of your day to poop.  Sometimes we need to stop and smell the roses……

 

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Learning Medical Spanish is Easy!!!

 

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician