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.

 

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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, Millennials, news, sex

Today is College Student Health Awareness Day

Millions of students are working overtime to become the next generation of wage earners.  But in the process, unfortunately, all too many let their health slip down the priority list.  And when they do, a vicious cycle ensues where grades start going down, forcing a student to further turn to less healthy behaviors such as getting less sleep, eating the wrong foods for energy, or engage in risky behavior.

 

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College Student Health Awareness Day hopes to highlight the multiple health issues incurred by many our students.  These include:

  • Depression, stress and anxiety
  • Frequent colds, illness
  • Poor flu vaccination rates
  • Risky sexual behavior
  • Sexual Assault
  • Poor eating, sleeping and exercise habits
  • Poor study habits
  • Excessive alcohol use
  • Drug use

and more.

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College Student Health Awareness Day will happen this Fall. In Nevada it falls on September 16, 2019 and is sponsored by UNLV’s American Medical Student Association and Silver State Health Centers.

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This year’s theme is STI Prevention.

Free condoms will be dispensed as well as information on various sexually transmitted illnesses at UNLV from 10:30 am – 3 pm.

 

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Great Gift!!!

The Ultimate Medical Student HandBook

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

 

Posted in Education, Employment, Health, Millennials, news

Personal Statement For Residency: Tips on Making a Great Impression

The trials and tribulations incurred during medical school culminate during one’s 4th year when they need to go on their biggest interview of their life: their residency interview.  But as with most interviews, one needs an excellent resume (CV) and cover letter to walk in the door.

Hence a student’s “Personal Statement” is what completes the package that is presented to residency directors who choose your fate.

An advantage to this is that it provides an opportunity to personalize your application, which unfortunately can look very itemized during the application process.

In communication we are successful when we use the “Three E’s.”  These stand for Engage, Educate and Enlist.  You engage a person by garnering their attention, then once you have their attention you educate them, and once they are educated you can enlist them (such as rank me for your residency).

So what makes a good personal statement?

Length

The length of your personal statement should be approximately one page.  This gives you 5-8 paragraphs to tell your story without boring one to death.  You don’t want to be too short and sweet but rather to the point and hammer your message home without getting into trouble saying too much later.

Open with a grab, but don’t choke them…

The average person puts down an article, book, essay within the first sentence if it doesn’t catch them.  So avoid opening your personal statement with “I’ve always wanted to be a doctor…”  Putting your future residency director to sleep seven words in prevents him from remembering your application and choosing you for his program.

So instead you should focus on a personal story that led to your resolve to dedicate your life to others.  Examples of this include:

My decision to pursue medicine began when I came to the United States with my family to start a new life……

The art of medicine compels one to study the canvas before haphazardly wielding a paintbrush.  I learned this when……

But don’t be too flowery. Get to the point early on in your first paragraph on how life experiences affected your decision to pursue medicine and the specific specialty for which you’re applying.

Which brings us to….

Know your specialty

If you are planning to pursue a career in Family Medicine, don’t discuss how you want to become a “Jack of all Trades.”  This isn’t what family medicine is about.  Just as the specialty of surgery isn’t all about “cutting.”  Let them know in your statement that you get it by saying something like…..

Understanding the wide range of pathologies that may affect a patient of any age is paramount to becoming an excellent family physician.

Being an advocate for my female patients and enabling them to bring life into this world attracted me to the field of obstetrics and gynecology.

Show you’re a team player

The residency director, who’s interviewing you, needs to know you play well with others.  The team with which you will work includes senior residents, attendings, nurses, ancillary staff and administrators to name a few.  So incorporate in your letter how you are cognizant of how a patient’s success is dependent on a hospital’s “team approach.”

Avoid negativity

Avoid insulting other specialties or specialists…which may occur inadvertently when describing why you chose your specialty.  For example, in one personal statement I edited, the student wrote, “I didn’t want to be a doctor who just cuts, so I chose primary care instead.”  

A better approach would be, “I found being a front-line provider, making the initial decisions in a patient’s care, to be exciting.”

Do your research

Most students begin their personal statement at the end of their third year, when actually it’s during your third year when you can gain much insight into how to write it. So questions you may want to ask your preceptor are:

How do you define family medicine (or the specific specialty)?

How did you come to decide to pursue medicine?

What do you look for in a personal statement?

If you could give me any advice on what to include in my personal statement what would that be?

Additionally, ask your clinical education department for resources or examples of good personal statements.  Prior graduates who secured their top five choices may have offered their personal statements to the medical school for others to use as a guide.

Have a format

Even though personal statements vary in length, creativity, subject matter and prose,  there is a general format most appear to follow.

Part 1 – your eye-catching opener that gives the program director a glimpse into your passion, personality, and plan (entering the field of ……).

Part 2 – a patient case or moment in your past that led you to forming this educated decision to pursue a specific specialty.  Don’t go into too many specifics regarding the patient due to HIPPA, and make sure your decision to pursue a particular field was not done on a whim or at the last minute before fourth year.

Part 3 – explain why you would be a good candidate for their residency program.  What makes you a good student, doctor, leader, team player, educator (you will be teaching medical students) and person.  Don’t itemize every accomplishment on your CV, but highlight some of your finest accomplishments and strengths.

Part 4 – after you’ve engaged and educated the reader, you are ready to enlist them.  The final portion of your personal statement reinforces why you are an excellent candidate for their program and how your goals are aligned with theirs in terms of providing good patient care, educating others, and giving back to your community.  This is also where you can suggest what you are looking for in a residency program, such as one that offers research opportunities.

Remember to end the personal statement with a note of gratitude, such as, “Thank you for considering my application to your residency program.”  A piece of humble pie goes along way.

Have it edited

When you have completed your personal statement, make sure you have someone else read it and find any grammatical and spelling errors.  Although most residency directors do not expect you to be a professional linguist, errors in one’s statement may suggest that you are haphazard, inattentive, have a lack of care for details, or lazy.

So in summary, being given the opportunity to market yourself is a gift.  So don’t put it off until the last minute and pray one draft does the trick.  Write this as it’s the most important 500 – 800 words of your life….

 

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 Education, Health, Millennials, news

Finals Week: Your Survival Guide

Millions of high school, college and graduate students are entering the most stressful time of the semester: Final’s Week.  Here’s your guide to getting through it:

Map out your strategy

Your time is divisible so grab a calculator and aliquot into equal periods.  Make sure you have extra sessions included for breaks and catch up sessions.  Or you can use a calendar that is already compartmentalized on which to create your timetable.

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Clean your desk!

A nice clean, crisp desk with plenty of pens and highlighters helps energize one more than cluttered paper.  Moreover have a second work space you can go to when you get sick of working at your desk.

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Prioritize

Now this is easier said than done. Some will put their hardest classes on their study calendar first, some the easiest.  There are pros and cons to both. What I suggest is alternating difficult and easy subjects.  You need the start of your day and initial power hours knocking out the difficult material, but then the easier classes will boost your confidence and sometimes energy.  So one option could be:

  • Study block 1:  Tough subject
  • Study block 2:  Easy subject
  • Study block 3:  Medium subject
  • Hour 4:  Review
  • With breaks, of course, in between.

 

Take real breaks!

You should design two types of breaks: Short and Long.

Your short break should be no shorter than 10 minutes.  During the break you must do the following:

  • Get up and stretch
  • Drink water
  • Eat a small snack
  • Go to the bathroom
  • Listen to some music, dance, phone a friend

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Your long break should be no shorter than 45 minutes.  During these breaks you can:

  • Eat a regular meal, if due, and drink plenty of fluids
  • Take a small nap
  • Take a shower – helps refresh and energize
  • Check social media – stick to your time limit though!
  • Watch a 30 minute episode of your favorite sitcom
  • Exercise such as going for a run

 

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Identify signs of burnout

If you’re “going through the motions” of studying and feel “burnt” you won’t be absorbing the material and subsequently you’ll be wasting precious hours.  You must identify burnout by looking for the following:

  • Apathy
  • Exhaustion
  • Poor sleep when you get done in the evening
  • Negative attitude towards school and others
  • Procrastinating your next study block
  • Being irritated
  • Feeling empty
  • Low energy
  • Thinking about quitting

 

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How to avoid burnout

When studying for finals it’s difficult to avoid the boredom and stress, but the following may help:

  • Study with friends
  • Mix up your study sessions with videos and flash cards if reading gets overwhelming
  • Watch a short funny video to get you laughing
  • Take regular breaks
  • Make sure you’re eating and sleeping well

 

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Finals week is never supposed to be easy so accept it and own it!  But put your health first since you can always make up a test……

 

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

 

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Posted in children, Entertainment, Health, Millennials, news, smart devices, Social Media

What Are They Saying? Your Guide to Teen Slang

Once we became accustomed to words like “dope,” “word,” and “sick”, a new generation introduced their vernacular.

Social media has changed the way we talk.  Words need to be abbreviated, and many times one word must assume a whole phrase.

Generation Y’s (Millennials) and Z’s (those born after 1995) have learned to be concise, descriptive, and to the point as technology and social media encourage less characters/keys being used to get one’s point across.

So here’s a guide to what the young ‘uns are saying:

  • GOAT: Greatest Of All Time (you may see pics of goats in Tom Brady jerseys…..”
  • BAE: one’s love, or babe.  Stands for “Before Anyone Else”
  • Lit:  Cool or Awesome!
  • Woke: aware of social issues
  • Gucci:  Good or cool
  • Hundo P – Short for “I’m 100% positive/certain”
  • Squad/Fam: Group of close friends
  • Throw Shade:  Make fun of/criticize, give a nasty look at someone
  • Curve: To reject someone romantically
  • Salty: Bitter about something or someone
  • Ghost: To ignore someone
  • Skurt: to leave, tell someone to go away
  • Sip Tea: mind your own business
  • Ship: relationship
  • Troll:  Those who say nasty things online

Netsanity provides this breakdown:

TeenSlangInfographic

 

And for those of you who need some help translating your kids’ texts:

 

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And we can’t forget the emoji’s. These allow a visual, pictoral way to get one’s message across:

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With building and maintaining strong relationships, communication is key.  For us old dogs, we might need to learn some new tricks.

 

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

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

Posted in Health, Millennials, news

Are Millennials Avoiding the Primary Care Doctor?

A recent analysis from Kaiser Family Foundation found the average younger American does not have a primary care provider (PCP).

Looking at survey answers from 1200 participants,  45% of 18 – 29 year-olds admitted to not having a PCP.  28% of those aged 30-49 and 18% of those aged 50-64 said the same. Those over age 65 were the largest group to have a primary care provider.

Those born between 1981-1996, known as the Millennials, may have different attitudes towards health care.  Keep in mind, they just lived through nearly a decade of recession, computer hacks, Obamacare controversies, and societal distrust of pharmaceutical companies.

PCP’s however are the “quarterback” in one’s healthcare, keeping accurate and thorough records on one’s medical history, addressing immediate and chronic issues, and coordinating where their patient needs to go if a specialist is needed.

But Millennials, instead, are preferring urgent cares, retail clinics, emergency rooms, or using telemedicine for their medical needs.

 

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However if one, unknowingly, suffers from a chronic condition and has various acute issues, they may be misdiagnosed because they are receiving piecemeal care without someone overseeing them and connecting the dots.

Diseases such as cancer, diabetes, heart disease, syphilis, AIDS, neurological disorders and autoimmune illnesses are just a few that may cause intermittent acute episodes before becoming deadly.  Someone needs to take a step back, look at one’s medical history and properly diagnose, or simply put, see the forest from the trees.

So why the hesitation to commit to a primary care provider?

  1.  Many aren’t sick.  They don’t need to have follow-up or chronic issues managed so find an urgent care or emergency room visit sufficient for their acute issues.
  2. They prefer not to have a record of their “life story.” Privacy is huge in this generation who has grown up with social media and smartphone pictures logging their every move.  They may want their STD to be long forgotten once they leave the clinic.
  3. They prefer knowing the price ahead of time and having “closure” once the visit is complete.  The concept of seeing a medical provider and then receiving a bill 3 months later and then following up on a condition is foreign to many who want to address an issue once and move on.
  4. They may not be at the same job, hence have the same insurance for long.  It’s common for the average Millennial to explore career paths and do not expect to be at one place of employment for “life”. Hence if their job changes, so will their insurance, and therefore the medical provider list offered.
  5. The internet provides medical advice.  Some feel rather than have a doctor visit to learn about a medical condition, it’s cheaper and more convenient to read the medical article oneself.
  6. “The doctor doesn’t spend time with me anyway.” They more often don’t get out of a doctor visit what we used to with time, hand holding, education and patience with all our questions.  Providers are busy these days and offer short office visits.

 

Our healthcare system is changing and the needs of the younger generation appear to be better met by clinics that charge up front, address a single issue, and provide convenient hours.   Therefore “primary care” providers will still be needed, however, the art of “primary care” may evolve into a whole new beast.

 

 

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Learning Medical Spanish is Easy!!!

 

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