Posted in diabetes, Health, medications, news

Diabetes Drug Investigated for Cancer-Causing Contaminant

This week the FDA reported they would investigate if metformin, a popular diabetic drug, contained NDMA within the US market.

NDMA, N-nitrosodimethylamine, is a known carcinogen in a wide range of animal species.  It’s in the class of nitrosamines, which may be genotoxic (altering the genetic material in cells causing them to mutate) and cancer-causing in those who are exposed to unacceptable levels for long periods of time. The “acceptable range” according the FDA is 96 ng per day.

The FDA on their website states the following:

The FDA is aware that some metformin diabetes medicines in other countries were reported to have low levels of NDMA. Based on the information we have available, the levels of NDMA seen outside the U.S. are within the range that is naturally occurring in some foods and in water. While we are aware that some regulatory agencies outside the U.S. may be recalling some metformin drugs, there are no metformin recalls affecting the U.S. market at this time. The FDA is investigating whether metformin in the U.S. market contains NDMA, and whether it is above the acceptable daily intake limit of 96 nanograms. The agency will also work with companies to test samples of metformin sold in the U.S. and will recommend recalls as appropriate if high levels of NDMA are found. If as part of our investigation, metformin drugs are recalled, the FDA will provide timely updates to patients and health care professionals.

So no recalls have been initiated at this time.

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.

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

Generic Zantac Being Investigated for NDMA

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 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.

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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).

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, stomach acid issues, or diabetes 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 or investigation.

 

 

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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.

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Posted in flu, Health, news, seniors

Flu Deaths Reported in Multiple States: Do We Also Have a Severe Pneumonia Season?

 

This year’s flu season has claimed the lives of at least 6 children and many more adults.  It’s widespread in many states, and we are told to brace ourselves for yet another severe flu season as we enter the peak.

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CDC

 

However, the number one cause of death when it comes to the flu is pneumonia.  And the respiratory depression that appears to come on with these otherwise healthy individuals, appears to affect them within hours. Which brings the question…. Should we be entertaining the possibility that a severe pneumonia strain is affecting us this “flu season” and should we be encouraging pneumonia vaccines as well as the flu vaccine?

Most children are vaccinated against pneumonia

The vaccine schedule for children in the US includes the pneumococcal vaccine (PCV13) given at 2 months, 4 months, 6 months, 12 – 15 months of age.  Over 2 years of a child, one can get the PPSV23 if they did not receive the PCV13.

Not all young adults get the pneumonia vaccine, however if one if over 65, the CDC recommends the pneumococcal vaccines receiving a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.

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CDC

 

Now a variety of pathogens can be responsible for pneumonia, including viruses’, fungi, and bacteria other than pneumococcus, but streptococcal pneumonia is the most common cause.  If those affected by pneumonia this year were vaccinated, we need to know the strain, meaning specifically what pathogen was responsible for their pneumonia.

Not all pneumonia presents with a cough

Although pneumonia presents with symptoms such as fever, body aches, cough, shortness of breath and sputum production, some individuals may not present with these symptoms when they have pneumonia. Some of the tragic “flu death” cases this year were in adults who initially had a “mild cough”. Since flu symptoms are similar, some may never know if they have pneumonia.

As a result we are telling patients who have the flu to return immediately to the doctor’s office/urgent care/emergency room if they have any of the below symptoms:

  • Recurring fever
  • Fever that won’t subside after 2 days
  • Shortness of breath
  • Difficulty breathing
  • Confusion
  • Weakness
  • Productive cough
  • Blood in sputum
  • Fast breathing
  • Fast heart rate
  • Chest pain

and speak with your medical provider regarding other symptoms they may want you to watch out for.

How to tell when your flu is turning deadly

 

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

 

 

 

Posted in Health, news, smoking, vaping

Vaping Linked to Cobalt Lung

This week researchers at the University of California San Francisco report a first case of “Cobalt Lung”, or hard metal pneumoconiosis, in a woman who vaped a marijuana pen for 6 months.

The 49 year-old retired dog trainer had suffered from coughing, wheezing and shortness of breath but did not have a previous industrial profession in which she could have been exposed to “cobalt dust.”  When pathology of her lung tissue revealed giant white blood cells and scar tissue, they looked to the vapor she inhaled and found toxic metals including cobalt, along with lead, manganese, aluminum and nickel.

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Published in the European Respiratory Journal, study authors suggest the damage from the inhaled metals may be “permanent.”

_____________________________________________________________

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

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

  • lead
  • nickel
  • manganese
  • chromium
  • arsenic

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

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

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

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

Vaping Creates New Dangerous Chemicals That Become Inhaled

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

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

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

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

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

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

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

 

 

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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.

 

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Posted in Blood, children, Christmas, donations, Health, news, seniors

Giving Tuesday: Ideas If You’re On A Budget

Giving Tuesday was created in 2012 to encourage generosity and altruism.  The holidays are an ideal time to share our blessings and fortunes with others who may be less fortunate.  Many charities find this time the busiest of the year and funds are needed to help the great work they do, hence #GivingTuesday couldn’t come at a more opportune time.  Donations of any size can be life saving.

giving

However, some of us may be on very tight budgets and unable to donate money.  No worries….Giving Tuesday is not just about monetary donations.  There are TONS of meaningful ways one can give to help others.

Blood Donation

The winter season is a challenging time for many of our blood banks and every 3 seconds, someone needs blood. When one donates a pint of blood it can help save up to 3 lives. And it doesn’t cost a cent.

The American Red Cross is accepting blood donations. Local blood drives can be found at redcross.org.

Vitalant has locations throughout the country that can accept your blood donation as well. Contact Vitalant here.

Food Drives

Collecting non perishable food items from your pantry, neighbors or coworkers can be done quickly, easily and when taken to a shelter or organization can feed hungry and sometimes malnourished people in your community.

Clothing Drives

How many of us have saved our clothes from high school hoping we’ll fit into them again?  Well we won’t….so why hold on to a lost dream.  Tons of clothes in your closet can clothe those in need of the community…and an extra benefit is now you’ll create extra space in your closet.

Volunteer

Many shelters and charities need all hands on deck during this time of year.  Churches and temples organize community events as well and could use the extra manpower. Donating your time is worth hundreds of dollars for charities who sometimes need to hire people to help them accomplish the great work they do.

Host a Neighborhood Garage Sale

This is easy and fun where the neighborhood comes together to donate items they wish to sell, and all the money raised goes to a charity of choice.

Donate your Work

Some families could use a service or product that your company provides.  Offering a family in need some surplus or an hour of your time could go a long way.

 

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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 Christmas, fashion, Health, news, shopping, smart devices

Compulsive Online Shopping: Are YOU at Risk?

Image above from misskyra.com

The fasting growing addiction in the US is online shopping.  Ads pop up on our social media, news feeds and email. Boxes pile up in your closet of unopened packages.  And then one day you notice you purchased the same item twice! Are you addicted to online shopping or any shopping for that matter?  Let’s break down this latest epidemic.

What is Compulsive Spending Disorder?

A “Compulsive Buying Disorder (CBD)” was first described in the early 20th century as a compulsive disorder that left the patient with debt.  Later in the century its classification was debated and eventually included with the personality disorders.

Compulsive buying is known as “oniomania” where one buys impulsively and excessively to the point that it leaves them in financial hardship.  And despite their financial issues they continue to make purchases.  We’ve used the term “shopaholics” to describe those addicted to shopping but compulsive buying connotes the lack sense of financial ruin that can ensue. The spending is an attempt to satisfy a need that never gets fulfilled.

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IMAGE ABOVE FROM SHUTTERSTOCK

 

Compulsive buying disorder may be seen in those who suffer from mania and bipolar disorder.  During manic episodes excessive spending may occur.  Additionally we may see CBD co-morbidly in those who suffer from eating, gambling, substance use, and mood disorders.

What is Compulsive Online Shopping?

Compulsive online shopping occurs when purchases are made online, without much thought or planning, and at a frequency where it may interfere with one’s life.  People who might have never become a compulsive shopper in a traditional store may become easily addicted to online shopping.  Those who are compulsive online shoppers may exhibit any of the following:

  • Preoccupation with when they can go online to search items
  • Anxiety when one cannot go online
  • Purchasing items they don’t necessarily need
  • Spending beyond their budget
  • Hiding their shopping behavior
  • Feeling guilt after shopping
  • Struggling at work or at home because of the time devoted to online shopping
  • Other addictive or impulsive behaviors such as binge eating, drinking, or substance abuse

So compulsive online shopping, as well as compulsive buying disorder, can affect relationships, employment, finances and health.

How many people suffer from Compulsive Online Shopping Disorder?

Various sources have put the range at 5-8% of the US population.

Why are people becoming addicted?

When one is able to shop in the comfort of one’s desk or work station, the “ease” factor drives more shopping.  Avoiding the need to leave work or home to battle traffic and weather and long lines, is one of the biggest draws.  Moreover, those who hate going into a store or dressing room, concerned others will see the sizes of clothes they are trying on, can now shop in the privacy in their own home.  Additionally shopping allows one to fight the boredom they have at work or home and give one a sense of accomplishment.  And once one has a successful and satisfying purchase, the reward centers of the brain are activated making one want to shop more.

Hence, shrewd marketing will appeal to the human psyche by any of the following:

  • Displaying or popping up attractive ads on your browser or social media
  • Disrupting your feed, reading material or game with above ads
  • Following your likes, searches or prior purchases and suggesting related products
  • Offering deals and coupons that can be used immediately
  • “Rewarding” the buyer with positive feedback after the purchase such as, “You SAVED 15%!”
  • Allowing the purchase to be done so quickly and easily that one has less of an opportunity to ponder the purchase
  • Sending reminders of a reorder

So how can one avoid becoming a compulsive online shopper?

Don’t give in to the ads.  People must realize they are being bombarded with some of the most creative marketing manipulation known to mankind.  We can’t fall for it.  Why are we letting our smart devices dictate to us what we need in our closets, pantries or garages?

But to fight the urge to shop online excessively, we must:

  • Budget expenditures and stick to it
  • Have hobbies
  • Avoid boredom, or going to the internet when bored
  • Limit internet time
  • Stop ads and unsubscribe on out tablet or smart phone
  • Deputize a family member to be our go-to when we want authorization to purchase something online.
  • Ask ourselves prior to purchasing:  Do I really need this item?
  • Seek counseling if unable to stop

If needed, compulsive shopping can be treated with therapy as well as medications including SSRI’s, selective serotonin reuptake inhibitors, which are efficacious in those with impulsive personalities or obsessive-compulsive disorder.

 

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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 Daylight Saving Time, Health, news

Multiple States Moving to End Daylight Saving Time Change

Multiple states have mobilized their #LocktheClock forces to put an end to biannual time changes.  Last year California passed Proposition 7, making Daylight Saving Time year-round and permanent.  Other states who have proposed legislation include the following:

Some states had put forth legislation to be on Atlantic Standard Time, a time zone one hour ahead of Eastern Standard Time that essentially puts them on year-round Daylight Saving Time.  These include Connecticut, Massachusetts and Rhode Island.

Multiple health risks have been cited in scientific literature during the “Spring Forward” and are cited below, including car accidents, heart attacks and workplace injuries.

Dr. Paul Kalekas, an Internal Medicine and Attending Physician at Valley Hospital Medical Center who has practiced in Nevada for years, states, “It’s time this gets done.”

Nevada’s original bill failed to pass in Congress a few years back so he and other physicians are working to resubmit legislation.

Senator Marco Rubio (R-FL) has introduced the Sunshine Protection Act to make daylight savings time the new, permanent standard time. States with areas exempt from daylight savings time may choose the standard time for those areas.

However critics worry that states choosing their own time may disrupt the time zone uniformity.

So how did we end up here in the first place?

History of Daylight Saving Time

This ritual began in ancient civilizations, when daily schedules would be adjusted to the change in daylight.  Later Benjamin Franklin wrote an essay for Parisians entitled “An Economical Project for Diminishing the Cost of Light” in 1784 explaining how less candles could be used if people woke up earlier, making  more use of natures early light.

 

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Although other countries adopted Daylight Saving Time before the US, such as Germany in 1916, President Woodrow Wilson was the first to sign it into law in 1918 to conserve coal during the  Great War.  It was eventually repealed, though a handful of states maintained it.  In 1942, Franklin D. Roosevelt, again to assist the conservation needed for the war efforts, made “Daylight Saving Time” year round, calling  it “War Time”.  After the war, however, no federal law maintained the time change and states chose to do what they wished.  The Uniform Time Law of 1966 attempted to unite the states in this effort and the law, signed by President Lydon B. Johnson, decreed Daylight Saving Time to begin on the last Sunday of April and to end on the last Sunday of October.  States had  the right to vote to exempt themselves.  By 2007, the Energy Policy Act, created in 2005 declared that Daylight Saving time begins at 2:00 a.m. on the second Sunday of March and ends at 2:00 a.m. on the first Sunday of November. Some states, including Arizona and Hawaii, do not convert to DST.

What are the risks to Daylight Saving Time start?

Now besides the groaning that occurs each week when we “lose” an hour at night of sleep, concerns have risen in the scientific community regarding health risks.  These include headaches, workplace injuries, car accidents and heart attacks to name a few.

A study from the University of Colorado a few years back found a spike in car accidents the first week after Daylight Savings Time change. Apparently drivers did worse with one hour less of sleep that those comfortable with their routine prior to the time change.

In 2014 a different study from the same university found heart attack risk to spike 25% the following Monday after the “spring forward” but fell to almost normal when the clocks fell back in the Fall.

An additional study in Chronobiology International found IVF success rates drop during this time in women, who had a previous miscarriage.

Studies citing health risks  associated with “Spring Forward” of daylight saving time include the following:

  1. Car accidents: https://www.nejm.org/doi/full/10.1056/NEJM199604043341416
  2. Heart Attacks:  https://www.nejm.org/doi/full/10.1056/NEJMc0807104
  3. Workplace injuries: https://www.apa.org/pubs/journals/releases/apl9451317.pdf
  4. Suicide: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8425.2007.00331.x
  5. Pregnancy loss and fertility: https://www.tandfonline.com/doi/full/10.1080/07420528.2017.1279173
  6. Depression: https://journals.lww.com/epidem/Fulltext/2017/05000/Daylight_Savings_Time_Transitions_and_the.7.aspx

Now with electricity, batteries, generators, and charged mobile devices the need to change the clocks to conserve energy isn’t as urgent as it once was. However to minimize the health risks, I, each year, suggest the following:

  1.  Prepare for the time change before it happens.  Wake up 10 -20 minutes early a few days before the change so that the one hour shift isn’t too drastic for our delicate circadian rhythms
  2. Continue your exercise each morning (and don’t skip it the Monday morning after DST) so your body gets accustomed to the adrenaline surge and you’ll be able to maintain your morning alertness despite the time change.
  3. Eat a balanced breakfast. You should be doing this as well year round but remember to include protein and complex carbs as energy sources.
  4. Make use of natural sunlight to help wake you up.  Just as we benefit from the moonlight to help us fall asleep, our body needs sunlight to wake up.  Take a short walk each morning to get some brisk exercise in and sunlight at the same time.
  5. Don’t stress about the time change. You’ll build it up bigger than it has to be and anxiety stresses the heart.
  6. Go to bed a little earlier Sunday night.

 

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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 cell phones, Health, news, smart devices

SmartPhones Again Linked to Temporary Blindness or “Eye Strokes”

Two new cases of “smartphone blindness” has been described in the last month.   One case was a gentleman in China who was playing games on his phone at night and suffered a retinal artery occlusion or “eye stroke”.
Another case was a woman in China, who was also playing on her phone at night but she sustained a bleed in her left eye.  
Just as those who suffer from cerebral strokes, a “lack of blood flow” to the retina, or layer of the eye that helps create visual images, can be caused by a clot or hemorrhage.  Apparently these can be induced with excessive focusing and eye strain.
This may result in temporary or permanent blindness.
Updated from June 23, 2016
Some people are being evaluated for stroke or transient ischemic attacks when they come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark.  This phenomenon, known as ‘smartphone blindness’, has been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.

 

In 2016, doctors reviewed the cases of two women who experienced episodes of “temporary blindness”; as the ladies put their cell phone down, one eye could not see the cell phone for 15 minutes.  Their vision restored after this length of time.Doctors investigated the cases thoroughly with a variety of medical tests including MRI’s and couldn’t find the cause.

Finally they conclude these transient episodes of “vision loss” were harmless, in that one eye was being used to look at the phone and the other eye needed time to “catch up”.  When the women, as many of us do, check our phones, one eye is snugly closed and resting on a pillow while the other is available to look at the phone.  When the ladies would turn over, the closed eye didn’t have a chance to catch up to the increased brightness of the phone screen, hence having a dimmed view.

If one uses both eyes to look at the screen, this phenomenon does not happen.

Smartphone Blindness Studies Are Cause For Concern

Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment.  In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss.  Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached.  A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurred.

Smartphones have also been linked to myopia, nearsightedness and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.

A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.

Increasing the size of the font helps your eyes since they don’t need to strain as much to read.  Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.

Additionally, avoid using the phone in the dark, but in a lit room.

 

Finally its good to use the 20,20,20 rule.  After every 20 minutes of use, look away at something 20 feet away for 20 seconds.  This may help avoid eyestrain from excessive smartphone use.

 

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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.