Posted in Health, news, Politics

Hillary Clinton Rumored to be Running Again for President in 2020

One of the most bitter and exhausting elections may have a rematch if Hillary Clinton, postulated to make a third attempt at the Presidency, runs in 2020.

According to a piece in the NY Post, emails were sent by Clinton five times, touting how Onward Together, her Super PAC is poised to help defeat Trump, if he seeks reelection.

According to author Michael Goodwin:

Most seized on headline events, such as the family-separation issue at the southern border.
Under the message line, “horrific,” she wrote June 18: “This is a moral and humanitarian crisis. Everyone of us who has ever held a child in their arms, and every human being with a sense of compassion and decency should be outraged.” She said she warned about Trump’s immigration policies during the 2016 campaign.
Three days later, she was back again, saying that her group, Onward Together, raised $1 million and would split it among organizations working to change border policy, including the American Civil Liberties Union and a gaggle of immigrant, refugee, Latino and women’s groups.
And the day after Supreme Court Justice Anthony Kennedy announced his retirement, Clinton introduced a newly minted resistance partner. Called Demand Justice, it promises to protect “reproductive rights, voting rights and access to health care” by keeping Senate Democrats united in opposing any conservative Trump nominee.

Many times, rumors get circulated not by the opposing party but by the affected one in an attempt to test the waters to see how the nation would react prior to millions of dollars being raised.

So would another run by Hillary Clinton be viable, and more importantly, successful?

In 2016, she did have a successful campaign securing the popular vote of 65,845,063 to Trump’s 62,980,160.  One reason for her failure to secure the electoral college was her sideline battle with Bernie Sanders, 76, who will most likely not run again.

In fact, besides the media frenzy that surrounded Oprah’s presidential aspiration rumors, there has not seemed to be any media chatter regarding the next Democratic stand out.

Funding won’t be an issue as Clinton’s super PAC appears to have an easy time raising money for the already wealthy candidate.

However, her success will be based on a multitude of factors going right this time.

Her health will be at the center of discussion as footage of stumbles, dizzy spells, braces, and secret service agents donning syringes were previously captured and used to illustrate a medical record with a poor political prognosis.

Hillary-clintonova.jpg

Democrats may frown upon Clinton’s age, who would be 72 during the next election, suggesting a two-term presidency would carry her into her 80’s.  And as presidents need to frequently stump for their Congressmen in tumultuous smaller elections, some may worry about her resilience and stamina.

Trump is gaining popularity.  With a stronger economy and lower unemployment rate democratic voters may find themselves doing better that they were a few years back making them less likely to “hate” the incumbent, despite disagreeing with some of his policies.

So do I think she’ll run?  Maybe.  Despite the Clintons hating to lose, they’ll seize an opportunity if no one else does.  As Ben Stein called roll in Ferris Bueller’s Day Off, we may hear the Democrats saying, “Anyone…..anyone……..?”

 

dw sketch.jpg

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

Advertisements
Posted in Health, news, Politics

Supreme Court Justice Anthony Kennedy Retiring

The long rumored and anticipated retiring of 81-year-old Supreme Court Justice Anthony Kennedy was announced Wednesday.

In a letter to President Trump he writes, “For a member of the legal profession it is the highest of honors to serve on this court,” he wrote. “Please permit me by this letter to express my profound gratitude for having had the privilege to seek in each case how best to know, interpret, and defend the Constitution and the laws that must always conform to its mandates and promises.”

Justice Anthony Kennedy was a swing vote on many issues and did not always rule towards the conservative side, siding with the liberal justices on issues involving banning capital punishment and limiting the powers of states to enforce tougher immigration laws.

Justice Kennedy is the second oldest justice, turning 82 in July.  The oldest is Ruth Bader Ginsburg, currently 85 years old.

His retirement, set for July 31st, allows the Trump Administration to appoint a younger judge who could help solidify the conservative edge of the Supreme Court for years to come.

USA Today reports the following may be considered to fill his seat:

Among the other judges on Trump’s list most often mentioned as potential Kennedy replacements are Thomas Hardiman of Pennsylvania, who serves on the U.S. Court of Appeals for the 3rd Circuit, and Raymond Kethledge of Michigan, who serves on the 6th Circuit. More intriguing are fresh faces such as newly confirmed federal appeals court judges Amy Coney Barrett of Indiana and Amul Thapar of Kentucky.

supreme court

 

This is a developing story.

Posted in Health, news, Politics

Death by Imodium Overdose: Is the Opioid Crisis Getting Worse?

Last year in Pittsburgh, a 29-year-old man died from loperamide poisoning, and officials are warning of a huge spike in Imodium overdose cases.

Loperamide, sold under brand names such as Imodium, is a mu opioid receptor agonist, meaning it can saturate the mu receptors in the brain responsible for quelling pain.  It acts similarly to morphine it its analgesic effect, and in one study by Ray et al, it worked better than morphine.

1200px-Loperamide.svg

Loperamide

114087_Morphine-structure

Morphine

Why is loperamide, then, used for diarrhea?

Loperamide slows down the motility of the gut by acting on the smooth muscle lining in the intestine.  Food as it transports down the colon is stripped of much of its water content prior to being expelled as feces.  However in those with diarrhea, the transit time is much shorter and the body does not have a chance to remove the water.  Slowing this pathway down, with loperamide, changes the consistency of the stool and the frequency of stools.

Earlier this year two British citizens died of Imodium overdose and officials are concerned many more non fatal overdoses may be occurring daily.

Loperamide is easy to obtain

First synthesized in the 1960’s, loperamde joined the pharmaceutical industry officially in 1976 when the FDA approved its brand named form, Imodium. Although first introduced as a prescription, Imodium became a widely popular over-the-counter (OTC) remedy by the 1980’s.  Still popular, it remains an OTC, easy to purchase, treatment for diarrhea stocked ubiquitously in stores.

How much Loperamide is too much?

According to drugs.com, dosing is:

4 mg orally after the first loose stool, then 2 mg orally after each unformed stool
Maximum dose: 16 mg per day

However, overdoses can occur based on weight, metabolism and if other medications are being used simultaneously that can interfere with the drug’s bioavailability.  Moreover if one is currently taking narcotics for pain, this could synergistically increase one’s levels of the drug.

What are the side effects of Loperamide?

Regular use of the agent can cause:

  • nausea
  • vomiting
  • fatigue
  • constipation
  • dry mouth
  • dizziness
  • abdominal pain

In training we learned that if one was suffering from an intestinal pathogen resulting in  diarrhea, using loperamide could lengthen the course of the illness as the flushing mechanism during diarrhea is now inhibited.

How can Loperamide kill one using it?

Uniquely, loperamide can cause dangerous heart arrhythmias such as Torsades de points, which can lead to cardiac arrest and death.

So why is Loperamide still used and easily available?

Diarrhea and hyper gut motility cause millions of Americans each year discomfort, time off work and embarrassment.  Moreover, diarrhea can acutely cause dehydration and medicines such as Imodium are widely used in the health care setting for this reason.

But its pharmacological similarity to opiates allows it to be one of the easiest drugs to obtain and abuse.  And with political pressure to decrease access to prescription narcotics becoming more successful, coupled with narcotic withdrawal being so painful and traumatizing, we anticipate more individuals hastily and non-responsibly seeking relief with medications such as Loperamide.

 

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

 

Posted in Health, Politics

President Trump’s Physical and Mental Health Exam Results

White House Physician, Navy Rear Adm. Dr. Ronny Jackson, performed President Donald Trump’s annual physical last week are released the following results:

From Politico:

President Donald J. Trump has completed his first periodic physical examination as President of the United States. I performed and supervised the examination with appropriate specialty consultations and diagnostic testing. The exam was conducted January 12, 2018 at the Walter Reed National Military Medical Center.

The purpose of this exam was to provide the public with an update of the President’s current health status and to ensure the President continues to enjoy all the benefits of good health. This examination focused on evidence-based health screening and disease prevention.

With President Trump’ s consent, I release the following health information:

Vital Statistics
Age: 71 years, 7 months
Height: 75 inches
Weight: 239 pounds 
Resting heart rate: 68 bpm
Blood pressure: 122/74 mm 
Hg Pulse-oximetry: 99% room air 
Temperature: 98.4 degrees F

Physical Examination by System (to include studies)
Eyes: Uncorrected visual acuity was 20/30 bilaterally, with corrected visual acuity of 20/20 bilaterally. Visual fields were normal. Fundoscopic exam was normal bilaterally. Intraocular pressures were normal bilaterally. No ocular pathology was discovered.

Head/Ears/Nose/Throat: Normal exam of the head, ears, nose, mouth, and throat.

Dental: Healthy teeth and gums.

Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of the carotid arteries normal.

Pulmonary: Lungs clear to auscultation. A screening Low Dose CT of the chest demonstrated no pulmonary pathology.

Cardiac: Heart exam normal. Regular rhythm. No murmurs or other abnormal heart sounds noted. ECG with normal sinus rhythm, rate of 71, normal axis, and no other significant findings. Transthoracic Echocardiogram demonstrated normal LV systolic function, EF 60-65%, normal LV chamber size and wall thickness, no wall motion abnormalities. RV normal, atria grossly normal, all valves normal. Exercise Stress Echocardiogram demonstrated above average exercise capacity based on age and sex, and normal heart rate, blood pressure, and cardiac output response to exercise. No evidence of ischemia noted and wall motion was normal in all images.

Gastrointestinal: Normal exam. No masses, hepatomegaly or splenomegaly noted. Normal optical colonoscopy with no polyps or abnormal findings completed June 2013. Repeat colonoscopy not indicated and was deferred until next periodic physical exam.

Genitourinary: Normal exam.

Extremities/Musculoskeletal: Normal throughout. Full range of motion in all joints. Strong distal pulses and good capillary refill in all extremities. No swelling or edema noted.

Neurological: Examination of cranial nerves, cerebellar function, deep tendon reflexes, motor function, and sensory system all normal. Cognitive Screening Exam using the Montreal Cognitive Assessment was normal with a score of 30/30.

Dermatologic: Normal exam. No evidence of melanoma , basal cell carcinoma, squamous cell carcinoma, or any other significant dermatologic disease.

Laboratory Results
Lipid Panel: 
Total cholesterol: 223 (mg/dL)
Triglycerides: 129 (mg/dL)
HDL cholesterol: 67 (mg/dL)
LDL cholesterol: 143 (mg/dL)
Cholesterol to HDL ratio: 3.3

Complete Blood Count: 
WBC: 5.5 (K/UL)
HGB: 16.1 (g/dL)
HCT: 48.7 (%)
PLT: 241 (K/UL)

Extended Metabolic Panel: 
Fasting Blood Glucose: 89 (mg/dL)
BUN: 19.0 (mg/dL)
CREAT: 0.98 (mg/dL)
ALT: 27 (U/L)
AST: 19 (U/L)
Hemoglobin AlC: 5.0 (%)
Vitamin D: 20.0 (ng/ml)
PSA: 0.12 (ng/ml)
TSH: 1.76 (ulU/ml)

Urinalysis: 
Appearance: Clear
Protein: Negative
Ketones: Negative
Glucose: Negative
Blood: Negative

Past Medical History
• Hypercholesterolemia 
• Rosacea

Past Surgical History 
Appendectomy (age 11)

Social History
• No past or present use of alcohol. 
• No past or present use of tobacco.

Medications
Rosuvastatin (Crestor), 10 mg daily to lower cholesterol.
Acetylsalicylic Acid (Aspirin), 81mg daily for cardiac health.
Finasteride (Propecia), 1 mg daily for prevention of male pattern hair loss.
Ivermectin Cream (Soolantra), As needed for treatment of Rosacea
Multi-vitamin (Centrum Silver), Daily for overall health maintenance.

Immunizations
• Prevnar 13 (to prevent pneumococcal pneumonia) and Twinrix (to prevent hepatitis A/B) given. 
• Routine vaccinations, to include seasonal influenza, all up to date.
• All indicated travel vaccinations up to date.

Summary
The President’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. We discussed diet, exercise and weight loss. He would benefit from a diet that is lower in fat and carbohydrates and from a routine exercise regimen. He has a history of elevated cholesterol and is currently on a low dose of Rosuvastatin. In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine screening tests and exams.

All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his Presidency.

President Trump is in “excellent health.”

At the above height and weight, Donald Trump’s BMI is 29.9 placing him in the overweight category just shy of the 30 BMI cut off for obesity.

His blood pressure and heart rate are excellent for his age, especially in the absence of a blood pressure medication.

His pulse oximetry demonstrating the oxygenation of his blood is excellent as well.

An uncorrected vision test of 20/30 means that without glasses, the president has near perfect vision.

A low dose CT of the chest is not routine during annual physicals in non-smokers, but is reassuring that he most likely doesn’t suffer from lung cancer, the number one cancer killer in America.

His EKG, which evaluates electrical abnormalities of the heart secondary to disease or heart attack, confirmed the ideal heart rate.

His echocardiogram, and ultrasound evaluating heart structures and pump activity, demonstrated no heart failure or issues with the filling or pumping of blood, as well as confirming normal anatomy (valves, wall thickness, etc).

A stress test evaluates for cardiac ischemia, or loss of blood flow to heart muscle during rest and exercise, and was normal as well.

A normal colonoscopy in 2013 suggests his next screening colonoscopy wouldn’t be performed until 2023 unless he had pain, rectal bleed, changes in his stool, or any risk factors for colon cancer.

The Montreal Cognitive Assessment was given to evaluate cognitive function and is not routinely done during annual physicals.  This was performed and passed with a 30/30 score.  The test evaluates memory, orientation, visuospatial and executive brain function, recal, concentration and language fluency.  An example is shown here.

His cholesterol is elevated but his good cholesterol is strong and his ratio of cholesterol to HDL is well within goal.

cholesterol-levels-chart

The remaining blood tests looked very good, especially his HBA1C and blood glucose evaluating for diabetes.

Of note is his Vitamin D level which appears low-normal and could put him at risk for osteoporosis.  It does not appear a bone density test, Dexa scan, was performed.

A PSA of 0.12 is reassuring as well although is not recommended as a screening test for prostate cancer.

Its been suggested that President Trump loses 10-15 lbs and increases his excercise activity.

My opinion, for a 71-year-old man with high cholesterol, President Trump is way ahead of the curve.  I’m a fan of Crestor, his cholesterol lowering mediation, and credit his lipid profile numbers to his use of the statin.  His weight is an issue but I think the White House has a bowling alley, chefs who could make asparagus taste like meat, and secret service who wear fitbits.  I think he’ll be just fine.

This is a developing story.

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

 

 

Posted in Health, news, Politics

Controlled Substance Prescribing in Nevada – What Does AB 474 Mandate?

In response to the rising opioid death crisis, Nevada lawmakers passed AB 474, which goes into effect January 1, 2018, to help curb overprescribing of narcotics. Although some hail it as a long-overdue measure to limit narcotic prescriptions, many medical providers and patients worry it will severely limit patient access to controlled substances.  Here’s the breakdown.

Chambers2.jpg

Summary of Assembly Bill 474

Providers will be required to report cases or suspected cases of drug overdose.  Failure to do so will be considered a misdemeanor.

Providers will be required to add additional information to the state’s Prescription Drug Monitoring Program (PDMP) for those requiring a controlled substance including the patient’s medical diagnoses and the least number of days the medication will be necessary.

Providers will be required to maintain proof that they have access and use the PDMP prior to their registration or renewal of license to prescribe a controlled substance.

Licensing boards will have the authority to obtain medical records and investigate any activity deemed fraudulent, illegal, unauthorized or inappropriate prescribing and impose disciplinary action if a violation has occurred.

Prescribers will have to increase their training to 2 hours in the subjects of abuse and misuse of controlled substances as well as prescribing of opioids.

Providers will have to document why the patient is needing the controlled substance and justify the quantity written.

Providers will need to obtain written consent by the patient as well as develop and document an evaluation, risk assessment and treatment plan prior to initiating the prescription for the controlled substance.

If the prescription will be a 30 day supply, a written agreement needs to be created between doctor and patient.

The State Board of Pharmacy will have the authorization to enforce provisions of the bill resulting in disciplinary action of the medical provider who violates the provisions or prescribes a controlled substance “inappropriately”.

Providers will be required to, every 90 days, obtain a patient utilization report created by the Board and the Investigation Division while the patient is being prescribed the controlled substance.

What are the Controlled Substances being referred to?

Medications are classified based on their abuse potential, safety profile and medical applications.

USP1310-CE-T2.gif

AB 474 refers to Schedule II, III and IV class drugs. These are broken down, according to the Controlled Substance Act, as the following:

Schedule II Drugs

Schedule II drugs have a high potential for abuse, and if abused may lead to severe psychological or physical dependence.

Some of these include:

  • Adderall
  • Ritalin
  • Hydrocodone, as used in Vicodin and Lortab
  • Oxycodone, as used in Percocet, Oxycontin
  • Percocet
  • Morphine
  • Oxymorphone
  • Demerol
  • Fentanyl
  • and more…

 

Schedule III Drugs

These still have a potential for abuse but are considered less than Schedule I or II and may lead to moderate to physical dependence, but still high psychological dependence.

Some of these include:

  • Testosterone products, such as AndroGel
  • Buprenorphine, used to treat opioid addiction
  • Codeine
  • Butalbital, used to treat headaches in prescriptive migraine formulations
  • Fiorinal and Fiorcet – a combination of acetaminophen or aspirin, caffeine and butalbital to treat headaches

 

Schedule IV Drugs

These have a smaller potential for abuse and may lead to limited physical dependence or psychological dependence.

Some of these include:

  • Phentermine, used in weight loss
  • Ambien, used for insomnia
  • Benzodiazepines, used for relaxation such as Xanax, Valium, Ativan
  • Belviq, used in weight loss
  • Carisoprodol, used as a muscle relaxant such as Soma
  • Darvocet, used for pain but pulled off the market in the US
  • Tramadol, used for pain such as Ultram

 

What are the pros to AB474?

Many tout this new bill will cause medical providers to pause prior to prescribing large amounts, hence leading to less prescriptions for highly addictive medications.  Thorough histories and exams will be mandatory prior to prescribing and dialogues will need to take place between medical provider and patient regarding abuse potential and the treatment plan.

What are the cons to AB474?

Many fear that the numerous steps providers need to take will be so time consuming and cumbersome that the average physician will avoid prescribing pain medications, sleeping aids, ADHD, testosterone, and migraine medications.  Moreover the fear of losing one’s prescribing licence in Nevada may cause many providers to leave the state.

Nevada sees close to 400 opioid related deaths each year.

 

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

 

 

Posted in Health, news, Politics

Rev. Jesse Jackson Reveals He is Battling Parkinson’s Disease

Civil right’s activist, Jesse Jackson, revealed Friday that he’s been diagnosed with Parkinson’s disease.

The 76-year-old two-time Democratic presidential candidate stated he and his family noticed changes three years ago and, “after a battery of tests, my physicians identified the issue as Parkinson’s disease, a disease that bested my father.”

His father, Noah L. Robinson, died in 1997 at the age of 88 of a heart attack and complications of Parkinson’s.

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

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

 

 

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

Posted in Health, news, Politics

Las Vegas Shooting, How YOU Can Help

Sunday night’s shooting of concert goers at the Route 91 Harvest Music Festival has left 58 dead and wounded hundreds others in the deadliest mass shooting to affect the United States.  Here’s how you can help:

Las Vegas Victim’s Fund

Established by Steve Sisolak, Clark County Commission Chair, this fund is helping to raise funds for victims and their families.  Go Fund Me Page is here.

Blood Donation

Thousands of units of blood are needed and can come from local and out of state donors.

United Blood Services have locations throughout the country that can accept your blood Donation. Contact UBS here.

The American Red Cross is accepting donations. On their website, they ask to visit redcross.org.

Moreover Red Cross is taking donations. Call 1-800-RED CROSS or text the word REDCROSS to 90999 to make a $10 donation.

Petition

We are asking President Trump to help declare a National Blood Donation Week.  Please sign and SHARE the petition below:

Petition

Secret Garden Radio For Las Vegas Fund

R&B icon Al B. Sure, Host of Secret Garden @SlowJams Morning show via iHeart Radio & Host of Secret Garden Radio @ our historic KCEP Power 88.1 FM is raising money for victims and their familes here.

National Compassion Fund

Funds will help the immediate and long term needs of victims and their families.  Donate here.

 

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