Posted in Health, news

New Blood Pressure Recommendations Released

High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg.  This will mean close to 103 million more Americans will fall under the “hypertensive” category.

Multiple agencies, including the American Heart Association and American College of Cardiology, redefined the guidelines, in practice for the last 14 years, to lower the threshold for high blood pressure from 140/90 to 130/80.

Under the old guidelines, 1/3 of US Americans were considered to have high blood pressure.  Now 42% of Americans will be “hypertensive”.

In lowering the guidelines, task force members hope to reduce complications associated with high blood pressure and start treatment earlier in those who have not been treated.

blood+pressure+chart

 

What do the blood pressure numbers mean?

The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.

Diastolic pressure is the pressure in your arteries between beats while the heart is “filling”.

Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.

What can long term high blood pressure do?

Chronic high blood pressure can be dangerous.  It may cause:

Heart attacks

Heart failure

Stroke

Kidney disease

Dementia

Eye damage – vision loss

Erectile dysfunction…to name a few.

How do we treat high blood pressure?

The stages of blood pressure are defined in the chart above.  At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:

Weight loss

Low salt diet

Low fat diet

Good sleep habits

Regular exercise

Avoiding tobacco products

Limiting alcohol consumption

As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.

If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.

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

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Posted in Health, news

TV Binge Watching May Increase Risk of Blood Clots

Image above from Geek and Sundry

 

We’ve known of video gamers developing blood clots after performing day-long marathons and now a study reveals binge-watching television could put us at risk of this deadly condition as well.

Streaming services such as Netflix have exploded in popularity by providing an endless supply of great shows.  Unfortunately, one hour can turn into 2, 3, or 4 very easily and lack of movement puts one at huge risk of developing a blood clot, especially if they are obese or predisposed.

Researchers from the University of Vermont’s Larner Medical College looked at 15,000 adults who were between the ages of 45 and 64 when the study began in 1987 to 1989. They asked subjects to rate their television viewing frequency  as “never”, “seldom”, “sometimes”,  “often” or “very often.”  After 20 years of follow-up, study authors found 700 participants to have suffered a blood clot and concluded that “very often” television viewing was linked to an 70-80% increase in risk, even if they were regular exercisers.

Binge watching has replaced the waiting of a whole week to find out the result of a cliffhanger as one can immediately view the next episode, and the next, up to a whole series in one sitting, satisfying their curiosity.

A blood clot, or venous thromboembolism (VTE), occurs when the blood coagulates.  It can travel to other parts of the body such as the lungs, obstructing blood flow.  In a study from 2007, VTE’s were also found to increase risk of heart attack and stroke.

 

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Image from Prevention

According to the American Heart Association, VTE’s occur in 300,000–600,000 Americans each year by means of a DVT (deep vein thrombosis) developing usually in the lower leg veins, and a PE (pulmonary embolism) in which a DVT breaks loose and travels to the lungs.

In the study, obesity was responsible for 25% of the increased risk and lack of activity accounted for 50% of the risk.

Risk factors for VTE include:

  • genetic predisposition
  • prior blood clots
  • cancer
  • prolonged immobility (long flights, hospitalization stays)
  • pregnancy (women)
  • smoking
  • age over 60

 

Prolonged sitting has also been linked to cancer, diabetes and heart disease, so there are plenty of reasons for us to get off the couch.

Many doctors therefore recommend frequent breaks from sitting or being immobile with 5 minutes of stretching or walking around the room.  If binge watching is your vice, walking on a treadmill or stepping up and down on a foot stool while watching your favorite show can help maintain good circulation.

 

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

Posted in Health, news, Sports

Aaron Hernandez’ Brain Images Show Severe Damage Due to CTE

Ex-Patriot’s tight end, and convicted murder, Aaron Hernandez, was found postmortem to have had severe CTE and again confirmed this week he had the worst CTE neuroscientists had ever seen in his age group.

Images were released showing severe atrophy, or shrinking of the brain, in key parts that regulate memory (hippocampus) and judgement (frontal lobe). This confirmed the loss of brain volume (atrophy), and tau protein deposits throughout his frontal lobes that were seen previously by neuropathologists.  The frontal lobe of the brain regulates impulse control, memory, judgement, social behavior and problem solving.

hernandez10s-2-web

 

hippocampus

Athletes who sustain multiple concussions are at high risk of developing CTE, Chronic Traumatic Encephalopathy.  This progressive, degenerative disease of the brain is also found in veterans and those who have sustained repeated head trauma.  Symptoms include mood disorders, paranoia, impulse control issues, aggression, and memory loss to name a few.

Dr. Ann McKee, Boston University CTE Center director, said, “We’ve never seen this in our 468 brains, except in individuals some 20 years older.”

Although McKee couldn’t confirm the CTE was responsible for Aaron Hernandez’ criminal history, it is strongly linked to behaviors that could be impulsive and violent.

A lawsuit (reportedly $20 million) has been filed by the family against the NFL and New England Patriots.  Hernandez was only 27 years old when he hung himself in his prison cell April 19th of this year.

Researchers from Boston University concluded the 27 year-old football star had stage 3 of 4 CTE.  This severity is rarely seen in someone this young.

What are the stages of CTE?

The CTE Stages are as follows:

Stage 1: Loss of concentration, attention, dizziness and headaches

Stage 2: Additionally short term memory loss,  mood disorder such as depression, and at times explosive outbursts

Stage 3: Worsening loss of memory, judgement, ability to do daily tasks, movement disorders, tremors and suicidality

Stage 4: Amnesia, severe cognitive impairment, evidence of dementia.

CTE.jpg

IMAGE FROM SITES AT PENNSTATE

 

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

Posted in Health, news

IUDs May Cut Cervical Cancer by 30%

A new study suggests intrauterine contraceptive devices (IUDs) may fight off the virus that causes cervical cancer.

Researchers from the University of Southern California’s Keck School of Medicine found the small T-shaped device may stimulate an immune response against the sexually transmitted Human Papilloma Virus (HPV) virus which causes cervical cancer.

 

iud.jpg

T-shaped IUD sitting within the uterus

 

IUDs are a favorite among women as they do not involve taking a daily hormone pill and can provide contraceptive protection for years.  There are two main types:

The ParaGard IUD is a non hormonal implant made of copper. The copper wards of sperm allowing contraception up to 12 years.

Hormonal IUDs, such as Mirena, release progestin, a hormone similar to progesterone, to the local environment, thickening the cervical mucous to prevent sperm from reaching the egg.  Hormonal IUDs may also prevent ovulation.  Additionally, IUDs can alter the lining of the uterus such that if a fertilized egg does occur, it may not be able to nest in the uterus without proper lining.

But both IUDs can stimulate an immune response that is both a deterrent to sperm and now suggested to viruses such as HPV.

Vaccines against the HPV virus exist and are given to 11-12 year old girls with the maximum age at which one could receive the vaccine, 26 years old.

If more research confirms this is the case, then those women who have not been vaccinated or are too old to receive the vaccine against cervical cancer may benefit from using an IUD.

What is the cervix and what is cervical cancer?

The uterus looks similar to a light bulb.  The larger top portion being where the fetus develops, and the bottom, narrower area, the cervix.  The cervix thins and dilates during childbirth, as you’ve heard in the movies “she’s only 7 cm!” and then after childbirth becomes narrow again.  It affects nearly 12,000 and kills 4,000 women each year.  It can affect women of any age but is more common between 20 and 50.

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HTTP://WWW.WEBMD.COM/WOMEN

 

What causes cervical cancer?

The most common cause is HPV (Human Papillomavirus), especially HPV-16 and HPV-18.  This is acquired through unprotected sex, so condom use is encouraged. Thus its one of the most preventable causes of cancer.  Additionally, there are 3 vaccines for HPV currently approved by the FDA, GardasilGardasil 9, and Cervarix.

 

What are the symptoms of cervical cancer?

Early cervical cancer may not be symptomatic but as it develops it may cause an odor, pain with urination, pelvic pain and bleeding. This bleeding may occur after sex, a pelvic exam, or intermittent bleeding not associated with a menstrual cycle.

 

Is cervical cancer treatable?

Yes.  Early detection is key and can be done by a Pap Smear, explained below.  Multiple treatments are available including surgery, chemotherapy,  radiation therapy, and targeted therapy such as Bevacizumab (Avastin®which prevents new blood vessel growth that can feed a tumor.

 

Who should get screened for Cervical Cancer?

The USPSTF (United States Preventive Services Task Force) recommends the following:

Screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

What is a Pap Smear?

It is the cytology (cell analysis) of the cervix.  Years ago, a cytobrush would collect the cells and the medical provider would “smear” it onto a slide, place fixative, and then send it to the laboratory for the pathologist to analyze it.  Now ThinPrep® Pap tests are used more commonly as the cells from the brush are placed into a container with fixative, and this vial is sent to the pathologist to spin down and analyze.

cervical-smear-test-equipment-97358274-575db1493df78c98dc633c53

TEK IMAGE/SPL / GETTY IMAGES

In order to obtain the cells from the cervix, the medical provider needs to use a speculum to open the vaginal canal and allow access to the uterus.  A woman may be in the lithotomy position…lying on one’s back on the exam table with her feet in stirrups and knees bent. During the speculum exam, the medical provider may take cultures to test for common vaginal infections such as yeast, bacteria vaginosis, or sexually transmitted illnesses such as gonorrhea and chlamydia.  After the speculum exam, the provider may perform a pelvic exam with her gloved hand to examine the uterus and ovaries, evaluating for tenderness, shape, size and masses.

How is an HPV test done?

An HPV test can be done with the cells obtained during the Pap Smear.  The laboratory evaluates the cells to see if the HPV virus that causes cervical cancer is present.

In summary the thousands of deaths that occur each year to cervical cancer can be prevented with simple testing, such as the Pap Smear.  Discuss with your medical provider when cervical cancer screening is best for you.

 

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

How Doctors Can Prevent Burnout

A new study from the American Medical Association (AMA), the Mayo Clinic and Stanford University finds 1 in 5 physicians plan to cut back their hours next year and 1 in 50 will leave the profession completely within the next 2 years.

Burnout is cited to be the main cause and is one of the biggest threats to healthcare today.

According to AMA President Dr. David Barbe, “An energized, engaged, and resilient  workforce is essential to achieving national health goals.”

And burnout affects all fields of medicine, surpassing 50%, in those including primary care and specialties such as gynecology, neurology, urology, emergency medicine, anesthesiology, cardiology and critical care to name a few.

Patients are at risk because if doctors aren’t at the top of their game, things get missed.  Moreover the keen instinct of a clinician is imperative to diagnosing correctly, and this gets blunted when one is emotionally fatigued, or burned out.

Why are Doctors Burning Out?

A variety of factors can lead to physician burnout but the following appear to be the most cited:

  1. Electronic medical records – these are time-consuming to learn and implement, take time away from patients and may be financially burdensome due to their cost and lack of revenue for those who struggle to type and work with computers.
  2. High patient insurance deductibles – with insurance companies not paying until patients reach their deductible, it forces doctor’s offices to work harder to collect the income needed to run a practice.  Physicians do not want to get into the financial aspect of patient collections and it adds undue stress on an already stressful field.
  3. Red tape – ICD 10 code changes, insurance authorizations, referral forms turn the average day of a physician to less patient care and more bureaucracy.
  4. Less respect – in the old days, doctors were considered heroes and revered greatly.  Today they are frequently blamed for issues such as rising healthcare costs and the opioid epidemic.
  5. Malpractice suit fears – doctors are human and can only combat nature so much.  When one is diagnosed with cancer a physician has to fear that one will accuse him of not diagnosing it “quickly enough”.  When a lab gets ordered, the clinician has to hope that his staff is ensuring that every lab value comes across his desk.  When a prescription gets written, he has to hope that the correct medicine gets dispensed, works effectively and does not cause an adverse reaction.  And when a referral is made to a specialist, he has to hope all the above issues go well with the second physician or he can be sued for the referral.  And since a doctor sees thousands of patients a year, the odds that he will be sued for something is higher than any other profession.  Moreover, one lawsuit is a enough to bankrupt him.  Pretty darn stressful.

 

What are the signs of burnout?

In any profession, the following may be signs of burnout:

  • Apathy
  • Exhaustion
  • Poor sleep
  • Negative attitude at work
  • Absence from work
  • Being irritated
  • Feeling empty
  • Dreading going to work
  • Feeling underappreciated
  • Feeling you don’t matter
  • Blame others for mistakes
  • Low energy
  • Thinking about quitting

burnout

 

How to prevent burnout?

  1. Find the humor – As Milton Berle once said, “Laughter is an instant vacation”.  Watching a comedy or taking a 10 minute break to watch some funny You Tube clips offers immediate relief and energizes you.  A day without laughter is a day wasted. Charlie Chaplin
  2. Take care of yourself – how can one heal others when he himself needs healing?  So what can you do?  Try Massage, Meditation, Yoga, Exercise, Stress diary, Sleep, Mini vacations, Staycations but most of all…..Take breaks!!
  3. Learn to say “No” – Its OK to take a day off. Why not take off early on Friday’s?  Or better yet, work a half day on Wednesday to break up the week?  Learn the 4 D’s…..Deflect, Defer, Deter, Delegate…..
  4. Make small goals – too many times we burnout because we failed to meet a goal that was unattainable in the first place.  So we toil for years to become “promoted”, or “wealthy”, or “slim”, or “married”, or “see the world”.  Instead, make smaller attainable goals (find a partner, open auxiliary office, lose 10 lbs, take a trip).
  5.  Quit comparing yourself to others – we watch Shark Tank and then wonder what we are doing wrong, not being millionaires.  It’s unrealistic to think you should be “rich by now”.  We will always be inferior to someone else.  So get over it and love who you are and what you’ve accomplished.
  6. Have fun at work – contests, pot luck lunches, lunch room decorating, accent days, dress up days, and end of the week happy hour can spice things up at work.  Plus it increases morale among coworkers and staff.
  7. Be charitable – Doing community service is so rewarding and energizing that having a pet project helping out a local charity may be just what this doctor orders.  You can choose a cause, fundraise, attend charity events or walks, or even create a campaign.
  8. Get a hobby – tap into your artistic side by writing a book, song, article; paint; cook; build; teach; sing; dance; or even ride.
  9. Work on your bucket list- whether its going to a foreign country, learning to speak a new language, buying a vacation property, or even starting a second business, don’t let job burnout deter you.  This may give you the energy and perspective you need.

Finally, be around others and have a Bitch and Moan session – it feels so good to complain and gripe. Find others in similar situations as you and you’ll realize that you may have it better than you think.

Remember you have to come first and doing so will make you more of a help to others.  Feel great and you’ll make others feel great!

 

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

Posted in Health, news

Mumps Cases Soaring in Vaccinated Communities

The CDC is recommending a third booster shot for Measles, Mumps, Rubella (MMR) in light of soaring mumps cases in vaccinated populations.

According to the CDC website, 4667 people had reported mumps infections during the period of January 2016 to October 2017.

 

mumps-outbreak-map

Image above from CDC

 

Many of these cases occurred in university settings as students commonly live in dorms or study and party in close proximity to each other.

What’s odd, however, is the spike seen in cases during the last two years as seen on the graph below and in populations where vaccination was completed.

 

outbreaks-graph.png

Image above from CDC

 

So is the Mumps virus mutating and out-smarting the immune response created by the vaccine?  Are those individuals who are “vaccinated” actually under-vaccinated, i.e. not receiving the full two shots?  Is the vaccine waning after a period of time such that a booster is needed?

If we look at the spike in mumps cases in college age students, that would fall approximately 15 years after their last MMR dose.  Its possible the immunity lessens after that many years.

This prompted the CDC to recommend a third shot, MMR booster, during a mumps outbreak.

Last year, 5311 cases were reported in all 50 states, including the District of Columbia, with eight states reporting more than 100 cases this year.  These are Arkansas, Iowa, Indiana, Illinois, Massachusetts, New York, Oklahoma and Texas.

Mumps commonly affected individuals prior to the MMR vaccine implementation in the late 1960s. At the time close to 186,000 people were affected each year.  Since vaccination, these numbers have drastically decreased, but outbreaks have sprung up sporadically.

What is “The Mumps”?

Mumps are caused by the virus, paramyxovirus, causing swelling of the parotid (salivary glands).  Other symptoms include fever, malaise, headache, body aches as with many viral illnesses. The facial swelling can occur symmetrically but in 1/4 of the cases only one side may swell.

Its spread by droplet transmission, hence being exposed to someone’s sneeze, cough, saliva and symptoms may appear within a few days to a few weeks.  The illness lasts on average 10-14 days but could last longer.

Complications of the mumps could include meningitis and encephalitis (inflammation of the brain), orchitis (inflammation of the testicle), pancreatitis (inflammation of the pancreas) and others leading to infertility, deafness and in rare cases death.

Prevention

Vaccination and avoiding those who are ill is paramount. Two doses are usually given of the vaccine when a child is between 12 and 15 months and then again between 4-6 years old.  A latest study from the University of Iowa finds demonstrable effectiveness with a third booster of the MMR vaccine.  The MMR vaccinates against Measles, Mumps and Rubella.  A newer vaccine, the MMVR also protects against Varicella (chicken pox).

 

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

Posted in Health, news

Marburg Virus Outbreak Reported in Uganda, Ebola Fears Return

The World Health Organization has reported an outbreak of the Marburg virus, similar to Ebola, has appeared in eastern Uganda on the border of Kenya.

Thus far 5 cases have been reported prompting the WHO to deploy funds to keep the spread contained.

Where did Marburg Originate?

Marburg was originally identified in 1967 when two simultaneous outbreaks occurred in Marburg and Frankfurt, Germany.  An outbreak in Serbia also occurred that same time.  Since then rare isolated cases have popped up in Kenya, Angola, South Africa, Uganda and the Democratic Republic of the Congo.

What is Marburg virus and its Symptoms?

Marburg virus is apart of the same family as Ebola, the Filoviridae.  Just like Ebola, it causes a hemorrhagic fever, where victims may bleed, have fever, vomiting, diarrhea, headaches, muscle aches, rash, red eyes, sore throat and abdominal pain to name a few.

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Image from KeyWordSuggest

How is Marburg Transmitted?

Marburg virus is transmitted to humans from monkeys and bats such as the African fruit bat and Rousettus bat.  But similarly to Ebola, human to human contact can spread Marburg, especially during body preparation for burial.  Saliva, tears, vomit, semen and blood can transmit the Marburg virus from human to human.

Greater short-nosed fruit bat (Cynopterus sphinx)

Fruit Bat, Image from Dignited

How is Marburg Treated?

There is no treatment currently known for Marburg.  It has an estimated 88% fatality rate.  Its incubation period ranges from 5 days to 2 weeks and those exposed may need to be in isolation for up to 21 days.

RNA interfering treatments are being researched to prevent Marburg virus replication in the host.  Its unclear if Zmapp, a treatment for Ebola, is effective in treating Marburg infection.

Between 2014 to 2015, 28,610 people were infected with Ebola resulting in 11,380 deaths.  Local officials are being very diligent to make sure Marburg doesn’t follow a similar epidemic path.

 

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