Ok... so I am a bit behind, but I am trying to get caught up! The following is from the June 22, 2012 episode of Let's Talk Medical with Doctor Gigi.
Foot & Ankle Health:
Podiatrists are specialists in foot & ankle care. They treat with medications, orthotics, bracing, & surgery. Orthopedists care for bones & joints, so they also treat foot & ankle problems, but I have found very few who "specialize" in the area of the foot & ankle. For this reason, I prefer to see a Podiatrist for my foot & ankle care as this is the Podiatrist's only focus, whereas most Orthopedists also treat knees, hips, shoulders, all types of fractures, & perhaps even backs. If you have an Orthopedist who likes to treat foot & ankle issues, I am certain he will give you great care. Just keep in mind that the Podiatrist makes 100% of his living on caring only for the foot & ankle, so they likely have more expertise in regards to these issues.
A common foot problem is plantar fasciitis, which is inflamation of the tissue which connects from the bottom of the heel to the toes. The tissue closest to the heel can get inflamed due to your going barefoot, or perhaps due to positions such as squatting, or even due to problems with your shoes. When you get plantar fasciitis, you are usually keenly aware of it by the classic description: "sharp pain in my heel when I take my first few steps after sleeping or sitting a while." It is interesting to note that the pain does usually subside after you take a few steps, but it generally reoccurs every time you take your first steps after being off your feet for a little while. This painful condition can be treated by your Primary Care doctor or a Podiatrist or an Orthopedist. Usual care involves anti-inflamatory drugs such as Ibuprofen, Aleve, or Celebrex, along with some behavioral changes, which include: never going barefoot, using a good arch support & a soft-soled shoe, & stretching the tissue at the bottom of your foot. Sometimes steroid injections, physical therapy, & even orthotics are needed.
Another common foot & ankle problem is osteoarthritis, which is a stiffness or pain in 1 or more joints of the foot or ankle. This process is usually associated with a history of trauma in the past, such as sprains, strains, or even fractures. X-rays are generally needed to confirm the typical joint changes of arthritis, & it should be noted that Podiatrists often do their x-rays in a standing position whereas most Orthopedists & typical radiology departments often do them in a seated position. X-rays done while the patient is standing allow for evaluation of the joint in the position it assumes while standing & walking. Usual treatment for arthritis is anti-inflamatories, though sometimes PT, orthotics, or even surgery are needed.
Stress fractures of the feet occur when the bones of the foot get weak, generally from osteoporosis, & simply walking or standing breaks one of those bones. These are commonly seen in older women, as these are the same people who get the most osteoporosis. Generally they involve the bones of the forefoot, so often the lady will present to the doctor with pain & swelling in the foot between the ankle & toes (on the top, not on the bottom of the foot). There is usually no significant history of trauma, as simply the stress of standing & walking can cause this fracture. Remember those standing x-rays done by the Podiatrist? Those allow the weight of the body to stress & thus spread out the bones & tissues of the feet, which often can make it easier to diagnose these types of fractures. Thankfully stress fractures usually heal well with a soft walking cast or similar brace, but it is most important to remember what this type of fracture tells us... you have osteoporosis!!! So, if you develop a stress fracture, you must not only treat it, but you must see your doctor to treat your osteoporosis!
The feet & ankles take a beating, & when your feet hurt, every step can be misery! If yours are painful, don't hesitate to see your Primary Care doctor, a Podiatrist, or an Orthopedist, as there are many diseases which affect these body parts, but these doctors have solutions which can make your life much less painful!
DO vs. MD, & Should I Interview My New Doctor?:
If you refer back to an earlier blog, you will find more information regarding the differences between DO physicians & MD physicians. Basically, both go to medical school & both go to residency training after medical school to get their specialty training. The biggest difference is that DO's learn chiropractic theory & training, whereas MD's do not. Once medical school is completed however, many DO's never do manipulation, so they often tend to be very similar to MD's, practicing mainstream medicine with pills, advice, compassion, & surgery. Often, these two physicians train in the same residency programs, so they are not necessarily that different from one another. For instance, I trained at Bayfront Medical Center in a Family Practice residency program run by MD's. Most of the residents were MD's, but at least one was a DO. She graduated from our program & I am certain that she practices medicine very similar to the way I practice medicine. So although we went to medical schools with different philosophies, our post-medical school training was the same, so ultimately the way we practice is the same.
So how do you know if you like & trust your new doctor? Should you "interview" him or her? Well, I for one do not like the idea of being interviewed, as I think that if you really want to know what kind of a physician I am, you need to let me tackle your medical concerns. I can explain to you that I went to LSU Medical Center, then to Bayfront Medical Center's Family Practice residency program, & then started my solo family practice office. I can inform you that I am Board Certified in Family Practice, & that I have never been sued (THANK GOD!). But what I really can't tell you is the way I think, the fact that I love to educate, the manner in which I work with you to come to an agreeable plan for your medical concerns & future health, nor the way that I practice cost-effective medicine. To really "interview" me (or any other physician), I believe you must present with a medical problem or concern, & watch us in action as we evaluate & treat you. If after that you do not like your doctor, find another one. But if you do like your new doctor after this first encounter, let that be the deciding factor, not the less important issue of what credentials are hanging on the wall.
In closing, don't forget to listen to the live version of Let's Talk Medical with Doctor Gigi as we broadcast during The Skip Show on Fridays at 1-2PM Eastern time on WTAN 1340-AM in the Tampa/St. Pete area. If you are not local, please catch us with live streaming via www.SkipShow.com, where you can also find podcasts of all our previous shows so you can listen at your convenience! As always, I welcome your medical questions or comments, & thus invite you to contact me during the live show via (727)-441-3000 or toll-free (866)-TAN-1340, or you can e-mail me at any time via DoctorGigi@SkipShow.com.
Until next time, here's to our health!
Doctor Gigi
Sunday, August 19, 2012
Sunday, July 22, 2012
Rating Physicians; Generic Plavix; Vicodin Reformulated; Stop Smoking; Headaches; Blood Clots & Travel.
Welcome back to my blog, which puts into writing the topics discussed during the June 15, 2012 episode of Let's Talk Medical with Doctor Gigi.
Rating Physicians:
Many websites are available to rate physicians, & you can use them to rate your doctor or even to learn about a doctor before you establish a relationship with him. Keep in mind however that like all statistics, these rating scales do not always tell the truth. Often times, the most dissatisfied patient is the one most likely to cast an opinion. Also, anybody is allowed to vote, so I could encourage friends & even relatives to give glowing reports. I generally get good scores, but I lose a few points when judged on timeliness. At first you might think that I don't respect my patient's time, or perhaps I overload my schedule, or perhaps I have too many distractions, but in fact I run late because I spend so much time with patients... they get the time they need, not just the time for which they were scheduled. So, the fact that I do not get a perfect score, does not truly reflect a defect or problem with my medical care. Keep in mind that a perfect doctor for you might not be the perfect doctor for someone else. If your doctor has good basic medical knowledge & judgement, if he listens to you, educates you, sincerely tries to understand & know you, & in general treats you as a friend or family member, you have a fabulous doctor... for yourself... & you should not worry about the rating he might get from other patients.
Generic Plavix:
Plavix (= Clopidogrel) is a medicine used to thin blood, thus it is used to decrease the risk of strokes & heart attacks. It is pretty expensive, so many people have been awaiting the release of the generic version. Happily, the generic Plavix hit the market in May 2012. If you have insurance coverage for your medications, you likely have seen the price drop. However, if you pay for your own medications, you might not see the price drop until after the first year that the generic is available. Thus you will get a cheaper Plavix around May 2013. Again, this illustrates the fact that although a generic medication is approved, the price often does not drop significantly for cash-pay patients until 1 whole year after the initial approval. This is due to the fact that usually only 1 company gets the right to produce the generic version the first year. Many companies can begin to produce their generic versions once that first year has passed, & this results in a significant cost savings for all patients (insured & non-insured).
Vicodin Reformulated:
With the use of narcotics on the rise... an epidemic you might say... there has been much concern about the fact that most narcotics are combined with Tylenol. Many doctors & most patients forget this, & frequently patients end up taking an overdose of Tylenol which can be lethal. In fact, we used to recommend a maximum daily dose of 4,000 mg of Tylenol, but now we have lowered that maximum dose to 3,000 mg of Tylenol per day.
Vicodin is a commonly used narcotic pain medication which combines Hydrocodone (the narcotic) with Tylenol. It used to be available with 5, 7.5, or 10 mg of Hydrocodone, combined with 325-500 mg of Tylenol. Physicians used to frequently prescribe the Vicodin 5/500 at a dose of "1 to 2 pills every 4 to 6 hours as needed for pain." Therefore a patient was allowed a maximum dose of 2 pills every 4 hours (6 times per day), resulting in a total daily dose of:
5 mg of Hydrocodone per pill X 2 pills = 10 mg of Hydrocodone per dose
10 mg Hydrocodone per dose X 6 doses per day = 60 mg Hydrocodone per day.
Unfortunately, if you figure out the dose of Tylenol, you will find that this dosing provides an OVERDOSE of Tylenol:
500 mg of Tylenol per pill X 2 pills = 1,000 mg of Tylenol per dose
1,000 mg of Tylenol per dose X 6 doses per day = 6,000 mg Tylenol per day!
Thank God for Pharmacists who have worked diligently to educate physicians about the dangers of these combination drugs, & have often suggested other doses which will not overdose our patients on Tylenol. This was not lost on the Pharmaceutical industry, who is now reformulating narcotic-Tylenol combination products.
Vicodin will soon be released in its newly reformulated version... which will use 300 mg of Tylenol regardless of the amount of Hydrocodone in the pill. Thus if a patient takes 2 pills 6 times per day, they will only get a max of: 2 pills X 300 mg Tylenol X 6 doses = 3,600 mg of Tylenol per day. Though this is higher than the new overdose level of 3,000 mg of Tylenol per day, it is at least below the 4,000 mg dose which is the known toxic dose. Expect to see this change occur during September or October 2012, & expect other narcotic medications to follow with similar reformulations.
By the way, Tylenol overdose is a nasty way to die. The Tylenol injures your liver, but it takes up to 5 days for your liver to show the full extent of that damage. Thus, a person who intentionally overdoses on Tylenol will often wake up in the hospital after having had his stomach pumped. Most times he is happy to be alive & thankful that the suicide attempt was not successful. Unfortunately, about 5 days later his liver will begin to die, & without a liver transplant, so might he. Physicians can check a Tylenol level when the person first shows up in the Emergency Room, & they can use this level to predict whether the liver will actually die or not. Of course, slow daily unintentional overdose is different as the damage to the liver occurs slowly over time, but the outcome is the same.
Stop Smoking:
If you or someone you love is trying to stop smoking, here are some helpful hints.
If you live in Florida, you should check out "Tobacco Free Florida" as I think they can provide you with free nicotine patches. If you have never tried these patches, you should, as they often work well for people truly committed to stopping smoking. Be sure to follow the directions, as the strenghth you will need varies depending upon the amount of cigarettes you smoke. The 21 mg patch is the correct strength for someone who smokes about 1 pack per day, whereas a 1/2 pack per day smoker should use the 14 mg patch. Of course you start with a high dose, then wean down over time.
Though the nicotine patches help many people stop smoking, I prefer the Nicotrol Inhaler device. It is a small plastic device that looks like the plastic tip on a cigar. It unscrews, & inside it holds a small sponge that is impregnated with nicotine. As you "smoke" the device, air comes in through the sponge & picks up the nicotine, thus carrying it into your lungs. Thus you get the nicotine... which is truly what you are addicted to... but you do not get the tar & smoke! Your hands & mouth feel as though you are smoking, so they are happy too! Over time you are supposed to use less & less of these inhalers, but even if you never stop using them, you will at least be doing less damage to your body than if you continue to smoke cigarettes. Also, because you only get nicotine when you "smoke" the Nicotrol inhaler, you can choose to smoke a real cigarette interspersed with the inhaler, thus you do not have to worry if you have an occassional "slip" with the tobacco cigarette.
Though Nicotrol inhalers are expensive, I recently saw where you can get a month's supply for a maximum of $50. To cash in on that deal, you should go to the website www.Nicotrol.com where you can get a coupon which will limit your cost to $50. You will still need a prescription, but I don't think there is a physician among us who would not be happy to provide you with that!
Headaches:
If a 50 year old lady starts to develop headaches which are associated with nausea, is this likely to be migraines? It is certainly true that migraine heasdaches can develop when ladies go through hormonal changes such as menopause, but at 50 years old you must also give consideration to neurologic abnormalities such as masses, tumors, strokes, or pre-strokes (called TIA's, which stands for transient ischemic attacks). Thus it is likely that this lady should have a neurologic examination & perhaps an MRI of her brain, just to be certain there is not a more ominous cause for her headaches.
Also, tension headaches, which are caused by muscle tension or spasm, can be associated with nausea as well. And don't forget, stress can cause both migraine & tension headaches.
Though you can certainly awaken with a tension headache or a migraine headache, you should also give consideration to the fact that morning headaches can be a sign of sleep apnea. So if you awaken with headahces, snore loudly, have daytime exhaustion, & awaken feeling as tired as you were when you went to bed, you just might have sleep apnea. Talk to your physician & he can order a sleep study to evaluate this further. As a cost-effective measure, ask if you can get a "home" sleep study, as these can now be conducted at your own home, which is less expensive than going to a sleep lab.
Blood Clots & Travel:
If blood sits still too long it tends to clot. Thus it should come as no surprise that travel increases the risk of getting blood clots in your legs which are called "deep vein thromboses" or DVT's. These unfortunately can break free & go to the lungs where we call them "pulmonary emboli" (= PE). Pulmonary emboli can kill you as they block up the blood vessels of the lungs, thus liquid blood cannot pass through the lungs to pick up oxygen, resulting in a deadly lack of oxygen to all the body's organs. So if you travel 2 hours or more, you should pump your feet up & down to push the blood through your leg veins. You should also stand up or at least try to stretch out straight so you remove the bend at your hips, thus re-establishing a straight course for the blood to flow from your feet to your heart. If you develop red, hot, swollen legs or shortness of breath after travel, do not delay in contacting your doctor & be sure to give him this history so he will evaluate you urgently. The best study to evaluate for DVT's is a Doppler ultrasound of the legs, & the usual test for a PE is either a ventillation-perfusion scan or a spiral CT of the chest. Again, these clots can be life-threatening, so if you think you have one, get your studies done urgently, even if that means going to the Emergency Room!
Thanks for visiting my blog, & I hope you learned something useful. Remember you can hear me live on WTAN 1340-AM on Fridays from 1-2PM Eastern time. Or if you prefer, check it out on www.SkipShow.com where you can listen live or to the podcasts. I would love to hear from you... comments of questions. You can reach me live during the show via (727)-441-3000 or on our toll-free number: (866)-TAN-1340. If you prefer, you can reach me any time via: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
PS I would love to impact more people, so please consider sharing this blog with your friends & family on Facebook or on your other chosen social media.
Rating Physicians:
Many websites are available to rate physicians, & you can use them to rate your doctor or even to learn about a doctor before you establish a relationship with him. Keep in mind however that like all statistics, these rating scales do not always tell the truth. Often times, the most dissatisfied patient is the one most likely to cast an opinion. Also, anybody is allowed to vote, so I could encourage friends & even relatives to give glowing reports. I generally get good scores, but I lose a few points when judged on timeliness. At first you might think that I don't respect my patient's time, or perhaps I overload my schedule, or perhaps I have too many distractions, but in fact I run late because I spend so much time with patients... they get the time they need, not just the time for which they were scheduled. So, the fact that I do not get a perfect score, does not truly reflect a defect or problem with my medical care. Keep in mind that a perfect doctor for you might not be the perfect doctor for someone else. If your doctor has good basic medical knowledge & judgement, if he listens to you, educates you, sincerely tries to understand & know you, & in general treats you as a friend or family member, you have a fabulous doctor... for yourself... & you should not worry about the rating he might get from other patients.
Generic Plavix:
Plavix (= Clopidogrel) is a medicine used to thin blood, thus it is used to decrease the risk of strokes & heart attacks. It is pretty expensive, so many people have been awaiting the release of the generic version. Happily, the generic Plavix hit the market in May 2012. If you have insurance coverage for your medications, you likely have seen the price drop. However, if you pay for your own medications, you might not see the price drop until after the first year that the generic is available. Thus you will get a cheaper Plavix around May 2013. Again, this illustrates the fact that although a generic medication is approved, the price often does not drop significantly for cash-pay patients until 1 whole year after the initial approval. This is due to the fact that usually only 1 company gets the right to produce the generic version the first year. Many companies can begin to produce their generic versions once that first year has passed, & this results in a significant cost savings for all patients (insured & non-insured).
Vicodin Reformulated:
With the use of narcotics on the rise... an epidemic you might say... there has been much concern about the fact that most narcotics are combined with Tylenol. Many doctors & most patients forget this, & frequently patients end up taking an overdose of Tylenol which can be lethal. In fact, we used to recommend a maximum daily dose of 4,000 mg of Tylenol, but now we have lowered that maximum dose to 3,000 mg of Tylenol per day.
Vicodin is a commonly used narcotic pain medication which combines Hydrocodone (the narcotic) with Tylenol. It used to be available with 5, 7.5, or 10 mg of Hydrocodone, combined with 325-500 mg of Tylenol. Physicians used to frequently prescribe the Vicodin 5/500 at a dose of "1 to 2 pills every 4 to 6 hours as needed for pain." Therefore a patient was allowed a maximum dose of 2 pills every 4 hours (6 times per day), resulting in a total daily dose of:
5 mg of Hydrocodone per pill X 2 pills = 10 mg of Hydrocodone per dose
10 mg Hydrocodone per dose X 6 doses per day = 60 mg Hydrocodone per day.
Unfortunately, if you figure out the dose of Tylenol, you will find that this dosing provides an OVERDOSE of Tylenol:
500 mg of Tylenol per pill X 2 pills = 1,000 mg of Tylenol per dose
1,000 mg of Tylenol per dose X 6 doses per day = 6,000 mg Tylenol per day!
Thank God for Pharmacists who have worked diligently to educate physicians about the dangers of these combination drugs, & have often suggested other doses which will not overdose our patients on Tylenol. This was not lost on the Pharmaceutical industry, who is now reformulating narcotic-Tylenol combination products.
Vicodin will soon be released in its newly reformulated version... which will use 300 mg of Tylenol regardless of the amount of Hydrocodone in the pill. Thus if a patient takes 2 pills 6 times per day, they will only get a max of: 2 pills X 300 mg Tylenol X 6 doses = 3,600 mg of Tylenol per day. Though this is higher than the new overdose level of 3,000 mg of Tylenol per day, it is at least below the 4,000 mg dose which is the known toxic dose. Expect to see this change occur during September or October 2012, & expect other narcotic medications to follow with similar reformulations.
By the way, Tylenol overdose is a nasty way to die. The Tylenol injures your liver, but it takes up to 5 days for your liver to show the full extent of that damage. Thus, a person who intentionally overdoses on Tylenol will often wake up in the hospital after having had his stomach pumped. Most times he is happy to be alive & thankful that the suicide attempt was not successful. Unfortunately, about 5 days later his liver will begin to die, & without a liver transplant, so might he. Physicians can check a Tylenol level when the person first shows up in the Emergency Room, & they can use this level to predict whether the liver will actually die or not. Of course, slow daily unintentional overdose is different as the damage to the liver occurs slowly over time, but the outcome is the same.
Stop Smoking:
If you or someone you love is trying to stop smoking, here are some helpful hints.
If you live in Florida, you should check out "Tobacco Free Florida" as I think they can provide you with free nicotine patches. If you have never tried these patches, you should, as they often work well for people truly committed to stopping smoking. Be sure to follow the directions, as the strenghth you will need varies depending upon the amount of cigarettes you smoke. The 21 mg patch is the correct strength for someone who smokes about 1 pack per day, whereas a 1/2 pack per day smoker should use the 14 mg patch. Of course you start with a high dose, then wean down over time.
Though the nicotine patches help many people stop smoking, I prefer the Nicotrol Inhaler device. It is a small plastic device that looks like the plastic tip on a cigar. It unscrews, & inside it holds a small sponge that is impregnated with nicotine. As you "smoke" the device, air comes in through the sponge & picks up the nicotine, thus carrying it into your lungs. Thus you get the nicotine... which is truly what you are addicted to... but you do not get the tar & smoke! Your hands & mouth feel as though you are smoking, so they are happy too! Over time you are supposed to use less & less of these inhalers, but even if you never stop using them, you will at least be doing less damage to your body than if you continue to smoke cigarettes. Also, because you only get nicotine when you "smoke" the Nicotrol inhaler, you can choose to smoke a real cigarette interspersed with the inhaler, thus you do not have to worry if you have an occassional "slip" with the tobacco cigarette.
Though Nicotrol inhalers are expensive, I recently saw where you can get a month's supply for a maximum of $50. To cash in on that deal, you should go to the website www.Nicotrol.com where you can get a coupon which will limit your cost to $50. You will still need a prescription, but I don't think there is a physician among us who would not be happy to provide you with that!
Headaches:
If a 50 year old lady starts to develop headaches which are associated with nausea, is this likely to be migraines? It is certainly true that migraine heasdaches can develop when ladies go through hormonal changes such as menopause, but at 50 years old you must also give consideration to neurologic abnormalities such as masses, tumors, strokes, or pre-strokes (called TIA's, which stands for transient ischemic attacks). Thus it is likely that this lady should have a neurologic examination & perhaps an MRI of her brain, just to be certain there is not a more ominous cause for her headaches.
Also, tension headaches, which are caused by muscle tension or spasm, can be associated with nausea as well. And don't forget, stress can cause both migraine & tension headaches.
Though you can certainly awaken with a tension headache or a migraine headache, you should also give consideration to the fact that morning headaches can be a sign of sleep apnea. So if you awaken with headahces, snore loudly, have daytime exhaustion, & awaken feeling as tired as you were when you went to bed, you just might have sleep apnea. Talk to your physician & he can order a sleep study to evaluate this further. As a cost-effective measure, ask if you can get a "home" sleep study, as these can now be conducted at your own home, which is less expensive than going to a sleep lab.
Blood Clots & Travel:
If blood sits still too long it tends to clot. Thus it should come as no surprise that travel increases the risk of getting blood clots in your legs which are called "deep vein thromboses" or DVT's. These unfortunately can break free & go to the lungs where we call them "pulmonary emboli" (= PE). Pulmonary emboli can kill you as they block up the blood vessels of the lungs, thus liquid blood cannot pass through the lungs to pick up oxygen, resulting in a deadly lack of oxygen to all the body's organs. So if you travel 2 hours or more, you should pump your feet up & down to push the blood through your leg veins. You should also stand up or at least try to stretch out straight so you remove the bend at your hips, thus re-establishing a straight course for the blood to flow from your feet to your heart. If you develop red, hot, swollen legs or shortness of breath after travel, do not delay in contacting your doctor & be sure to give him this history so he will evaluate you urgently. The best study to evaluate for DVT's is a Doppler ultrasound of the legs, & the usual test for a PE is either a ventillation-perfusion scan or a spiral CT of the chest. Again, these clots can be life-threatening, so if you think you have one, get your studies done urgently, even if that means going to the Emergency Room!
Thanks for visiting my blog, & I hope you learned something useful. Remember you can hear me live on WTAN 1340-AM on Fridays from 1-2PM Eastern time. Or if you prefer, check it out on www.SkipShow.com where you can listen live or to the podcasts. I would love to hear from you... comments of questions. You can reach me live during the show via (727)-441-3000 or on our toll-free number: (866)-TAN-1340. If you prefer, you can reach me any time via: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
PS I would love to impact more people, so please consider sharing this blog with your friends & family on Facebook or on your other chosen social media.
Sunday, July 8, 2012
Bleeding After Menopause; Nipple Confusion?; PSA vs. BPH; Coumadin & Vitamin K; Iron for Anemia.
I recently attended the 25th Reunion of my medical school class. If you are quick with math, you know now that I graduated from medical school in 1987! The reunion of the LSUMC Class of 1987 was in New Orleans, & I guess we have gotten old enough that we "earned" the opportunity to celebrate at Arnaud's Restaurant. This grande restaurant served great food, & provided a balcony over-looking Bourbon Street... so we really felt the New Orleans experience! The highlight of the night was a tour of the restaurant, where we learned that it occupies the entire city block & is a conglomeration of 14 houses which were individually purchased & joined together over many years. I guess that explains the variable decor & the steps up & down from one room to another! And of course, the true highlight of the entire weekend was the opportunity to spend quality time with many friends, most of whom we see all too seldom! I have found that the bond we established during our 4 years of medical school seems to be an ever-lasting one, & I am already looking forward to our 30th reunion. Even better than that is the fact that due to social media, we will likely be better at keeping up with one another from here forward!
Despite my "play time," I did broadcast "Let's Talk Medical with Doctor Gigi" from my parents' home in Port Allen, LA. Following are the highlights of that June 8, 2012 episode.
Bleeding After Menopause:
We have discussed that menopause is the absence of ovarian function, either due to the "death" of the ovaries or due to their surgical removal. With the lack of ovarian function there is also a lack of a menstrual cycle as it is the ovaries which normally produce the hormones which cause this cyclic bleeding monthly. Once you lose ovarian function, you stop having periods, & though the bleeding usually does not just stop, the cycles usually get further & further apart. Once there is no period for one year, you are fully menopausal... also known as "post-menopausal."
It is very important to know that once you have stopped having periods for 1 year, you should never have a period or vaginal bleeding again... & this includes "spotting!" In fact, doctors call any of these "post-menopausal bleeding," & we generally assume that this is endometrial cancer (= cancer of the uterine lining) until proven otherwise. Of course, if you have had a hysterectomy then you have had your uterus removed, so you no longer have an endometrium (as this is the inner lining of the uterus). Thus a person with post-menopausal bleeding would not need to be as concerned if she does not have a uterus. But if she has a uterus, she MUST see her GYN or Primary Care physician for a physical exam, probably a pelvic ultrasound, & likely a biopsy of her endometrium... & she should NOT wait!
Fortunately most post-menopausal bleeding is found to be due to benign causes, but the work-up for cancer must prove this as it cannot be assumed! Often times the cause is infection, but I believe the most common etiology is vaginal dryness (= atrophic vaginitis) which is common is women who have lost their estrogen hormone. Fortunately a small amount of estrogen cream applied to the vagina & external tissues can make these dry tissues healthy again, resulting in resolution of the abnormal bleeding, as well as a return to more supple, pliable, moist genital tissues which makes sex more fun!
Also, note that if you take hormone replacement for menopause, you might have bleeding depending upon how you take those hormones, & how long you have been on them. If you take them in a cyclic fashion... 25 days of progesterone, with the last 10 days combined with estrogen, followed by 5-6 days of no hormones... you should bleed monthly (during the 5-6 days of no hormones). If you take both the estrogen & progesterone every day, you might bleed irregularly for the first 6 months, but after that, you should not bleed... so call your doctor if you do!
As a last note, a Pap smear only tests for cervical cancer. That means that it looks for cancer on the bottom of the uterus. It does not tell you anything about endometrial cancer, so even if your Pap was recently normal, you must call your doctor if you develop unexpected post-menopausal bleeding!
Nipple Confusion?:
Don't get me wrong, I strongly believe in breast feeding! It provides the most natural source of nutrition to our babies, & the first 3 days of breast feeding is particularly important as the breast milk is very special at that time. It is called "colostrum," & it is loaded with antibodies (from the mother) which provide the baby with a great immune system until he can produce his own!
But will it confuse the baby if you inter-mix the breast feeding with a bottle? People have proposed that if you feed the baby a bottle, he will get "nipple confusion" & not feed properly. I really don't subscribe to this idea, as I know that babies are born with what doctors call "primitive" reflexes, which are hard-wired from birth to help the baby survive. This includes a "rooting" reflex which causes the baby to turn his head toward anything that tickles or presses against his cheek, & a "suck" reflex which causes him to suck anything put in his mouth. So a baby really doesn't care about nipples or bottles, he just has reflexes which drive him to find nutrition! So I believe that most babies can be fed both & not get confused. Of course, over time they might develop a preference for one or the other, but you can deal with that when or if it happens. If he happens to prefer the breast, great! If he prefers the bottle, you can always pump your breasts & place that breast milk in the bottle he likes.
I propose that having a baby who will take both the breast & the bottle is beneficial. If somehow your breast milk does not come in properly, you could be starving &/or dehydrating your baby if you do not offer him a supplement! Also, what will you do if you get ill & have to take medication which is not safe for your baby (Mom's body will share many medications with her baby by secreting them into the breast milk as it is produced)? What will you do if you want to go out & have an adult beverage? And don't forget, breast feeding is a fabulous bonding opportunity for Mom & baby, but what about dear old Dad? Allowing him to feed the baby (with a bottle of breast milk OR formula) will help insure that he & the baby bond as well!
PSA versus BPH:
Does a normal PSA mean that the prostate is fine? No, it means that the "prostatic specific antibody" is normal, thus indicating that it is unlikely that you have prostate cancer or prostate infection/inflamation.
What about symptoms like: urinary frequency (= the need to urinate often), urinary hesitancy (= a delay in starting urination when you try), nocturia (= having to get up at night to urinate), or poor urinary stream (= a weak stream, so basically you don't make bubbles in the toilet, & perhaps you don't make noise)? These are symptoms of an enlarged prostate... what we call "Benign Prostatic Hypertrophy" or BPH. If you have these symptoms you should discuss them with your doctor, who will likely do a digital rectal exam (= DRE) to check the size of the prostate, & also to feel for masses which could be cancerous. If there are no masses & the PSA is normal, it is not likely that you have prostate cancer, so treatment for the enlarged prostate can begin. Certain blood pressure medications can shrink the prostate, so often Hytrin (= Terazosin) or Cardura (=Doxazosin) are used if the man has high blood pressure AND BPH. If he does not have high blood pressure, often Flomax (= Tamsulosin) is used. If these medications do not help, surgery is generally indicated. The old surgery is the Transurethral Resection of the Prostate (= TURP) which is more bloody & requires a longer time in the hospital with a foley catheter in the bladder. The newer pocedure is the GreenLight Laser treatment, which uses a laser to remove the excess prostate tissue. Due to the laser cauterizing the tissue, there is almost no bleeding & faster healing, so it is usually done as an out-patient procedure... though you usually go home with a catheter which is removed in the Urologist's office the next day.
Coumadin & Vitamin K:
Coumadin is a blood thinner used to decrease the risk of blood clots (and thus strokes) in people who have an irregular heart beat, such as atrial fibrillation. It is also used when a person has a deep vein thrombosis (= DVT) or even a pulmonary embolism (= PE), as these blood clots must be thinned, dissolved, & then prevented. Coumadin interacts with many foods & medicines, thus it will vary in effectiveness depending on what you eat & the meds you take. In particular, Vitamin K reverses the effect of Coumadin. For this reason, doctors recommend that anyone who takes Coumadin should also follow a low Vitamin K diet. This is difficult for many people as Vitamin K is found in large amounts in leafy green vegetables. So, must a person who takes Coumadin change his diet radically & avoid leafy greens? Well, it is best to simply avoid Vitamin K food products, but this is impractical for some people. I recommend therefore that if you really enjoy leafy greens or other high Vitamin K foods, eat them... but do so consistently. Find the amount of Vitamin K contained in these foods & try to eat the same amount of Vitamin K every day. In doing so, your Vitamin K level will be stable so the doctor will be able to find the dose of Coumadin that will work with that dose of Vitamin K. So if you ever end up on Coumadin, but love spinach, don't worry. You can eat it, but you will have to eat it daily or find something with a similar amount of Vitamin K to eat daily.
Many of you may know that there is a new blood thinner on the market. It is called Pradaxa, & it is very special in that it is not affected by food & meds. In fact, doctors need not monitor labs to insure proper effectiveness. Unfortunately it is new so we are still getting familiar with it, & of course it is expensive. Perhaps it's biggest downfall however is that it's effect is not reversible, so if you are injured & bleeding, the doctor cannot give you medicine to reverse it's blood thinning effect, meaning that you will bleed freely until it's effect wears off. Conversely, Coumadin can easily be reversed by giving the patient a large dose of Vitamin K... so perhaps in the long run, it is the safer blood thinner.
By the way, Coumadin is the name-brand version of Warfarin. You have likely used Warfarin around your house or camp, as it is commonly known as rat poison!
Iron for Anemia:
Anyone who has ever taken an iron supplement knows that iron often causes constipation & stomach upset. I learned many years ago about a supplement which is great for treating anemia, and which does not tend to cause stoamch upset. It is called "hematinic" which I tend to think translates to "blood tonic." Since learning of its existence I have not written a prescription for iron, as my patients have responded very well to the hematinic & have essentially no side-effects. You should be able to find a hematinic in a good health food store. Like any other medication, you need to follow your body's response to the supplement, so be sure to get lab work after 1-2 months to be sure your blood counts are improving.
Keep in mind that I am happy to answer your medical questions. Just call during the live show or e-mail me any time. "Let's Talk Medical with Doctor Gigi" airs live during "The Skip Show" on Fridays at 1:00 PM Eastern time. We're on WTAN 1340-AM in the St. Pete/Clearwater area, or you can catch us live via www.SkipShow.com where you will also have access to our recorded podcasts. Our contact info is as follows: (727)-441-3000 or toll-free (866)-TAN-1340 or DoctorGigi@SkipShow.com.
Hope to hear from you soon, & until then, here's to our health!
Doctor Gigi
Despite my "play time," I did broadcast "Let's Talk Medical with Doctor Gigi" from my parents' home in Port Allen, LA. Following are the highlights of that June 8, 2012 episode.
Bleeding After Menopause:
We have discussed that menopause is the absence of ovarian function, either due to the "death" of the ovaries or due to their surgical removal. With the lack of ovarian function there is also a lack of a menstrual cycle as it is the ovaries which normally produce the hormones which cause this cyclic bleeding monthly. Once you lose ovarian function, you stop having periods, & though the bleeding usually does not just stop, the cycles usually get further & further apart. Once there is no period for one year, you are fully menopausal... also known as "post-menopausal."
It is very important to know that once you have stopped having periods for 1 year, you should never have a period or vaginal bleeding again... & this includes "spotting!" In fact, doctors call any of these "post-menopausal bleeding," & we generally assume that this is endometrial cancer (= cancer of the uterine lining) until proven otherwise. Of course, if you have had a hysterectomy then you have had your uterus removed, so you no longer have an endometrium (as this is the inner lining of the uterus). Thus a person with post-menopausal bleeding would not need to be as concerned if she does not have a uterus. But if she has a uterus, she MUST see her GYN or Primary Care physician for a physical exam, probably a pelvic ultrasound, & likely a biopsy of her endometrium... & she should NOT wait!
Fortunately most post-menopausal bleeding is found to be due to benign causes, but the work-up for cancer must prove this as it cannot be assumed! Often times the cause is infection, but I believe the most common etiology is vaginal dryness (= atrophic vaginitis) which is common is women who have lost their estrogen hormone. Fortunately a small amount of estrogen cream applied to the vagina & external tissues can make these dry tissues healthy again, resulting in resolution of the abnormal bleeding, as well as a return to more supple, pliable, moist genital tissues which makes sex more fun!
Also, note that if you take hormone replacement for menopause, you might have bleeding depending upon how you take those hormones, & how long you have been on them. If you take them in a cyclic fashion... 25 days of progesterone, with the last 10 days combined with estrogen, followed by 5-6 days of no hormones... you should bleed monthly (during the 5-6 days of no hormones). If you take both the estrogen & progesterone every day, you might bleed irregularly for the first 6 months, but after that, you should not bleed... so call your doctor if you do!
As a last note, a Pap smear only tests for cervical cancer. That means that it looks for cancer on the bottom of the uterus. It does not tell you anything about endometrial cancer, so even if your Pap was recently normal, you must call your doctor if you develop unexpected post-menopausal bleeding!
Nipple Confusion?:
Don't get me wrong, I strongly believe in breast feeding! It provides the most natural source of nutrition to our babies, & the first 3 days of breast feeding is particularly important as the breast milk is very special at that time. It is called "colostrum," & it is loaded with antibodies (from the mother) which provide the baby with a great immune system until he can produce his own!
But will it confuse the baby if you inter-mix the breast feeding with a bottle? People have proposed that if you feed the baby a bottle, he will get "nipple confusion" & not feed properly. I really don't subscribe to this idea, as I know that babies are born with what doctors call "primitive" reflexes, which are hard-wired from birth to help the baby survive. This includes a "rooting" reflex which causes the baby to turn his head toward anything that tickles or presses against his cheek, & a "suck" reflex which causes him to suck anything put in his mouth. So a baby really doesn't care about nipples or bottles, he just has reflexes which drive him to find nutrition! So I believe that most babies can be fed both & not get confused. Of course, over time they might develop a preference for one or the other, but you can deal with that when or if it happens. If he happens to prefer the breast, great! If he prefers the bottle, you can always pump your breasts & place that breast milk in the bottle he likes.
I propose that having a baby who will take both the breast & the bottle is beneficial. If somehow your breast milk does not come in properly, you could be starving &/or dehydrating your baby if you do not offer him a supplement! Also, what will you do if you get ill & have to take medication which is not safe for your baby (Mom's body will share many medications with her baby by secreting them into the breast milk as it is produced)? What will you do if you want to go out & have an adult beverage? And don't forget, breast feeding is a fabulous bonding opportunity for Mom & baby, but what about dear old Dad? Allowing him to feed the baby (with a bottle of breast milk OR formula) will help insure that he & the baby bond as well!
PSA versus BPH:
Does a normal PSA mean that the prostate is fine? No, it means that the "prostatic specific antibody" is normal, thus indicating that it is unlikely that you have prostate cancer or prostate infection/inflamation.
What about symptoms like: urinary frequency (= the need to urinate often), urinary hesitancy (= a delay in starting urination when you try), nocturia (= having to get up at night to urinate), or poor urinary stream (= a weak stream, so basically you don't make bubbles in the toilet, & perhaps you don't make noise)? These are symptoms of an enlarged prostate... what we call "Benign Prostatic Hypertrophy" or BPH. If you have these symptoms you should discuss them with your doctor, who will likely do a digital rectal exam (= DRE) to check the size of the prostate, & also to feel for masses which could be cancerous. If there are no masses & the PSA is normal, it is not likely that you have prostate cancer, so treatment for the enlarged prostate can begin. Certain blood pressure medications can shrink the prostate, so often Hytrin (= Terazosin) or Cardura (=Doxazosin) are used if the man has high blood pressure AND BPH. If he does not have high blood pressure, often Flomax (= Tamsulosin) is used. If these medications do not help, surgery is generally indicated. The old surgery is the Transurethral Resection of the Prostate (= TURP) which is more bloody & requires a longer time in the hospital with a foley catheter in the bladder. The newer pocedure is the GreenLight Laser treatment, which uses a laser to remove the excess prostate tissue. Due to the laser cauterizing the tissue, there is almost no bleeding & faster healing, so it is usually done as an out-patient procedure... though you usually go home with a catheter which is removed in the Urologist's office the next day.
Coumadin & Vitamin K:
Coumadin is a blood thinner used to decrease the risk of blood clots (and thus strokes) in people who have an irregular heart beat, such as atrial fibrillation. It is also used when a person has a deep vein thrombosis (= DVT) or even a pulmonary embolism (= PE), as these blood clots must be thinned, dissolved, & then prevented. Coumadin interacts with many foods & medicines, thus it will vary in effectiveness depending on what you eat & the meds you take. In particular, Vitamin K reverses the effect of Coumadin. For this reason, doctors recommend that anyone who takes Coumadin should also follow a low Vitamin K diet. This is difficult for many people as Vitamin K is found in large amounts in leafy green vegetables. So, must a person who takes Coumadin change his diet radically & avoid leafy greens? Well, it is best to simply avoid Vitamin K food products, but this is impractical for some people. I recommend therefore that if you really enjoy leafy greens or other high Vitamin K foods, eat them... but do so consistently. Find the amount of Vitamin K contained in these foods & try to eat the same amount of Vitamin K every day. In doing so, your Vitamin K level will be stable so the doctor will be able to find the dose of Coumadin that will work with that dose of Vitamin K. So if you ever end up on Coumadin, but love spinach, don't worry. You can eat it, but you will have to eat it daily or find something with a similar amount of Vitamin K to eat daily.
Many of you may know that there is a new blood thinner on the market. It is called Pradaxa, & it is very special in that it is not affected by food & meds. In fact, doctors need not monitor labs to insure proper effectiveness. Unfortunately it is new so we are still getting familiar with it, & of course it is expensive. Perhaps it's biggest downfall however is that it's effect is not reversible, so if you are injured & bleeding, the doctor cannot give you medicine to reverse it's blood thinning effect, meaning that you will bleed freely until it's effect wears off. Conversely, Coumadin can easily be reversed by giving the patient a large dose of Vitamin K... so perhaps in the long run, it is the safer blood thinner.
By the way, Coumadin is the name-brand version of Warfarin. You have likely used Warfarin around your house or camp, as it is commonly known as rat poison!
Iron for Anemia:
Anyone who has ever taken an iron supplement knows that iron often causes constipation & stomach upset. I learned many years ago about a supplement which is great for treating anemia, and which does not tend to cause stoamch upset. It is called "hematinic" which I tend to think translates to "blood tonic." Since learning of its existence I have not written a prescription for iron, as my patients have responded very well to the hematinic & have essentially no side-effects. You should be able to find a hematinic in a good health food store. Like any other medication, you need to follow your body's response to the supplement, so be sure to get lab work after 1-2 months to be sure your blood counts are improving.
Keep in mind that I am happy to answer your medical questions. Just call during the live show or e-mail me any time. "Let's Talk Medical with Doctor Gigi" airs live during "The Skip Show" on Fridays at 1:00 PM Eastern time. We're on WTAN 1340-AM in the St. Pete/Clearwater area, or you can catch us live via www.SkipShow.com where you will also have access to our recorded podcasts. Our contact info is as follows: (727)-441-3000 or toll-free (866)-TAN-1340 or DoctorGigi@SkipShow.com.
Hope to hear from you soon, & until then, here's to our health!
Doctor Gigi
Sunday, June 17, 2012
He Who Pays Chooses How to Play; Metastatic Cancer; Hurricane Preparedness.
This blog contains information presented in the live broadcast of Let's Talk Medical with Doctor Gigi on June 1, 2012. Please check out the podcast on www.SkipShow.com if you prefer the audio version.
He Who Pays Chooses How to Play:
The New York mayor has proposed that his city should essentially outlaw large sodas. So what do you think about government taking away your Big Gulp? As a physician, I see the beauty of encouraging people to eat & drink sensible serving sizes, especially as we battle our epidemic of obesity, but I really hate the idea that my dietary habits might be dictated by government! The problem is that as long as government is responsible for our healthcare, they have a vested interest in our health. Thus, they just might be justified in passing laws that seemingly help to keep us healthy. Again, I like the idea of healthy habits, but I despise the idea of government-mandated anything! We as Americans like our freedoms, so how can we think this is a good idea?
Well, the unfortunate truth is that "he who pays chooses how to play." So if government pays for your healthcare, they will dictate how you live your life... perhaps affecting your diet, your exercise habits, your sleep habits, your sexual habits, etc. If that sounds frightening, start paying attention to healthcare policy, & start thinking about the control Big Brother already has... & be leery of giving them more control! This is an aspect of government-provided healthcare which many of us have not considered.
When government or insurance pays the doctor, realize that the doctor actually works for them. When you pay the doctor, he works for you. Which program do you think provides for an appropriate doctor-patient relationship? There are many political policies which might seriously affect your health, as well as your freedoms, so if you care, get involved & realize that "free" healthcare is NOT FREE!
Metastatic Cancer:
A "primary cancer" is the initial cancer that develops, & it is named according to the area in which it first begins. When that primary cancer spreads to a different area, then it is called "metastatic" or "secondary" cancer. So if cancer begins in the breast, it is called a primary breast cancer. If that cancer spreads or metastasizes to the brain, it is still called breast cancer (not brain cancer), but it is metastatic breast cancer which has gone to the brain.
Metastatic cancer is obviously not likely to be as treatable as primary cancer, but it is not by definition terminal! The curability depends on the type of primary cancer as well as the extent of metastatic spread... which is determined by the number of metastases & the organs involved with metastases. It also depends upon the overall health of the patient, & also to a large degree upon the patient's attitude. So never decide that there is no hope just based upon the knowledge that a cancer has metastasized... ask for treatment options & perhaps get several opinions.
During the show someone asked questions regarding a cancer which has just been diagnosed & has already metastasized to the bone. Obviously I cannot say whether this is curable, but certainly the patient should not assume there is no hope! Oncologists are the specialists who treat cancer patients, & they know treatment protocols, expected outcomes, cancer behavior, etc. So obviously this person must see an Oncologist soon! Many cancers like to metastasize to bone, so this could be a primary breast cancer, or perhaps a primary prostate cancer, or even some other cancer. Depending upon the type of primary cancer, the treatment will vary, so the Oncologist will need to diagnosis the primary cancer. The work-up is chosen by the Oncologist based upon the patient's history & a physical exam, & might include x-ray studies like CT scans or PET scans, biopsy of the bone tumor, mammograms, prostate checks, blood tests, & more. Treatment will
depend on the type of primary cancer, but generally the bone lesions are treated with radiation, which shrinks the tumors & helps decrease the pain... & yes, bone cancer is VERY painful! Bone cancer also weakens the bone, thus patients with bone cancer are at risk of breaking those affected bones. This type of fracture is called a "pathologic fracture" indicating that the bone has broken due to a pathologic process (the cancer), not because of trauma or osteoporosis. Radiation also helps to decrease the risk of these pathologic fractures.
As a side-thought, there are primary bone cancers, so not all bone cancer is metastatic. There are
many primary bone cancers, including Multiple Myeloma (which actually is cancer of the bone marrow), Osteosarcoma (which is most common in young people aged 10-25, & saddly is very malignant), Chondrosarcoma (which is cancer of cartilage), & several others. Each cancer has it's own personality & behavior, so I guess it is easy to see why we need Oncologists!!!
If you want to check out a great website with patient-friendly yet thorough cancer information, check out www.AboutCancer.com. It is the website of my friend Dr. Robert Miller who is a Radiation Oncologist in St. Petersburg, FL. Once in the website, go to "Dr. Miller's Web Site," then click on "Cancer Information."
Hurricane Preparedness:
So June 1 has arrived, & with it comes another hurricane season. Those of us who live in coastal states must prepare our homes, our property, & ourselves just in case the next 6 months bring threatening storms.
First it is important to know your evacuation zone, so you will know when it is imperative for you to leave. Have a plan as to where you will go, but pack a road map in case you have to take an alternative route. If you cannot evacuate independently, register with your city so they can get you the help you need. It is best to not depend on a shelter, but if you must, be sure you know where those are. If you require a special-needs shelter to assist with medical issues, be sure to register for that as well.
I am from Louisiana & live in Florida, so I've been through the drill more than a few times. I also recall a hurricane which hit Louisiana when I was 5 years old. Though we were 70 miles from the coast, I still remember the frightening wind & sideways rain. My home was also hit by a tornado which came from Hurricane Andrew as it headed north in the Gulf after having devastated Homestead, FL. To say the least, I have great respect for hurricanes, & as such, I evacuate. I can only hope you will do the same!
As a physician I would strongly encourage you to pack the following:
1) a 2 week supply of your medicines - ask your doctor for samples or a separate prescription which you can purchase on your own if your insurance will not allow an extra or early refill.
2) a list of your medications including the dose of each pill & how you take them.
3) a paper with your medical problems, past surgeries, allergies (to meds & to foods), physicians, & immunizations.
After a bad storm you could be incapacitated & unable to tell rescue personnel this information, & without electricity there might be no access to your medical record if it is electronic. Also, your physician might not be available or reachable. If you have a medical app (like My Medical) on your iPhone, iPod, etc., be sure to update it now.
4) perhaps a copy of your last 1 or 2 office visits from your doctor, as well as your most recent lab tests, including blood tests, x-rays, colonoscopy, mammogram, DEXA, etc.
5) equipment you'll need such as your CPAP machine, oxygen, bandages, crutches, braces, glasses, contac solution, etc.
6) water - plan to need 1 gallon per person per day & prepare for 3-7 days... but don't forget the animals!
If you can, keep the water in plastic jugs, but if you are caught without an adequate storage unit, fill the bathtub with water (after scrubbing it of course). Also, as water is so heavy, you might not be able to take enough with you if you evacuate. In this event, you should pack panty hose to act as a strainer, & bleach to purify water. Bleach should be pure Sodium Hypochlorite 5-6%, & you should mix it as follows: 2 drops of bleach to 1 quart of water, or 8 drops to 1 gallon. If the water is cloudy you should double the amount of bleach: 4 drops to 1 quart of cloudy water, or 16 drops to 1 gallon of cloudy water. Mix the bleach with the water & allow it to sit for 30 minutes before you drink it. Of course, if you have propane or another source of heat, you can boil the water to purify it. Remember however that flood water not only contains bacterial contamination, but also often contains contaminants such as chemicals (from cars, boats, pipelines, etc.). Unfortunately neither bleach nor boiling will help with this issue.
7) NOAA radio which will sound an alarm when a weather emergency happens in your area (such as a change in the hurricane's route or speed, or such as a tornado).
8) food - remember that you can go days without eating, but you won't last long without water!
Consider buying MRE's or similar packaged food from an Army store or camping store. If you pack canned goods, don't forget a hand-held can-opener.
9) a full tank of gas in a well-tuned car.
10) pets, leashes, pet food & medications, crates & beds, shot records, & perhaps towels to dry them off.
If your pet is fearful of bad weather, ask your Veterinarian for "storm pills" & be sure to pack them with your other supplies!
It is a good idea to pack things in advance, & those that cannot be packed early can be written on a list so you can quickly grab & go! I like to keep evacuation supplies in the attic, so if I am caught off guard I can just climb up & honker down. Don't forget, you'll need a ladder to get up there, & you should store an ax or chain-saw in the attic in case you have to cut your way out!
As some last thoughts:
Be sure that you only use a generator in a well-ventillated area; otherwise you might survive the disaster only to die from carbon monoxide poisoning.
Don't walk through storm water. It possibly has contaminants such as sewage & other chemicals, & it might be deeper than you expect. Also, you could be electrocuted if there is a downed power line hidden beneath the water.
And so we conclude another blog. I hope you find the information helpful... & if you do, please consider sharing the blog with your friends & family. You can do that by hitting the "F" or "T" button at the bottom of the blog to share with your Facebook or Twitter connections.
Also, consider listening to the radio program. You can do this by tuning to WTAN 1340-AM in Tampa/St. Pete, FL area, or if you are not local, find us on the web via www.SkipShow.com where you can listen live or check out the recorded podcast. Feel free to call or e-mail questions or concerns: (727)-441-3000 local, or (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Stay safe, & here's to our health!
Doctor Gigi
He Who Pays Chooses How to Play:
The New York mayor has proposed that his city should essentially outlaw large sodas. So what do you think about government taking away your Big Gulp? As a physician, I see the beauty of encouraging people to eat & drink sensible serving sizes, especially as we battle our epidemic of obesity, but I really hate the idea that my dietary habits might be dictated by government! The problem is that as long as government is responsible for our healthcare, they have a vested interest in our health. Thus, they just might be justified in passing laws that seemingly help to keep us healthy. Again, I like the idea of healthy habits, but I despise the idea of government-mandated anything! We as Americans like our freedoms, so how can we think this is a good idea?
Well, the unfortunate truth is that "he who pays chooses how to play." So if government pays for your healthcare, they will dictate how you live your life... perhaps affecting your diet, your exercise habits, your sleep habits, your sexual habits, etc. If that sounds frightening, start paying attention to healthcare policy, & start thinking about the control Big Brother already has... & be leery of giving them more control! This is an aspect of government-provided healthcare which many of us have not considered.
When government or insurance pays the doctor, realize that the doctor actually works for them. When you pay the doctor, he works for you. Which program do you think provides for an appropriate doctor-patient relationship? There are many political policies which might seriously affect your health, as well as your freedoms, so if you care, get involved & realize that "free" healthcare is NOT FREE!
Metastatic Cancer:
A "primary cancer" is the initial cancer that develops, & it is named according to the area in which it first begins. When that primary cancer spreads to a different area, then it is called "metastatic" or "secondary" cancer. So if cancer begins in the breast, it is called a primary breast cancer. If that cancer spreads or metastasizes to the brain, it is still called breast cancer (not brain cancer), but it is metastatic breast cancer which has gone to the brain.
Metastatic cancer is obviously not likely to be as treatable as primary cancer, but it is not by definition terminal! The curability depends on the type of primary cancer as well as the extent of metastatic spread... which is determined by the number of metastases & the organs involved with metastases. It also depends upon the overall health of the patient, & also to a large degree upon the patient's attitude. So never decide that there is no hope just based upon the knowledge that a cancer has metastasized... ask for treatment options & perhaps get several opinions.
During the show someone asked questions regarding a cancer which has just been diagnosed & has already metastasized to the bone. Obviously I cannot say whether this is curable, but certainly the patient should not assume there is no hope! Oncologists are the specialists who treat cancer patients, & they know treatment protocols, expected outcomes, cancer behavior, etc. So obviously this person must see an Oncologist soon! Many cancers like to metastasize to bone, so this could be a primary breast cancer, or perhaps a primary prostate cancer, or even some other cancer. Depending upon the type of primary cancer, the treatment will vary, so the Oncologist will need to diagnosis the primary cancer. The work-up is chosen by the Oncologist based upon the patient's history & a physical exam, & might include x-ray studies like CT scans or PET scans, biopsy of the bone tumor, mammograms, prostate checks, blood tests, & more. Treatment will
depend on the type of primary cancer, but generally the bone lesions are treated with radiation, which shrinks the tumors & helps decrease the pain... & yes, bone cancer is VERY painful! Bone cancer also weakens the bone, thus patients with bone cancer are at risk of breaking those affected bones. This type of fracture is called a "pathologic fracture" indicating that the bone has broken due to a pathologic process (the cancer), not because of trauma or osteoporosis. Radiation also helps to decrease the risk of these pathologic fractures.
As a side-thought, there are primary bone cancers, so not all bone cancer is metastatic. There are
many primary bone cancers, including Multiple Myeloma (which actually is cancer of the bone marrow), Osteosarcoma (which is most common in young people aged 10-25, & saddly is very malignant), Chondrosarcoma (which is cancer of cartilage), & several others. Each cancer has it's own personality & behavior, so I guess it is easy to see why we need Oncologists!!!
If you want to check out a great website with patient-friendly yet thorough cancer information, check out www.AboutCancer.com. It is the website of my friend Dr. Robert Miller who is a Radiation Oncologist in St. Petersburg, FL. Once in the website, go to "Dr. Miller's Web Site," then click on "Cancer Information."
Hurricane Preparedness:
So June 1 has arrived, & with it comes another hurricane season. Those of us who live in coastal states must prepare our homes, our property, & ourselves just in case the next 6 months bring threatening storms.
First it is important to know your evacuation zone, so you will know when it is imperative for you to leave. Have a plan as to where you will go, but pack a road map in case you have to take an alternative route. If you cannot evacuate independently, register with your city so they can get you the help you need. It is best to not depend on a shelter, but if you must, be sure you know where those are. If you require a special-needs shelter to assist with medical issues, be sure to register for that as well.
I am from Louisiana & live in Florida, so I've been through the drill more than a few times. I also recall a hurricane which hit Louisiana when I was 5 years old. Though we were 70 miles from the coast, I still remember the frightening wind & sideways rain. My home was also hit by a tornado which came from Hurricane Andrew as it headed north in the Gulf after having devastated Homestead, FL. To say the least, I have great respect for hurricanes, & as such, I evacuate. I can only hope you will do the same!
As a physician I would strongly encourage you to pack the following:
1) a 2 week supply of your medicines - ask your doctor for samples or a separate prescription which you can purchase on your own if your insurance will not allow an extra or early refill.
2) a list of your medications including the dose of each pill & how you take them.
3) a paper with your medical problems, past surgeries, allergies (to meds & to foods), physicians, & immunizations.
After a bad storm you could be incapacitated & unable to tell rescue personnel this information, & without electricity there might be no access to your medical record if it is electronic. Also, your physician might not be available or reachable. If you have a medical app (like My Medical) on your iPhone, iPod, etc., be sure to update it now.
4) perhaps a copy of your last 1 or 2 office visits from your doctor, as well as your most recent lab tests, including blood tests, x-rays, colonoscopy, mammogram, DEXA, etc.
5) equipment you'll need such as your CPAP machine, oxygen, bandages, crutches, braces, glasses, contac solution, etc.
6) water - plan to need 1 gallon per person per day & prepare for 3-7 days... but don't forget the animals!
If you can, keep the water in plastic jugs, but if you are caught without an adequate storage unit, fill the bathtub with water (after scrubbing it of course). Also, as water is so heavy, you might not be able to take enough with you if you evacuate. In this event, you should pack panty hose to act as a strainer, & bleach to purify water. Bleach should be pure Sodium Hypochlorite 5-6%, & you should mix it as follows: 2 drops of bleach to 1 quart of water, or 8 drops to 1 gallon. If the water is cloudy you should double the amount of bleach: 4 drops to 1 quart of cloudy water, or 16 drops to 1 gallon of cloudy water. Mix the bleach with the water & allow it to sit for 30 minutes before you drink it. Of course, if you have propane or another source of heat, you can boil the water to purify it. Remember however that flood water not only contains bacterial contamination, but also often contains contaminants such as chemicals (from cars, boats, pipelines, etc.). Unfortunately neither bleach nor boiling will help with this issue.
7) NOAA radio which will sound an alarm when a weather emergency happens in your area (such as a change in the hurricane's route or speed, or such as a tornado).
8) food - remember that you can go days without eating, but you won't last long without water!
Consider buying MRE's or similar packaged food from an Army store or camping store. If you pack canned goods, don't forget a hand-held can-opener.
9) a full tank of gas in a well-tuned car.
10) pets, leashes, pet food & medications, crates & beds, shot records, & perhaps towels to dry them off.
If your pet is fearful of bad weather, ask your Veterinarian for "storm pills" & be sure to pack them with your other supplies!
It is a good idea to pack things in advance, & those that cannot be packed early can be written on a list so you can quickly grab & go! I like to keep evacuation supplies in the attic, so if I am caught off guard I can just climb up & honker down. Don't forget, you'll need a ladder to get up there, & you should store an ax or chain-saw in the attic in case you have to cut your way out!
As some last thoughts:
Be sure that you only use a generator in a well-ventillated area; otherwise you might survive the disaster only to die from carbon monoxide poisoning.
Don't walk through storm water. It possibly has contaminants such as sewage & other chemicals, & it might be deeper than you expect. Also, you could be electrocuted if there is a downed power line hidden beneath the water.
And so we conclude another blog. I hope you find the information helpful... & if you do, please consider sharing the blog with your friends & family. You can do that by hitting the "F" or "T" button at the bottom of the blog to share with your Facebook or Twitter connections.
Also, consider listening to the radio program. You can do this by tuning to WTAN 1340-AM in Tampa/St. Pete, FL area, or if you are not local, find us on the web via www.SkipShow.com where you can listen live or check out the recorded podcast. Feel free to call or e-mail questions or concerns: (727)-441-3000 local, or (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Stay safe, & here's to our health!
Doctor Gigi
Tuesday, June 5, 2012
Asthma Awareness Month; Claudication & Vascular Problems.
The following reviews topics discussed on Let's Talk Medical with Dr. Gigi as it aired live on WTAN 1340-AM on May 25, 2012.
Asthma Awareness Month:
May is Asthma Awareness Month, so let's discuss some highlights of this disease. It is basically inflamation of the airways, which results in sputum, spasm, & swelling. The inflamation can be due to infections (viral, bacterial, or fungal), allergens (pets, dust mites, cockroaches), or irritants (like smoke, perfumes, chemicals, or even acid from GE reflux). People with asthma react more vigorously to these triggers than the average person as they have a gene which causes an over-production of inflamatory substances in their airways.
Despite the advancement of medicine over the past decades, the prevalence of asthma has been steadily increasing since the 1970's. We are not sure why this disease continues to affect more & more people, but perhaps it is related to poor air quality or perhaps the gene is being passed on to more of our relatives! At present, approximately 20 million people have asthma, & of these 6 million are children. In general, children have worse outcomes than adults, so they must be monitored more closely & treated more aggressively.
There are many medications for treating asthma, but there are basically 2 types of meds: anti-inflamatory meds & anti-spasm meds. The anti-inflamatory meds decrease the inflamation in the airways, so they essentially treat the disease itself, & are thus considered MAINTENANCE meds as they are used daily to maintain control of asthma. Anti-inflamatory products are either steroids (like Asmanex, Azmacort, Q-Var, Pulmicort, Flovent, & Aerobid) or leukotriene inhibitors (like Singulaire, Accolate, & Zyflo).
On the other hand, the anti-spasm meds are also called beta-agonists, & they come in 2 types: short-acting & long-acting. Short-acting beta-agonists are meds like Albuterol & Xopenex, which start to work within several minutes but only work for about 4-6 hours. Long-acting beta-agonists are meds like Foradil & Serevent which take a little while to start to work (15-30 minutes) but then last for about 12 hours. The short-acting meds like Albuterol are used as EMERGENCY (or RESCUE) inhalers as they work so quickly, but if you have good control of your asthma you should not need them very often. In fact, if you use your rescue inhaler more than 2 times per week, you should call your doctor as you might need additional evaluation or treatment. The long-acting beta-agonists can be used as maintenance meds, & are often found combined with steroids in products such as Advair (which is a steroid plus Serevent) or Symbicort (which is a steroid plus Foradil), but as they take a while to work, they are never used as rescue inhalers!
If you take your maintenance inhaler daily but suddenly realize that you are having more shortness of breath or more wheezing (this is actually the noise made by the air passing through an airway which is in spasm), you should start to use your rescue inhaler. Remember however that if you use it more than 2 times per week, you should call your physician. You should consider it an emergency each time you reach for your rescue inhaler. So would you really allow yourself to have more than 2 emergencies in 1 week without calling your doctor for help? The doctor will likely look for factors that cause worsening of asthma such as infection or exposures to allergens or irritants. Depending upon the cause for your worsening asthma (called an "exacerbation" of asthma), the doctor might order a chest x-ray, blood tests, or sputum culture, & might treat you with antibiotics, reflux meds, or oral steroids. Severe asthmatic attacks often require hospitalization for IV fluids, nebulizer treatments, & IV antibiotics.
Many people used to use an over-the-counter rescue inhaler called Primatene Mist as treatment for asthma. This was Epinephrine in an inhaled form. Since January 2012 it is no longer available due to the fact that it was very potent, had many side-effects, & was over-used by people who could be better managed by seeing a physician & getting a maintenance inhaler.
There is a gadget called a peak-flow meter which can be used to assess your lung function. It is an inexpensive plastic device which your doctor can prescribe, & which you can get from the pharmacy. It measures the peak force exerted when you exhale forcefully. There are standards for age & height, but more importantly, if you check your peak flow intermittently, you will be able to determine your own baseline, so you will know when you are deteriorating.
Though asthma is a treatable disease, it is still a deadly disease. In fact during my 20+ years of practice, I have had 2 patients die from asthma. They were only 29 & 45 years old! So if you have asthma, become knowledgable about your disease, take your meds as instructed, & if you have worsening, do not over-use your rescue inhaler! Instead, call your doctor for further evaluation & treatment! After all, if you can't breath, you can't live!!!
Claudication & Vascular Problems:
People sometimes complain of pain in their legs. When the pain occurs with walking or similar exertion, it is generally due to a blood flow problem though sometimes it is caused by a neurologic problem. People with back problems, in particular spinal stenosis, often have pinched nerves in the back which cause a heaviness or pain in the legs which resolves with rest AND sitting. In fact, sometimes this "neurogenic claudication" resolves or abates with simply bending forward at the waist... which unloads pressure on the spine. This is why many people like to lean on a shopping cart while walking, as it relieves stress on the spine.
On the other hand, people with vascular (or blood flow) problems get pain & cramps in their legs, but these resolve with rest alone... sitting is not required. This "vascular claudication" is basically like a heart attack of the leg muscles. The muscles are busy working, but due to blockage of an artery, the blood (& oxygen) cannot get to the muscle, so the muscle cramps up & can no longer function. When you rest, the oxygen demands of the muscle decrease & the blood flow is adequate, so the pain resolves & you can walk a little further before the pain returns. If you do not intervene & re-establish good blood flow, you can end up with limited mobility, but over time you can actually get pain even at rest. This is an indication that the blood flow in that leg is so limited that the muscle does not get enough oxygen even at rest. Usually by this time people & their doctors figure out that there is a real problem & they do a bypass surgery or an angioplasty to improve the blood flow.
Early on, vascular claudication is treated with medications like Pletal which make the red blood cells (which carry the oxygen) more pliable. Red cells look like frisbees, but they are fairly rigid, so the Pletal allows them to be more flexible so they can fold in half, thus squeezing through the blocked arteries more easily. It is interesting to note that although walking triggers pain, a walking program is actually prescribed as treatment for vascular claudication as the body often responds to this oxygen-deprived situation by growing its own bypasses called "collateral" blood vessels!
Though neurogenic claudication is evidence of a nerve problem, vascular claudication is evidence of a circulation problem. It is a reflection of blocked arteries, so if you have it, you should have a work-up to look for other blocked arteries. This should include a carotid ultrasound to look for blockage that could lead to a stroke, & a stress test or heart catheterization to look for blockage that could result in a heart attack. Remember, the vascular system is one system... if you have blockages in one place you are prone to have blockages elsewhere! Note however, that although you should push through the pain of vascular claudication to stress the body & encourage it to create collateral circulation, never push through chest pain, as the body does not generally create its own heart bypasses!
So we'll end on that note! Hope you learned something, & I hope you'll listen to the live radio broadcast of Let's Talk Medical with Doctor Gigi on Fridays at 1PM Eastern time on WTAN 1340-AM in the St. Pete/Tampa area. Of course you can always catch me on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. I appreciate any input, & please don't hesitate to call or to e-mail your questions:
(727)-441-3000 local, (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Asthma Awareness Month:
May is Asthma Awareness Month, so let's discuss some highlights of this disease. It is basically inflamation of the airways, which results in sputum, spasm, & swelling. The inflamation can be due to infections (viral, bacterial, or fungal), allergens (pets, dust mites, cockroaches), or irritants (like smoke, perfumes, chemicals, or even acid from GE reflux). People with asthma react more vigorously to these triggers than the average person as they have a gene which causes an over-production of inflamatory substances in their airways.
Despite the advancement of medicine over the past decades, the prevalence of asthma has been steadily increasing since the 1970's. We are not sure why this disease continues to affect more & more people, but perhaps it is related to poor air quality or perhaps the gene is being passed on to more of our relatives! At present, approximately 20 million people have asthma, & of these 6 million are children. In general, children have worse outcomes than adults, so they must be monitored more closely & treated more aggressively.
There are many medications for treating asthma, but there are basically 2 types of meds: anti-inflamatory meds & anti-spasm meds. The anti-inflamatory meds decrease the inflamation in the airways, so they essentially treat the disease itself, & are thus considered MAINTENANCE meds as they are used daily to maintain control of asthma. Anti-inflamatory products are either steroids (like Asmanex, Azmacort, Q-Var, Pulmicort, Flovent, & Aerobid) or leukotriene inhibitors (like Singulaire, Accolate, & Zyflo).
On the other hand, the anti-spasm meds are also called beta-agonists, & they come in 2 types: short-acting & long-acting. Short-acting beta-agonists are meds like Albuterol & Xopenex, which start to work within several minutes but only work for about 4-6 hours. Long-acting beta-agonists are meds like Foradil & Serevent which take a little while to start to work (15-30 minutes) but then last for about 12 hours. The short-acting meds like Albuterol are used as EMERGENCY (or RESCUE) inhalers as they work so quickly, but if you have good control of your asthma you should not need them very often. In fact, if you use your rescue inhaler more than 2 times per week, you should call your doctor as you might need additional evaluation or treatment. The long-acting beta-agonists can be used as maintenance meds, & are often found combined with steroids in products such as Advair (which is a steroid plus Serevent) or Symbicort (which is a steroid plus Foradil), but as they take a while to work, they are never used as rescue inhalers!
If you take your maintenance inhaler daily but suddenly realize that you are having more shortness of breath or more wheezing (this is actually the noise made by the air passing through an airway which is in spasm), you should start to use your rescue inhaler. Remember however that if you use it more than 2 times per week, you should call your physician. You should consider it an emergency each time you reach for your rescue inhaler. So would you really allow yourself to have more than 2 emergencies in 1 week without calling your doctor for help? The doctor will likely look for factors that cause worsening of asthma such as infection or exposures to allergens or irritants. Depending upon the cause for your worsening asthma (called an "exacerbation" of asthma), the doctor might order a chest x-ray, blood tests, or sputum culture, & might treat you with antibiotics, reflux meds, or oral steroids. Severe asthmatic attacks often require hospitalization for IV fluids, nebulizer treatments, & IV antibiotics.
Many people used to use an over-the-counter rescue inhaler called Primatene Mist as treatment for asthma. This was Epinephrine in an inhaled form. Since January 2012 it is no longer available due to the fact that it was very potent, had many side-effects, & was over-used by people who could be better managed by seeing a physician & getting a maintenance inhaler.
There is a gadget called a peak-flow meter which can be used to assess your lung function. It is an inexpensive plastic device which your doctor can prescribe, & which you can get from the pharmacy. It measures the peak force exerted when you exhale forcefully. There are standards for age & height, but more importantly, if you check your peak flow intermittently, you will be able to determine your own baseline, so you will know when you are deteriorating.
Though asthma is a treatable disease, it is still a deadly disease. In fact during my 20+ years of practice, I have had 2 patients die from asthma. They were only 29 & 45 years old! So if you have asthma, become knowledgable about your disease, take your meds as instructed, & if you have worsening, do not over-use your rescue inhaler! Instead, call your doctor for further evaluation & treatment! After all, if you can't breath, you can't live!!!
Claudication & Vascular Problems:
People sometimes complain of pain in their legs. When the pain occurs with walking or similar exertion, it is generally due to a blood flow problem though sometimes it is caused by a neurologic problem. People with back problems, in particular spinal stenosis, often have pinched nerves in the back which cause a heaviness or pain in the legs which resolves with rest AND sitting. In fact, sometimes this "neurogenic claudication" resolves or abates with simply bending forward at the waist... which unloads pressure on the spine. This is why many people like to lean on a shopping cart while walking, as it relieves stress on the spine.
On the other hand, people with vascular (or blood flow) problems get pain & cramps in their legs, but these resolve with rest alone... sitting is not required. This "vascular claudication" is basically like a heart attack of the leg muscles. The muscles are busy working, but due to blockage of an artery, the blood (& oxygen) cannot get to the muscle, so the muscle cramps up & can no longer function. When you rest, the oxygen demands of the muscle decrease & the blood flow is adequate, so the pain resolves & you can walk a little further before the pain returns. If you do not intervene & re-establish good blood flow, you can end up with limited mobility, but over time you can actually get pain even at rest. This is an indication that the blood flow in that leg is so limited that the muscle does not get enough oxygen even at rest. Usually by this time people & their doctors figure out that there is a real problem & they do a bypass surgery or an angioplasty to improve the blood flow.
Early on, vascular claudication is treated with medications like Pletal which make the red blood cells (which carry the oxygen) more pliable. Red cells look like frisbees, but they are fairly rigid, so the Pletal allows them to be more flexible so they can fold in half, thus squeezing through the blocked arteries more easily. It is interesting to note that although walking triggers pain, a walking program is actually prescribed as treatment for vascular claudication as the body often responds to this oxygen-deprived situation by growing its own bypasses called "collateral" blood vessels!
Though neurogenic claudication is evidence of a nerve problem, vascular claudication is evidence of a circulation problem. It is a reflection of blocked arteries, so if you have it, you should have a work-up to look for other blocked arteries. This should include a carotid ultrasound to look for blockage that could lead to a stroke, & a stress test or heart catheterization to look for blockage that could result in a heart attack. Remember, the vascular system is one system... if you have blockages in one place you are prone to have blockages elsewhere! Note however, that although you should push through the pain of vascular claudication to stress the body & encourage it to create collateral circulation, never push through chest pain, as the body does not generally create its own heart bypasses!
So we'll end on that note! Hope you learned something, & I hope you'll listen to the live radio broadcast of Let's Talk Medical with Doctor Gigi on Fridays at 1PM Eastern time on WTAN 1340-AM in the St. Pete/Tampa area. Of course you can always catch me on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. I appreciate any input, & please don't hesitate to call or to e-mail your questions:
(727)-441-3000 local, (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Sunday, June 3, 2012
Better Hearing Month; Pre-Menopause Symptoms; When Do Meds Expire; Celiac Sprue.
Happy (late) Memorial Day! I hope you found time to enjoy yourself, but more importantly I hope you found time to thank those Americans who have fought to provide us with the freedoms we so enjoy. And while you were contemplating these heroes, I hope you thought gratefully of the families of these soldiers, as they too have given so much to our country & thus deserve our heartfelt thanks as well!
The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical with Doctor Gigi.
Better Hearing Month:
As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing & balance problems. They usually possess a Master's degree or a Doctorate. Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services. My friend Susan Terry is an Audiologist in St. Petersburg, FL. She owns Broadwater Hearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues. May is Better Hearing Month, so she recently sent educational sheets which I found enlightening; thus, I chose to share her information with the audience.
Hearing impairment affects 10% of the population & is the 3rd most common chronic health condition in the US. Hearing loss increases with age, thus it affects 30-35% of people 65 or older, whereas 40-50% of people 75 or older will be affected.
The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family. This is the reason so many people adamantly deny having a problem until they get tested & treated.
Hearing loss can lead to frustration, which in turn can lead to social isolation. This is turn can lead to depression, so we must always consider hearing loss as a possible cause for depression, especially in the elderly.
For each 10 decibels of hearing lost, the risk of dementia increases about 20%. Thus we must also consider hearing loss as a possible cause for dementia.
Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.
Every person over the age of 40 should have a baseline hearing test. Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years. Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!
Pre-Menopausal Symptoms:
Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause). The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes. Most women go through natural menopause between the ages of 48 - 52. By definition, a person is menopausal when she has gone 1 year without a menstrual period.
For several years before full menopause, a woman will have pre-menopause. This is a roller-coaster ride hormonally as the ovaries are "sputtering" before they die. Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount. As you can imagine, this is a hard time for many women as they don't know day to day how they are going to feel... physically or emotionally! Unfortunately this period of pre-menopause can last 5 years!
Pre-menopausal symptoms include: irregular periods, hot flushes, poor sleep, fatigue, moodiness, & vaginal dryness. Initially the periods get closer together... every 2-3 weeks. Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause.
Hot flushes are common, so many people think they are synonymous with menopause, but they are not! Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine. Some anti-depressants cause hot flushes as well. It is interesting to note that the heat associated with a hot flush can actually be felt by other people! If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!
Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically! It is not always an early symptom of menopause, but once it starts, it generally worsens. In fact, without estrogen replacement, vaginal dryness often gets worse year after year, even after the other pre-menopausal symptoms have abated.
As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody! So ladies, we owe no one an apology!
When Do Meds Expire?:
Most medications are labeled with an expiration date that is 2 years after the date that the prescription bottle was filled. But does that really mean that they are unsafe or in need of disposal once that date has passed? First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency. So the real question is whether or not you can accept a bit less potency & still be safe.
If the medication is an antibiotic, I would recommend that you NOT take an expired version. If the antibiotic does not work well you could end up with an untreated infection which could kill you.
On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough. Certainly if that occurs, you would dispose of the expired med & purchase a new batch. Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply. Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.
If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med. For the record though, I would seldom take one which is more than 2 years post expiration. Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!
Celiac Sprue:
Celiac sprue is a disease caused by an intolerance to gluten... which is a protein found in wheat, rye, & barley. It is a hereditary disorder & runs in families. Though it often becomes symptomatic during childhood, it can begin later in life. The symptoms of sprue are many: weakness, anorexia, diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis, reduced fertility, & rashes. There is also an association between diabetes, autoimmune thyroid disease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.
Recently this disease has gotten a lot of attention, & many people believe that they have it. They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps. Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.
So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up. In this manner you will know for certain whether or not you MUST follow this diet. The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminase immuneglobulin A. You must know however that this test is measuring your body's immune response to gluten, so if you have been on a gluten-free diet, it will be negative! Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn. Also, since the test measures IgA, people who have IgA Deficiency will test negative.
To have proper evaluation you should eat a lot of gluten for several weeks, then have the tTG IgA test drawn.
If it is high, you have sprue.
If it is normal or low, you need another blood test... a Total IgA level.
If it is normal, you do not have sprue.
If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue.
You thus need further testing to evaluate for sprue, so you would need an upper endoscopy
(= EGD) to get into your small bowel and obtain a biopsy.
If the biopsy is normal, you do not have sprue.
If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have
sprue & are stuck with the gluten-free diet!
I hope this has been educational for you! Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live or on podcasts via www.SkipShow.com. Please call or e-mail me with questions or comments: (727)-441-3000, or toll-free (866)-TAN-1340, or DoctorGigi@SkipShow.com.
Until the next time, here's to our health!
Doctor Gigi
The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical with Doctor Gigi.
Better Hearing Month:
As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing & balance problems. They usually possess a Master's degree or a Doctorate. Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services. My friend Susan Terry is an Audiologist in St. Petersburg, FL. She owns Broadwater Hearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues. May is Better Hearing Month, so she recently sent educational sheets which I found enlightening; thus, I chose to share her information with the audience.
Hearing impairment affects 10% of the population & is the 3rd most common chronic health condition in the US. Hearing loss increases with age, thus it affects 30-35% of people 65 or older, whereas 40-50% of people 75 or older will be affected.
The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family. This is the reason so many people adamantly deny having a problem until they get tested & treated.
Hearing loss can lead to frustration, which in turn can lead to social isolation. This is turn can lead to depression, so we must always consider hearing loss as a possible cause for depression, especially in the elderly.
For each 10 decibels of hearing lost, the risk of dementia increases about 20%. Thus we must also consider hearing loss as a possible cause for dementia.
Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.
Every person over the age of 40 should have a baseline hearing test. Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years. Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!
Pre-Menopausal Symptoms:
Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause). The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes. Most women go through natural menopause between the ages of 48 - 52. By definition, a person is menopausal when she has gone 1 year without a menstrual period.
For several years before full menopause, a woman will have pre-menopause. This is a roller-coaster ride hormonally as the ovaries are "sputtering" before they die. Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount. As you can imagine, this is a hard time for many women as they don't know day to day how they are going to feel... physically or emotionally! Unfortunately this period of pre-menopause can last 5 years!
Pre-menopausal symptoms include: irregular periods, hot flushes, poor sleep, fatigue, moodiness, & vaginal dryness. Initially the periods get closer together... every 2-3 weeks. Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause.
Hot flushes are common, so many people think they are synonymous with menopause, but they are not! Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine. Some anti-depressants cause hot flushes as well. It is interesting to note that the heat associated with a hot flush can actually be felt by other people! If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!
Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically! It is not always an early symptom of menopause, but once it starts, it generally worsens. In fact, without estrogen replacement, vaginal dryness often gets worse year after year, even after the other pre-menopausal symptoms have abated.
As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody! So ladies, we owe no one an apology!
When Do Meds Expire?:
Most medications are labeled with an expiration date that is 2 years after the date that the prescription bottle was filled. But does that really mean that they are unsafe or in need of disposal once that date has passed? First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency. So the real question is whether or not you can accept a bit less potency & still be safe.
If the medication is an antibiotic, I would recommend that you NOT take an expired version. If the antibiotic does not work well you could end up with an untreated infection which could kill you.
On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough. Certainly if that occurs, you would dispose of the expired med & purchase a new batch. Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply. Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.
If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med. For the record though, I would seldom take one which is more than 2 years post expiration. Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!
Celiac Sprue:
Celiac sprue is a disease caused by an intolerance to gluten... which is a protein found in wheat, rye, & barley. It is a hereditary disorder & runs in families. Though it often becomes symptomatic during childhood, it can begin later in life. The symptoms of sprue are many: weakness, anorexia, diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis, reduced fertility, & rashes. There is also an association between diabetes, autoimmune thyroid disease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.
Recently this disease has gotten a lot of attention, & many people believe that they have it. They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps. Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.
So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up. In this manner you will know for certain whether or not you MUST follow this diet. The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminase immuneglobulin A. You must know however that this test is measuring your body's immune response to gluten, so if you have been on a gluten-free diet, it will be negative! Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn. Also, since the test measures IgA, people who have IgA Deficiency will test negative.
To have proper evaluation you should eat a lot of gluten for several weeks, then have the tTG IgA test drawn.
If it is high, you have sprue.
If it is normal or low, you need another blood test... a Total IgA level.
If it is normal, you do not have sprue.
If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue.
You thus need further testing to evaluate for sprue, so you would need an upper endoscopy
(= EGD) to get into your small bowel and obtain a biopsy.
If the biopsy is normal, you do not have sprue.
If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have
sprue & are stuck with the gluten-free diet!
I hope this has been educational for you! Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live or on podcasts via www.SkipShow.com. Please call or e-mail me with questions or comments: (727)-441-3000, or toll-free (866)-TAN-1340, or DoctorGigi@SkipShow.com.
Until the next time, here's to our health!
Doctor Gigi
Sunday, May 20, 2012
Diabetes & Low Blood Sugar; Nurses' Week; Adult Immunizations; Proper Med Lists.
Welcome back! This blog will re-iterate & expand upon the topics discussed in the May 11, 2012 broadcast of Let's Talk Medical with Doctor Gigi. Feel free to listen to the corresponding broadcast via www.SkipShow.com where you can find the podcast version.
Diabetes & Low Blood Sugar:
Most of us know that diabetes is a disease in which a person has a disregulation of glucose (= sugar)metabolism, resulting in the person having a high glucose. Diabetes can lead to many bad things, including heart disease, strokes, neuropathy, poor healing, frequent infections, kidney failure, & even blindness, so anyone with the disease obviously wants to have good diabetic control. This means that you would like to have your glucose be between 80-150. If your sugar is often higher than this, you have a higher risk of getting these ill effects, but what happens if you get your sugars too low?
A glucose below 60 is too low, and doctors really worry if it gets below 40. This is due to the fact that the brain needs sugar, so if your glucose gets too low, the brain actually dies. Symptoms of hypoglycemia (= low blood sugar) include feeling anxious, confused, cold, sweaty, shaky, & agitated. If you experience these episodes of low sugar, you can quickly correct the problem by eating sugar, so you should carry glucose pills (which you can purchase at a pharmacy) or packets of sugar (like you get in a coffee shop). In the absence of these, you can try juice or soda... as long as they are NOT sugar-free versions.
Though we aim to control glucose to decrease the harmful effects of diabetes, we must realize that too low of a glucose can actually be more harmful than a high glucose. When your glucose gets below 40 (or perhaps even 60), you can suffer brain damage & even death within several HOURS. On the other hand, a high sugar (more than 150) will take YEARS to cause enough damage to result in brain damage or death. So work with your physician to get good control of your diabetes, but don't try to have such tight control that you bottom-out & have low glucose as that will likely cause you more harm than good!
Nurses' Week:
We recently celebrated Nurses' Week. This celebration begins on May 6th & ends on May 12th... which is the birthday of Florence Nightengale, who is the founder of modern nursing. Though being a nurse often involves doing tasks which are less than glamorous, it is in my opinion the closest thing to being a mother. Nurses care for us when we can't care for ourselves, & they do so without judgement or malice. Though they often make us do things we don't want to do, they do it for our benefit. They are the quiet support that hold our hands & care for our dignity & emotions, as much as they care for our physical health. They do more for us than we know, & during this week, we celebrate those nurses, past, present, & future who give so unselfishly of themselves to care for us! And though they might not love us like our mothers do, the service they give us is done so with love in their hearts!
Adult Immunizations:
Though we are aware that children need immunizations, we often forget that adults also need certain immunizations. Perhaps because schools mandate proof of immunizations, most children get their shots. On the other hand, no one insures adults get their shots, so consider the following & discuss with your doctor to be sure you keep up-to-date.
There are generally 4 adult immunizations: Td or TdaP (tetanus & diphtheria without or with whooping cough), Pneumovax, Flu, & Zostavax (shingles).
Td stands for tetanus & diphtheria, & everyone should get one every 10 years, unless they have had a problem with previous Td shots. This shot protects us from getting tetanus, which is also called lock-jaw. Though we mostly think we are prone to tetanus when we get a rusty nail injury, any open wound can be a source of tetanus. Thus, even a clean wound predisposes us to tetanus, so it behooves us to keep current with this shot! Unfortunately, if you have Medicare benefits, Medicare will only pay for the Td shot if you have an open wound.
TdaP is the tetanus & diphtheria shot with whooping cough as well. Whooping cough does not usually harm adults, but it can kill or permanently injure children. Most kids get DPT shots which include whooping cough, but not every child will make proper immunity, so we still want to immunize adults to decrease the risk of an adult getting the disease & spreading it to a susceptible child. So adults have the choice of Td or TdaP... & those who have frequent exposure to children should opt for the TdaP.
Pneumovax is a vaccine to protect you from getting Strep. pneumonia... which is a bacteria that often causes sinusitis, ear infections, pharyngitis, bronchitis, & pneumonia. It is recommended that anyone who is prone to these respiratory illnesses (such as those with asthma, emphysema, or even chronic allergies) should get a Pneumovax shot every 5 years. Everyone older than 65 should get this shot. Medicare will pay for only one shot after the age of 65, unless you have high risks for respiratory infections as noted above, though I recommend all of my patients over 65 continue to get this vaccine every 5 years, even if they have to pay cash for it.
Flu shots are given every fall in an effort to protect the population from influenza. As the shot changes every year, it is given to virtually everybody every year. Again, those who are highest risk of respiratory disease should get this shot annually, but it likely is a good idea for everyone to get one.
Zostavax is the vaccination which helps decrease the risk of getting shingles, which is also known as Herpes Zoster. When a person gets Chicken Pox, the virus causes infection & then goes dormant in the body. If it re-awakens many years later, it causes shingles... which is heralded by a classic painful, blistery, red rash which involves only one side of the body. Anybody older than 50 can get a Zostavax, but unfortunately it is expensive, costing $250-$300 or more. Because of this expense, many wait to get this vaccine when they have Medicare coverage, as Medicare Part D will usually pay for it. Oddly enough though, it is covered as a pharmacy benefit, so most physicians cannot bill for it so they do not give it. Instead, it is recommended that you go to a pharmacy with an in-house walk-in clinic... such as CVS or Walgreens... where the doctor or nurse can get the vaccine from the pharmacy, administer it, & then bill your pharmacy insurance. If you wonder why you can't just pick up a vial of this stuff from the pharmacy then bring it to your doctor to be administered, it is because it must be given to the patient within 30 minutes after being removed from the freezer.
Proper Medication List:
Just a note to make you aware that as a physician I would love for my patients to keep a list of their medications. I have noticed however that they do not record the meds as I would like, so here's a few helpful hints.
The list should include the name of the medication, preferably the generic & name-brand if you know... as different doctors will use different names. Also, include the strenghth of each pill AND how many you take & when you take them. This seems straightforward enough, but patients sometimes try to help me by writing the total dose they take in a day... yet I need to know the way the prescriptions are written. For example, if a patient takes Pravachol 40 mg 2 pills with supper, this is how I want it recorded. If the patient writes Pravachol 80 mg per day (their total daily dose), I will likely write the prescription for an 80 mg pill which is more expensive than 2 of the 40 mg pills. Also, if the patient calls to ask a question about the "2 pills" he takes at night, there will be a disconnect in our communication if my records indicate he is taking one pill at night for his cholesterol problem. Be accurate & be honest when you write your list, as it will help protect you from medication errors in the long-run.
An example of how this can make management difficult, I recall a recent situation at a local hospital. One of my patients was being treated for an infection but also had some chronic pain. Unfortunately he also had a swallowing problem, so swallowing pills was difficult for him. I ordered MS Contin 30 mg one pill 2 times per day, so I was confused & agitated when the patient complained repeatedly about having to take 6 pills every morning & 6 pills every night. I checked the computer & could not find where he had 6 pills of any type ordered, so I spoke with the nurse who checked her records. Her records showed that the pharmacy did not have the 30 mg pills, so they had switched to six of the 5 mg pills for each of the 2 doses. Though there would usually be no problem with this substitution, it certainly was a problem for my patient with swallowing problems! And worse yet, it was a problem for all of us because the records did not show me an accurate med list, so this impaired my ability to properly care for my patient!
Until next time, you can catch us on the radio... WTAN 1340-AM on Fridays 1:00-1:45 PM in the Tampa/St. Petersburg, FL area, or on the web... www.SkipShow.com where you can listen live or to the podcasts. We are always happy to answer your questions, so keep them coming... (727)-441-3000 or tollfree (866)-TAN-1340 or DoctorGigi@SkipShow.com. And if you find this blog educational & worthwhile, please become a "follower" & please consider sharing the link with your Facebook & Twitter friends! By the way, I will soon have a central website for the podcasts & this blog, so stay tuned for the opening of www.DoctorGigi.com.
Here's to our health!
Doctor Gigi
Diabetes & Low Blood Sugar:
Most of us know that diabetes is a disease in which a person has a disregulation of glucose (= sugar)metabolism, resulting in the person having a high glucose. Diabetes can lead to many bad things, including heart disease, strokes, neuropathy, poor healing, frequent infections, kidney failure, & even blindness, so anyone with the disease obviously wants to have good diabetic control. This means that you would like to have your glucose be between 80-150. If your sugar is often higher than this, you have a higher risk of getting these ill effects, but what happens if you get your sugars too low?
A glucose below 60 is too low, and doctors really worry if it gets below 40. This is due to the fact that the brain needs sugar, so if your glucose gets too low, the brain actually dies. Symptoms of hypoglycemia (= low blood sugar) include feeling anxious, confused, cold, sweaty, shaky, & agitated. If you experience these episodes of low sugar, you can quickly correct the problem by eating sugar, so you should carry glucose pills (which you can purchase at a pharmacy) or packets of sugar (like you get in a coffee shop). In the absence of these, you can try juice or soda... as long as they are NOT sugar-free versions.
Though we aim to control glucose to decrease the harmful effects of diabetes, we must realize that too low of a glucose can actually be more harmful than a high glucose. When your glucose gets below 40 (or perhaps even 60), you can suffer brain damage & even death within several HOURS. On the other hand, a high sugar (more than 150) will take YEARS to cause enough damage to result in brain damage or death. So work with your physician to get good control of your diabetes, but don't try to have such tight control that you bottom-out & have low glucose as that will likely cause you more harm than good!
Nurses' Week:
We recently celebrated Nurses' Week. This celebration begins on May 6th & ends on May 12th... which is the birthday of Florence Nightengale, who is the founder of modern nursing. Though being a nurse often involves doing tasks which are less than glamorous, it is in my opinion the closest thing to being a mother. Nurses care for us when we can't care for ourselves, & they do so without judgement or malice. Though they often make us do things we don't want to do, they do it for our benefit. They are the quiet support that hold our hands & care for our dignity & emotions, as much as they care for our physical health. They do more for us than we know, & during this week, we celebrate those nurses, past, present, & future who give so unselfishly of themselves to care for us! And though they might not love us like our mothers do, the service they give us is done so with love in their hearts!
Adult Immunizations:
Though we are aware that children need immunizations, we often forget that adults also need certain immunizations. Perhaps because schools mandate proof of immunizations, most children get their shots. On the other hand, no one insures adults get their shots, so consider the following & discuss with your doctor to be sure you keep up-to-date.
There are generally 4 adult immunizations: Td or TdaP (tetanus & diphtheria without or with whooping cough), Pneumovax, Flu, & Zostavax (shingles).
Td stands for tetanus & diphtheria, & everyone should get one every 10 years, unless they have had a problem with previous Td shots. This shot protects us from getting tetanus, which is also called lock-jaw. Though we mostly think we are prone to tetanus when we get a rusty nail injury, any open wound can be a source of tetanus. Thus, even a clean wound predisposes us to tetanus, so it behooves us to keep current with this shot! Unfortunately, if you have Medicare benefits, Medicare will only pay for the Td shot if you have an open wound.
TdaP is the tetanus & diphtheria shot with whooping cough as well. Whooping cough does not usually harm adults, but it can kill or permanently injure children. Most kids get DPT shots which include whooping cough, but not every child will make proper immunity, so we still want to immunize adults to decrease the risk of an adult getting the disease & spreading it to a susceptible child. So adults have the choice of Td or TdaP... & those who have frequent exposure to children should opt for the TdaP.
Pneumovax is a vaccine to protect you from getting Strep. pneumonia... which is a bacteria that often causes sinusitis, ear infections, pharyngitis, bronchitis, & pneumonia. It is recommended that anyone who is prone to these respiratory illnesses (such as those with asthma, emphysema, or even chronic allergies) should get a Pneumovax shot every 5 years. Everyone older than 65 should get this shot. Medicare will pay for only one shot after the age of 65, unless you have high risks for respiratory infections as noted above, though I recommend all of my patients over 65 continue to get this vaccine every 5 years, even if they have to pay cash for it.
Flu shots are given every fall in an effort to protect the population from influenza. As the shot changes every year, it is given to virtually everybody every year. Again, those who are highest risk of respiratory disease should get this shot annually, but it likely is a good idea for everyone to get one.
Zostavax is the vaccination which helps decrease the risk of getting shingles, which is also known as Herpes Zoster. When a person gets Chicken Pox, the virus causes infection & then goes dormant in the body. If it re-awakens many years later, it causes shingles... which is heralded by a classic painful, blistery, red rash which involves only one side of the body. Anybody older than 50 can get a Zostavax, but unfortunately it is expensive, costing $250-$300 or more. Because of this expense, many wait to get this vaccine when they have Medicare coverage, as Medicare Part D will usually pay for it. Oddly enough though, it is covered as a pharmacy benefit, so most physicians cannot bill for it so they do not give it. Instead, it is recommended that you go to a pharmacy with an in-house walk-in clinic... such as CVS or Walgreens... where the doctor or nurse can get the vaccine from the pharmacy, administer it, & then bill your pharmacy insurance. If you wonder why you can't just pick up a vial of this stuff from the pharmacy then bring it to your doctor to be administered, it is because it must be given to the patient within 30 minutes after being removed from the freezer.
Proper Medication List:
Just a note to make you aware that as a physician I would love for my patients to keep a list of their medications. I have noticed however that they do not record the meds as I would like, so here's a few helpful hints.
The list should include the name of the medication, preferably the generic & name-brand if you know... as different doctors will use different names. Also, include the strenghth of each pill AND how many you take & when you take them. This seems straightforward enough, but patients sometimes try to help me by writing the total dose they take in a day... yet I need to know the way the prescriptions are written. For example, if a patient takes Pravachol 40 mg 2 pills with supper, this is how I want it recorded. If the patient writes Pravachol 80 mg per day (their total daily dose), I will likely write the prescription for an 80 mg pill which is more expensive than 2 of the 40 mg pills. Also, if the patient calls to ask a question about the "2 pills" he takes at night, there will be a disconnect in our communication if my records indicate he is taking one pill at night for his cholesterol problem. Be accurate & be honest when you write your list, as it will help protect you from medication errors in the long-run.
An example of how this can make management difficult, I recall a recent situation at a local hospital. One of my patients was being treated for an infection but also had some chronic pain. Unfortunately he also had a swallowing problem, so swallowing pills was difficult for him. I ordered MS Contin 30 mg one pill 2 times per day, so I was confused & agitated when the patient complained repeatedly about having to take 6 pills every morning & 6 pills every night. I checked the computer & could not find where he had 6 pills of any type ordered, so I spoke with the nurse who checked her records. Her records showed that the pharmacy did not have the 30 mg pills, so they had switched to six of the 5 mg pills for each of the 2 doses. Though there would usually be no problem with this substitution, it certainly was a problem for my patient with swallowing problems! And worse yet, it was a problem for all of us because the records did not show me an accurate med list, so this impaired my ability to properly care for my patient!
Until next time, you can catch us on the radio... WTAN 1340-AM on Fridays 1:00-1:45 PM in the Tampa/St. Petersburg, FL area, or on the web... www.SkipShow.com where you can listen live or to the podcasts. We are always happy to answer your questions, so keep them coming... (727)-441-3000 or tollfree (866)-TAN-1340 or DoctorGigi@SkipShow.com. And if you find this blog educational & worthwhile, please become a "follower" & please consider sharing the link with your Facebook & Twitter friends! By the way, I will soon have a central website for the podcasts & this blog, so stay tuned for the opening of www.DoctorGigi.com.
Here's to our health!
Doctor Gigi
Monday, May 14, 2012
When Should We Die?; Quality of Life & Living Wills; Euthanasia; Zostavax shot; Protein in Diet; Birth Control & Blood Pressure.
This blog corresponds to the May 4, 2012 broadcast of Let's Talk Medical with Doctor Gigi. Feel free to refer to the podcast of that show via www.SkipShow.com if you want to hear us speak about these issues, & as always, please feel free to leave comments here or call us during the live show on Fridays at 1PM Eastern time... (866)-TAN-1340 tollfree.
When Should We Die?:
All machines break down at some point, so when should the human body break down? Are we really doing good to make discoveries that increase one's life expectancy?
I believe that the human body can certainly live well into the 90's or even longer, but at some point it does become frail & ill, & there is little if anything we can do to reverse or cure that. Also, if you want to be the lucky person who lives a healthy life to that age, you must make good choices in your life! You must eat right, sleep well, exercise routinely, find joy in life, & love & be loved! You also pray that you received great genes from your parents, as some issues that effect your life expectancy are not within your control. Even environmental issues such as where you live will have tremendous impact on your health, as we unfortunately learned from the Love Canal incident in New York.
Obviously we spend a lot of money trying to find medications which impact our health. The best option however is to stay healthy... so we should all aspire to do that! Realize that you have but one body, & affirm to take great care of it, as we can not always reverse the damage a poor or risky lifestyle causes.
So we all want to live to be old & die of old age, but "old" seems to get older as we age. I guess that "old" might even be more defined by one's quality of life than by a distinct number of years which they have lived. Thus a sick 50 year old person might be "older" than a healthy 70 year old.
But when should we as humans die? Obviously no one wants to die if they have good quality of life. But, without older generations dying, how can Earth support the overpopulation? So life & death become not only a health issue but a socio-economic one as well. If we want to live longer lives, we need to use birth control appropriately & thus decrease over-population. Thankfully, we seem to be doing a better job at that as the birth rate has recently declined. We must also realize that if we live longer, we will need more money for those elder years, thus retirement age will have to go up. This means the work-force will not have as rapid a turn-over, so jobs for younger people will be hard to find. Again, a population issue!
So one of our listeners posed a question: Do I support the one-child policy? I really don't like laws which restrict choices, but I would like it if people would adopt this belief. People should make choices to not over-populate the world, & at the very least, we should be responsible enough to not have more children than we can comfortably feed, educate, & love. So judge your own circumstances & make your own choices, but keep these issues in mind!
Quality of Life & Living Wills:
A study several years ago discovered that the majority of the Medicare money is spent in the last 90 days of a person's life. While we do not want to give up hope when a person gets ill, we do need to recognize when treatment becomes futile. At the present time, our government & health insurance plans are looking at ways to cut costs. They are toying with the idea of withholding certain treatments based on age. I would rather that we withhold care based on the likelihood of a good versus bad outcome, as this would take into account more important issues than simply a person's age, & certainly seems more scientific to me. Thus a 35 year old with a brain injury who must live in a nursing facility, & who cannot talk or travel might not qualify for aggressive chemotherapy for cancer, whereas a healthy 75 year old who lives independently, cares for himself, & continues to drive might qualify for the treatment. I propose that before we get arbitrary guidelines, we need to start using common sense & make our own good choices!
We also need to make Living Wills which express our wishes to not be kept alive if there is no chance for meaningful recovery, & we must discuss this with our families so they are prepared to honor our wishes when or if the time comes. When a physician approaches a family member to ask if he can abide by the Living Will & thus withhold treatment, he is not really asking you to decide about heroics for your family member. In fact, your family member has already made that decision, & you can only decide to allow the doctor to follow your family's written wishes or not. So you are not letting your family member die, you are simply following their wishes as expressed in the written instructions we call a Living Will.
Euthanasia:
Though I believe in euthanasia, I am not certain that I could actually perform it. I have had my pets euthanized, & though I know it alleviates suffering, I don't know that I could do it. I am thankful however to have Hospice available, as they too ease a patient's suffering, & their pain medications likely expedite death a little... as they suppress respiratory drive. If you or a loved one has a terminal illness, you likely qualify for Hospice. You could instead have "the dwindles" which is not truly a disease, but rather a "failure to thrive." In this instance, we simply know that you are slowly dying, for whatever reason. There is a thought that you must have only 6 months of life left to qualify for Hospice, but that does not mean that you have to die in 6 months. Hospice can provide longer term care if needed, so ask your doctor if you think you need their services, or if you prefer, call Hospice directly to speak with them yourself.
Zostavax Vaccine:
If you have had chicken pox, you are prone to getting shingles, as shingles is a reactivation of the chicken pox virus which continues to live in your spinal cord area after your initial infection. Shingles is a painful, red, blistery rash which wraps around your body in a nerve distribution. This means it will cover a stripe of skin on the right or left side of your body, & it never crosses the midline or middle of your body. It can cause pain before the rash even appears, & usually the pain is pretty severe. The older you are the more likely you will get it, but thankfully most people only get it once. Younger people usually get better, but older people can end up with chronic pain, called post-herpetic neuralgia, which can be so severe that it is debilitating.
Zostavax is the vaccine which helps decrease the chance that a person will get shingles (also called herpes zoster). Thus, it is indicated for people 50 years old or older, as they are prone to the disease, & if they get it, it is possible that the pain might never resolve. Generally we believe you only need one Zostavax injection in your lifetime. The vaccination costs about $250-$300, & most insurances do not pay for it, but Medicare Part D (which pays for the Medicare recipient's medications) will pay. Thus many people wait to get the shot when they are 65 years old as that is generally when they get Medicare benefits. If you really want to get a Zostavax shot, call your insurance to see if they will pay, but if they won't, you have the option to pay for it yourself. Though $250 or $300 is a lot of money, it is probably money well spent to avoid chronic pain.
Protein in Diet:
Linda asked about the amount of protein a woman should have in her diet. First, realize that very few doctors understand nutrition very well as we do not get a lot of nutritional training in medical school. Dieticians are the specialists who know this stuff, so if you have tremendous concerns, see a Dietician for input. I think that a person's diet is supposed to be composed of 40% protein, 30% carbohydrate, & 30% fat. As everyone has different caloric needs due to their age, sex, weight, genetics, activity, medications, etc., you must first determine how many calories you truly need each day. You might discuss this with a Dietician or perhaps you can get a guesstimate by using on-line calculators. Once you have the total calories you need in a day, you multiply by 0.4 to get the 40% of calories which should come from protein. Lastly, you must know that 1 gram of protein = 4 calories, so you must divide the protein calories by 4 to get the number of grams of protein you should have per day. You should also know that 1 gram of carbohydrate = 4 calories, but 1 gram of fat = 9 calories!
For example:
Let's assume I need 2,000 calories per day to maintain my weight.
2,000 calories X 0.4 = 800 calories which should come from protein.
800 calories of protein divided by 4 calories/gram of protein = 200 grams of protein needed/day.
Based on the above, you would need 2,000 X 0.3 = 600 calories from carbs, & 600 from fat.
But due to the different calories in these, you would need 600 divided by 4 = 150 grams of carb, but 600 divided by 9 = 66 grams of fat.
Lastly, if you have certain diseases, the above might not apply to you. In particular, people with liver disease must limit their protein intake as otherwise they produce excess ammonia which acts a bit like alcohol to make them not think clearly. Thus a person with significant liver disease should see a dietician to learn how to eat properly as their needs are somewhat unique.
Birth Control & Blood Pressure:
A patient was recently told that her blood pressure was high, & that due to this she needed to stop her birth control pill. Birth control pills are usually a combination of estrogen & progesterone, & estrogen can increase blood pressure.
First, as she had never had high blood pressure, she must stop the birth control pill, but she must also look for other things that might have caused the high blood pressure. She should stop any products for weight loss as these can elevate the blood pressure. Similarly she should limit decongestants (such as Sudafed, Pseudoephedrine, & Phenylephrine) & caffeine, as well as alcohol. She should try to exercise & perhaps lose weight (if she is over-weight). She might need to consider a sleep study to look for sleep apnea, especially if she is obese & snores a lot.
If the blood pressure normalizes, she could then re-try the birth control pill, but if the blood pressure again increases, she probably should not take the pills any longer. There is a progestin-only pill which she might try, as this should not effect the blood pressure, or perhaps she could simply use condoms & a spermicide. If she is older & in a stable relationship, an IUD might be a good option or perhaps even a diaphragm or a cervical cap would be acceptable. There is a new procedure called Essure which is a permanent, non-surgical, non-hormonal procedure that will cause blockage of the Fallopian tubes thus preventing pregnancy as the sperm cannot get to the egg. It is basically a non-surgical tubal ligation which is performed in several minutes in the office, but it is NOT reversible, so it is considered a form of sterilization.
Obviously there are many good options in this situation, & the final choice will vary based upon the patient's age, relationship status, & desire for pregnancy in the future. As always, a discussion with her GYN or Family Practitioner should help her make the most appropriate choice for her.
I hope you learned something useful in this blog, & please consider listening to Let's Talk Medical with Doctor Gigi on Fridays at 1:00PM Eastern time. We are broadcast locally on WTAN 1340-AM in the St. Petersburg/Tampa area, but you can also find us on the web via www.SkipShow.com where you can listen live or to the podcast at your convenience. Keep in touch & don't hesitate to contact me with questions or comments: (727)-441-3000 or (866)-TAN-1340 which is toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
When Should We Die?:
All machines break down at some point, so when should the human body break down? Are we really doing good to make discoveries that increase one's life expectancy?
I believe that the human body can certainly live well into the 90's or even longer, but at some point it does become frail & ill, & there is little if anything we can do to reverse or cure that. Also, if you want to be the lucky person who lives a healthy life to that age, you must make good choices in your life! You must eat right, sleep well, exercise routinely, find joy in life, & love & be loved! You also pray that you received great genes from your parents, as some issues that effect your life expectancy are not within your control. Even environmental issues such as where you live will have tremendous impact on your health, as we unfortunately learned from the Love Canal incident in New York.
Obviously we spend a lot of money trying to find medications which impact our health. The best option however is to stay healthy... so we should all aspire to do that! Realize that you have but one body, & affirm to take great care of it, as we can not always reverse the damage a poor or risky lifestyle causes.
So we all want to live to be old & die of old age, but "old" seems to get older as we age. I guess that "old" might even be more defined by one's quality of life than by a distinct number of years which they have lived. Thus a sick 50 year old person might be "older" than a healthy 70 year old.
But when should we as humans die? Obviously no one wants to die if they have good quality of life. But, without older generations dying, how can Earth support the overpopulation? So life & death become not only a health issue but a socio-economic one as well. If we want to live longer lives, we need to use birth control appropriately & thus decrease over-population. Thankfully, we seem to be doing a better job at that as the birth rate has recently declined. We must also realize that if we live longer, we will need more money for those elder years, thus retirement age will have to go up. This means the work-force will not have as rapid a turn-over, so jobs for younger people will be hard to find. Again, a population issue!
So one of our listeners posed a question: Do I support the one-child policy? I really don't like laws which restrict choices, but I would like it if people would adopt this belief. People should make choices to not over-populate the world, & at the very least, we should be responsible enough to not have more children than we can comfortably feed, educate, & love. So judge your own circumstances & make your own choices, but keep these issues in mind!
Quality of Life & Living Wills:
A study several years ago discovered that the majority of the Medicare money is spent in the last 90 days of a person's life. While we do not want to give up hope when a person gets ill, we do need to recognize when treatment becomes futile. At the present time, our government & health insurance plans are looking at ways to cut costs. They are toying with the idea of withholding certain treatments based on age. I would rather that we withhold care based on the likelihood of a good versus bad outcome, as this would take into account more important issues than simply a person's age, & certainly seems more scientific to me. Thus a 35 year old with a brain injury who must live in a nursing facility, & who cannot talk or travel might not qualify for aggressive chemotherapy for cancer, whereas a healthy 75 year old who lives independently, cares for himself, & continues to drive might qualify for the treatment. I propose that before we get arbitrary guidelines, we need to start using common sense & make our own good choices!
We also need to make Living Wills which express our wishes to not be kept alive if there is no chance for meaningful recovery, & we must discuss this with our families so they are prepared to honor our wishes when or if the time comes. When a physician approaches a family member to ask if he can abide by the Living Will & thus withhold treatment, he is not really asking you to decide about heroics for your family member. In fact, your family member has already made that decision, & you can only decide to allow the doctor to follow your family's written wishes or not. So you are not letting your family member die, you are simply following their wishes as expressed in the written instructions we call a Living Will.
Euthanasia:
Though I believe in euthanasia, I am not certain that I could actually perform it. I have had my pets euthanized, & though I know it alleviates suffering, I don't know that I could do it. I am thankful however to have Hospice available, as they too ease a patient's suffering, & their pain medications likely expedite death a little... as they suppress respiratory drive. If you or a loved one has a terminal illness, you likely qualify for Hospice. You could instead have "the dwindles" which is not truly a disease, but rather a "failure to thrive." In this instance, we simply know that you are slowly dying, for whatever reason. There is a thought that you must have only 6 months of life left to qualify for Hospice, but that does not mean that you have to die in 6 months. Hospice can provide longer term care if needed, so ask your doctor if you think you need their services, or if you prefer, call Hospice directly to speak with them yourself.
Zostavax Vaccine:
If you have had chicken pox, you are prone to getting shingles, as shingles is a reactivation of the chicken pox virus which continues to live in your spinal cord area after your initial infection. Shingles is a painful, red, blistery rash which wraps around your body in a nerve distribution. This means it will cover a stripe of skin on the right or left side of your body, & it never crosses the midline or middle of your body. It can cause pain before the rash even appears, & usually the pain is pretty severe. The older you are the more likely you will get it, but thankfully most people only get it once. Younger people usually get better, but older people can end up with chronic pain, called post-herpetic neuralgia, which can be so severe that it is debilitating.
Zostavax is the vaccine which helps decrease the chance that a person will get shingles (also called herpes zoster). Thus, it is indicated for people 50 years old or older, as they are prone to the disease, & if they get it, it is possible that the pain might never resolve. Generally we believe you only need one Zostavax injection in your lifetime. The vaccination costs about $250-$300, & most insurances do not pay for it, but Medicare Part D (which pays for the Medicare recipient's medications) will pay. Thus many people wait to get the shot when they are 65 years old as that is generally when they get Medicare benefits. If you really want to get a Zostavax shot, call your insurance to see if they will pay, but if they won't, you have the option to pay for it yourself. Though $250 or $300 is a lot of money, it is probably money well spent to avoid chronic pain.
Protein in Diet:
Linda asked about the amount of protein a woman should have in her diet. First, realize that very few doctors understand nutrition very well as we do not get a lot of nutritional training in medical school. Dieticians are the specialists who know this stuff, so if you have tremendous concerns, see a Dietician for input. I think that a person's diet is supposed to be composed of 40% protein, 30% carbohydrate, & 30% fat. As everyone has different caloric needs due to their age, sex, weight, genetics, activity, medications, etc., you must first determine how many calories you truly need each day. You might discuss this with a Dietician or perhaps you can get a guesstimate by using on-line calculators. Once you have the total calories you need in a day, you multiply by 0.4 to get the 40% of calories which should come from protein. Lastly, you must know that 1 gram of protein = 4 calories, so you must divide the protein calories by 4 to get the number of grams of protein you should have per day. You should also know that 1 gram of carbohydrate = 4 calories, but 1 gram of fat = 9 calories!
For example:
Let's assume I need 2,000 calories per day to maintain my weight.
2,000 calories X 0.4 = 800 calories which should come from protein.
800 calories of protein divided by 4 calories/gram of protein = 200 grams of protein needed/day.
Based on the above, you would need 2,000 X 0.3 = 600 calories from carbs, & 600 from fat.
But due to the different calories in these, you would need 600 divided by 4 = 150 grams of carb, but 600 divided by 9 = 66 grams of fat.
Lastly, if you have certain diseases, the above might not apply to you. In particular, people with liver disease must limit their protein intake as otherwise they produce excess ammonia which acts a bit like alcohol to make them not think clearly. Thus a person with significant liver disease should see a dietician to learn how to eat properly as their needs are somewhat unique.
Birth Control & Blood Pressure:
A patient was recently told that her blood pressure was high, & that due to this she needed to stop her birth control pill. Birth control pills are usually a combination of estrogen & progesterone, & estrogen can increase blood pressure.
First, as she had never had high blood pressure, she must stop the birth control pill, but she must also look for other things that might have caused the high blood pressure. She should stop any products for weight loss as these can elevate the blood pressure. Similarly she should limit decongestants (such as Sudafed, Pseudoephedrine, & Phenylephrine) & caffeine, as well as alcohol. She should try to exercise & perhaps lose weight (if she is over-weight). She might need to consider a sleep study to look for sleep apnea, especially if she is obese & snores a lot.
If the blood pressure normalizes, she could then re-try the birth control pill, but if the blood pressure again increases, she probably should not take the pills any longer. There is a progestin-only pill which she might try, as this should not effect the blood pressure, or perhaps she could simply use condoms & a spermicide. If she is older & in a stable relationship, an IUD might be a good option or perhaps even a diaphragm or a cervical cap would be acceptable. There is a new procedure called Essure which is a permanent, non-surgical, non-hormonal procedure that will cause blockage of the Fallopian tubes thus preventing pregnancy as the sperm cannot get to the egg. It is basically a non-surgical tubal ligation which is performed in several minutes in the office, but it is NOT reversible, so it is considered a form of sterilization.
Obviously there are many good options in this situation, & the final choice will vary based upon the patient's age, relationship status, & desire for pregnancy in the future. As always, a discussion with her GYN or Family Practitioner should help her make the most appropriate choice for her.
I hope you learned something useful in this blog, & please consider listening to Let's Talk Medical with Doctor Gigi on Fridays at 1:00PM Eastern time. We are broadcast locally on WTAN 1340-AM in the St. Petersburg/Tampa area, but you can also find us on the web via www.SkipShow.com where you can listen live or to the podcast at your convenience. Keep in touch & don't hesitate to contact me with questions or comments: (727)-441-3000 or (866)-TAN-1340 which is toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
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