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
Monday, May 14, 2012
Sunday, May 6, 2012
Weight Loss Programs; Medical Credentials?; Beano; Weight Gain & Anti-Depressants; Depression; Over-used Tests.
Welcome back to the Let's Talk Medical with Doctor Gigi follow-up. This blog refers to the show which was broadcast on Friday April 27, 2012.
Weight Loss Programs:
I am certainly no expert on weight loss programs, though I did attend a weight loss program myself when I was a teen, & I even underwent a suction lipectomy when I was 24. I also used to work in a Phen-Fen clinic years ago, so I do understand the desire to discover a magic bullet for obesity! Unfortunately there still is no such thing. Though many programs exist, no one program works for everybody, so I really can't suggest one over the other. I would however like to make you aware that if the program involves an herbal supplement, that supplement is on the market as a food product only. In other words, unless it is a prescription medication, it has not been evaluated as a medication by the FDA; thus, it is treated as food. No one evaluates food for safety or efficacy, so again the claims of weight loss have not been verified... unless it is listed on the product label (which cannot make false claims). So be cautious of supplements, & realize that the gold standard weight loss programs involve a decrease of calories eaten, AND an increase in calories spent. I like healthy meal replacements like Jenny Craig as they give you complete nutrition but help limit your caloric intake. Be sure to increase your activity, even if you just take a brisk 30 minute walk every day or two, as this helps to increase your metabolism thus burning off the calories more effectively.
Also, just because a physician has a weight loss program in his office does not mean that it is a great program or more medically sound than others. It also does not mean the doctor is going to oversee the program, as sadly most doctors have had very little training in obesity & nutrition. There is a specialty in Bariatrics which we can obtain if we wish to learn more about this, but few docs truly pursue that training. The draw for physicians to have weight loss programs in their offices is usually a financial incentive, as usually it is a cash pay program. Unfortunately, doctors no longer make ancillary income through ownership in labs, home healthcare agencies, radiology suites, or medical supply companies. This, along with the increased costs of running a medical clinic, as well as fairly stagnant fees (which are controlled by insurance companies &/or the government) has resulted in many physicians looking to do things which bring in cash money... as these cash pay services are not controlled by insurance or government.
Medical Credentials?:
All physicians have an MD or DO degree, indicating that he has a doctorate degree in medicine. After that however, that are many different residencies which train us to be specialists. Many of the procedures done by one specialty are also done by other specialists. Thus an ENT doctor might do a face lift, as Plastic Surgeons are not the only group trained to do this. After the doctor becomes a specialist, he can also choose to study in other programs to achieve the knowledge needed to do certain procedures, such as liposuction or face peels.
The point is that many doctors are qualified to do procedures, & they get that training in a variety of ways. You as the consumer have a right however to know what the doctor's training is, so don't hesitate to ask... especially if you are paying cash for a procedure as you are a person who has a choice...
Beano:
Beano is one of my favorite products! It is basically a digestive enzyme which humans do not have. It digests certain carbohydrates which are found in gassy foods such as beans & cabbage. Unfortunately the bacteria which live in your bowel do have this enzyme. So when you eat these foods which you cannot digest, the food gets to your bowel where your bacteria do digest the carbohydrate... and the byproduct of that digestion is methane gas. So, if you take Beano with these foods which you cannot digest, the Beano will digest the carb so by the time the food gets to your bowel the bacteria have nothing to do, thus you get no gas production! Yeah Beano... natural & effective!
Weight Gain & Anti-Depressants:
Many anti-depressants do cause weight gain. The most notorious for this is Paxil, & I can remember this as we used to say: "Paxil packs on pounds." In all fairness, this is probably an issue with all SSRI's, including Paxil, Prozac, Zoloft, Celexa, & Lexapro. Though Paxil is thought to be the worst offender, it has been modified to decrease it's side-effects including this one. Paxil was changed slightly to create Celexa, which was in turn modified to create Lexapro. So perhaps Lexapro (which just went generic) has less weight-gain issue than other SSRI anti-depressants. There is a new anti-depressant named Viibryd (Vilazodone), which is a special sort of an SSRI. It has studies which actually show it does not cause weight gain. If reality proves to be true, it would perhaps be the preferred SSRI anti-depressant as it is also reportedly well tolerated, has little to no sexual dysfunction side-effects, & has less likelihood of a "poop-out syndrome"... call or e-mail if you want to know more about what that is!
We don't really know why weight gain occurs with anti-depressant use, but some propose that they cause the patient to crave carbs, which might result in increased calorie intake. So I try to remind my patients to be cognizant of this carb craving & to try to make an effort to limit carb intake... & instead to increase protein intake as this tends to be more filling.
So what can you do if you have depression, but are concerned about your weight? First, watch your carbohydrate intake. Secondly, ask your doctor if Wellbutrin (= Buproprion) is an option. Remember however that although Wellbutrin is a good anti-depressant which is associated with very little in the way of weight gain & sexual dysfunction, it is not good if that depressed person also has anxiety. By the way, the SSRI's (see above) are the best for treating depression AND anxiety. Another option is to try an SNRI such as Effexor (= Venlafaxine), Cymbalta (= Duloxetine), Pristiq (= Desvenlafaxine), or Savella (= Milnacipran), but they often cause weight gain also. Lastly, perhaps you should simply take the best anti-depressant for you, & when you feel better physically & emotionally, make better choices regarding your diet & exercise, as often depressed people don't exercise or eat properly.
As a final thought, hypothyroidism is a condition in which a person's thyroid functions too slowly. The thyroid is essentially your metabolic gland, so when it is slow, your metabolism is slow & you tend to gain weight. Also, when you have a slow thyroid, you tend to be depressed. So every depressed patient needs a TSH blood test to rule-out hypothyroidism as part of the problem.
Depression:
How do you know when to take medication for depression? First we need to understand that depression can be due to outside influences, such as unemployment or relationship issues. But depression can also be due to a chemical imbalance in the brain. It is this chemical imbalance which is corrected by the medications we call anti-depressants. Though some anti-depressants replace the serotonin in one's brain, others replace norepinephrine, & still others replace dopamine.
Depression is like any other disease... it has a stepwise method of treatment depending upon a patient's disease severity & personal choices. I suggest that it is similar to diabetes. If you are diabetic, it is first your responsibility to eat right & exercise. If that does not control your diabetes, then you might need pills, & ultimately you might need insulin. So a depressed person should first try to deal with life issues within his control, & perhaps try counseling, but if that is not successful, perhaps medications are necessary... to correct that chemical imbalance.
Realize that anti-depressants often do not work well until you have been on them for 6 weeks, so it is important not to wait too long to try them. There is no shame in trying an anti-depressant, & you can certainly stop at any time, but they work best if you take them for about one year. They also can cause a withdrawal if you stop them too quickly, so always speak with your doctor before you abruptly stop or skip doses. The withdrawal is not an indication that the anti-depressant is addicting however. The anti-depressant replaces certain chemicals in the brain (as noted above), so when you abruptly stop your pills it takes a while for your brain to try to produce those chemicals, resulting in odd feelings such as shock-type feelings in your body & brain. After a few days this will resolve, but slowly weaning your dose should prevent withdrawal from occurring.
Over-used Tests:
Recently each of 9 specialty organizations in medicine, including mine... the American Association of Family Physicians... chose 5 tests which they feel are over-used in practices today. This establishes 45 procedures for which our specialty organizations have given us guidance to help decrease over-use... likely in an effort to rein in healthcare spending. Most make sense & should not result in withholding of care. Instead, this sets guidelines which allows doctors to decrease inappropriate use of tests by applying scientific principles to when & why tests should be conducted. Also, by having these guidelines, doctors have created a means of protecting ourselves from lawsuits which might claim that we did wrong to a patient by delaying such tests.
Remember however that these are only guidelines. A patient & his physician can always opt to do more agressive testing if the situation calls for it, so be sure to speak with your doctor if you have concerns, as exeptions can always be made. I think the point of all this is that because we live in an educated society, we have gotten to the point where much of medical care is done at the demand of society or to protect the doctor from lawsuits. These guidelines will help get doctors back in control of the practice of medicine which should help with the tremendous costs of healthcare.
And so this concludes another segment of the blog. Hopefully you found something useful in it, & don't forget to share with your friends & family as perhaps they can learn something useful as well. And don't forget to tune in on Fridays at 1:00 PM Eastern time when we broadcast Let's Talk Medical with Doctor Gigi live on WTAN 1340-AM in the Tampa/St. Pete area. If you are not local, you can catch us on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. As always, I happily accept questions & comments, & you can reach me during the broadcast via: (727)-441-3000 or toll-free (866)-TAN-1340, or you can e-mail me any time via: DoctorGigi@SkipShow.com.
So until the next time, here's to our health!
Doctor Gigi
Weight Loss Programs:
I am certainly no expert on weight loss programs, though I did attend a weight loss program myself when I was a teen, & I even underwent a suction lipectomy when I was 24. I also used to work in a Phen-Fen clinic years ago, so I do understand the desire to discover a magic bullet for obesity! Unfortunately there still is no such thing. Though many programs exist, no one program works for everybody, so I really can't suggest one over the other. I would however like to make you aware that if the program involves an herbal supplement, that supplement is on the market as a food product only. In other words, unless it is a prescription medication, it has not been evaluated as a medication by the FDA; thus, it is treated as food. No one evaluates food for safety or efficacy, so again the claims of weight loss have not been verified... unless it is listed on the product label (which cannot make false claims). So be cautious of supplements, & realize that the gold standard weight loss programs involve a decrease of calories eaten, AND an increase in calories spent. I like healthy meal replacements like Jenny Craig as they give you complete nutrition but help limit your caloric intake. Be sure to increase your activity, even if you just take a brisk 30 minute walk every day or two, as this helps to increase your metabolism thus burning off the calories more effectively.
Also, just because a physician has a weight loss program in his office does not mean that it is a great program or more medically sound than others. It also does not mean the doctor is going to oversee the program, as sadly most doctors have had very little training in obesity & nutrition. There is a specialty in Bariatrics which we can obtain if we wish to learn more about this, but few docs truly pursue that training. The draw for physicians to have weight loss programs in their offices is usually a financial incentive, as usually it is a cash pay program. Unfortunately, doctors no longer make ancillary income through ownership in labs, home healthcare agencies, radiology suites, or medical supply companies. This, along with the increased costs of running a medical clinic, as well as fairly stagnant fees (which are controlled by insurance companies &/or the government) has resulted in many physicians looking to do things which bring in cash money... as these cash pay services are not controlled by insurance or government.
Medical Credentials?:
All physicians have an MD or DO degree, indicating that he has a doctorate degree in medicine. After that however, that are many different residencies which train us to be specialists. Many of the procedures done by one specialty are also done by other specialists. Thus an ENT doctor might do a face lift, as Plastic Surgeons are not the only group trained to do this. After the doctor becomes a specialist, he can also choose to study in other programs to achieve the knowledge needed to do certain procedures, such as liposuction or face peels.
The point is that many doctors are qualified to do procedures, & they get that training in a variety of ways. You as the consumer have a right however to know what the doctor's training is, so don't hesitate to ask... especially if you are paying cash for a procedure as you are a person who has a choice...
Beano:
Beano is one of my favorite products! It is basically a digestive enzyme which humans do not have. It digests certain carbohydrates which are found in gassy foods such as beans & cabbage. Unfortunately the bacteria which live in your bowel do have this enzyme. So when you eat these foods which you cannot digest, the food gets to your bowel where your bacteria do digest the carbohydrate... and the byproduct of that digestion is methane gas. So, if you take Beano with these foods which you cannot digest, the Beano will digest the carb so by the time the food gets to your bowel the bacteria have nothing to do, thus you get no gas production! Yeah Beano... natural & effective!
Weight Gain & Anti-Depressants:
Many anti-depressants do cause weight gain. The most notorious for this is Paxil, & I can remember this as we used to say: "Paxil packs on pounds." In all fairness, this is probably an issue with all SSRI's, including Paxil, Prozac, Zoloft, Celexa, & Lexapro. Though Paxil is thought to be the worst offender, it has been modified to decrease it's side-effects including this one. Paxil was changed slightly to create Celexa, which was in turn modified to create Lexapro. So perhaps Lexapro (which just went generic) has less weight-gain issue than other SSRI anti-depressants. There is a new anti-depressant named Viibryd (Vilazodone), which is a special sort of an SSRI. It has studies which actually show it does not cause weight gain. If reality proves to be true, it would perhaps be the preferred SSRI anti-depressant as it is also reportedly well tolerated, has little to no sexual dysfunction side-effects, & has less likelihood of a "poop-out syndrome"... call or e-mail if you want to know more about what that is!
We don't really know why weight gain occurs with anti-depressant use, but some propose that they cause the patient to crave carbs, which might result in increased calorie intake. So I try to remind my patients to be cognizant of this carb craving & to try to make an effort to limit carb intake... & instead to increase protein intake as this tends to be more filling.
So what can you do if you have depression, but are concerned about your weight? First, watch your carbohydrate intake. Secondly, ask your doctor if Wellbutrin (= Buproprion) is an option. Remember however that although Wellbutrin is a good anti-depressant which is associated with very little in the way of weight gain & sexual dysfunction, it is not good if that depressed person also has anxiety. By the way, the SSRI's (see above) are the best for treating depression AND anxiety. Another option is to try an SNRI such as Effexor (= Venlafaxine), Cymbalta (= Duloxetine), Pristiq (= Desvenlafaxine), or Savella (= Milnacipran), but they often cause weight gain also. Lastly, perhaps you should simply take the best anti-depressant for you, & when you feel better physically & emotionally, make better choices regarding your diet & exercise, as often depressed people don't exercise or eat properly.
As a final thought, hypothyroidism is a condition in which a person's thyroid functions too slowly. The thyroid is essentially your metabolic gland, so when it is slow, your metabolism is slow & you tend to gain weight. Also, when you have a slow thyroid, you tend to be depressed. So every depressed patient needs a TSH blood test to rule-out hypothyroidism as part of the problem.
Depression:
How do you know when to take medication for depression? First we need to understand that depression can be due to outside influences, such as unemployment or relationship issues. But depression can also be due to a chemical imbalance in the brain. It is this chemical imbalance which is corrected by the medications we call anti-depressants. Though some anti-depressants replace the serotonin in one's brain, others replace norepinephrine, & still others replace dopamine.
Depression is like any other disease... it has a stepwise method of treatment depending upon a patient's disease severity & personal choices. I suggest that it is similar to diabetes. If you are diabetic, it is first your responsibility to eat right & exercise. If that does not control your diabetes, then you might need pills, & ultimately you might need insulin. So a depressed person should first try to deal with life issues within his control, & perhaps try counseling, but if that is not successful, perhaps medications are necessary... to correct that chemical imbalance.
Realize that anti-depressants often do not work well until you have been on them for 6 weeks, so it is important not to wait too long to try them. There is no shame in trying an anti-depressant, & you can certainly stop at any time, but they work best if you take them for about one year. They also can cause a withdrawal if you stop them too quickly, so always speak with your doctor before you abruptly stop or skip doses. The withdrawal is not an indication that the anti-depressant is addicting however. The anti-depressant replaces certain chemicals in the brain (as noted above), so when you abruptly stop your pills it takes a while for your brain to try to produce those chemicals, resulting in odd feelings such as shock-type feelings in your body & brain. After a few days this will resolve, but slowly weaning your dose should prevent withdrawal from occurring.
Over-used Tests:
Recently each of 9 specialty organizations in medicine, including mine... the American Association of Family Physicians... chose 5 tests which they feel are over-used in practices today. This establishes 45 procedures for which our specialty organizations have given us guidance to help decrease over-use... likely in an effort to rein in healthcare spending. Most make sense & should not result in withholding of care. Instead, this sets guidelines which allows doctors to decrease inappropriate use of tests by applying scientific principles to when & why tests should be conducted. Also, by having these guidelines, doctors have created a means of protecting ourselves from lawsuits which might claim that we did wrong to a patient by delaying such tests.
Remember however that these are only guidelines. A patient & his physician can always opt to do more agressive testing if the situation calls for it, so be sure to speak with your doctor if you have concerns, as exeptions can always be made. I think the point of all this is that because we live in an educated society, we have gotten to the point where much of medical care is done at the demand of society or to protect the doctor from lawsuits. These guidelines will help get doctors back in control of the practice of medicine which should help with the tremendous costs of healthcare.
And so this concludes another segment of the blog. Hopefully you found something useful in it, & don't forget to share with your friends & family as perhaps they can learn something useful as well. And don't forget to tune in on Fridays at 1:00 PM Eastern time when we broadcast Let's Talk Medical with Doctor Gigi live on WTAN 1340-AM in the Tampa/St. Pete area. If you are not local, you can catch us on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. As always, I happily accept questions & comments, & you can reach me during the broadcast via: (727)-441-3000 or toll-free (866)-TAN-1340, or you can e-mail me any time via: DoctorGigi@SkipShow.com.
So until the next time, here's to our health!
Doctor Gigi
Sunday, April 22, 2012
Earth Day; OTC Med More Expensive Than Prescription Med?; Pharmacists; Belly Upset & Arthritis Meds; Hospitalization & List of Home Meds.
So I have gotten back to the blog after celebrating Earth Day on April 22nd & Arbor Day on April 27th. The following reflects the topics discussed on Let's Talk Medical with Doctor Gigi on Friday April 20, 2012. Sorry for the delay, but one must celebrate holidays!
Earth Day:
Sunday April 22, 2012 we celebrated Earth Day. This is a day upon which we seek to do something good for Mother Earth. It began as a celebration on April 22, 1970, & it was this event which lead to the creation of the Environmental Protection Agency (EPA). In other words, until 1970 there was no agency to oversee the health of our environment. In the 42 years that we have celebrated Earth Day, we have actually celebrated the healthier environment which it has provided, & we have sought ways to improve it even more. Things you can do to celebrate Earth Day include: bike to work, buy local products, use less plastics, use less petroleum products, recycle, plant a tree or garden, invest in renewable energy, or clean litter or trash from a park or roadside. I hope that you found time to celebrate this year, but if you did not, put the date on your calendar for 2013... or better yet, celebrate in your own way by making small changes to your routine daily! After all, without a healthy Earth, is it really possible for you & I to be healthy?
OTC Med More Expensive Than Prescription Med?:
Prilosec is an H2-blocker. It causes your stomach to produce less acid, thus it is used to treat stomach ulcers & gastroesophageal reflux (GERD). Many people take it, but many do not know that it is cheaper if you get a prescription from your doctor. There is a generic for Prilosec... called Omeprazole... which can be gotten from the pharmacy with a prescription. The generic prescription version costs about $15 for a 90-day supply at WalMart & K-Mart, whereas the name-brand Prilosec OTC costs about $44 for the same 90-day supply.
The point is that just because a medicine can be purchased over-the-counter does not mean that it cannot be purchased with a prescription, & often times for significantly less! Be sure to ask your doctor &/or pharmacist for advice if you take an OTC med frequently, as you might save money if you get a prescription for it. And don't worry about the insurance saying that they will not pay for it because you can get it over-the-counter. Simply tell the Pharmacist that you want to be "self-pay" for this medicine, & simply pay for it yourself... you'll still save money in the long-run!
Several medications should work this way, so be sure to inquire about them:
1) Prilosec (= Omeprazole) - for treatment of ulcers & GERD,
2) Zantac (= Ranitidine) - a weaker medicine to treat ulcers & GERD,
3) Claritin (= Loratidine) - a non-drowsy anti-histamine to treat allergies,
4) Motrin (= Ibuprofen) - an anti-inflammatory medicine to treat pain... works best if you ask for the 600 or 800 mg strength,
5) Miralax (= Glycolax) - a laxative for chronic constipation.
Pharmacists:
Your Pharmacist is an invaluable part of your health... & finances! He helps me to take care of you by helping to coordinate your care, as I am not always privie to the medication changes ordered by your other physicians. He also watches for drug interactions & let's me know if he has concerns. I find however that the Pharmacist is not always forthcoming with advise in regards to the cost of medications. However, if you ASK about cost-effective options, he will often have some advise... so be bold & ask!
I recently thought that I would save my patient money by prescribing the old version of Detrol instead of the newer Detrol LA. The original Detrol is given as a 2 mg pill which is taken 2 times per day, whereas the newer version, Detrol LA, is "long-acting" so it is given as a 4 mg pill ONCE per day. I thought that the twice a day Detrol had a generic version, thus I thought it should be cheaper & wrote that prescription for my patient. Obviously I was mistaken, & thankfully the Pharmacist alerted me that my good intentions were not going to help with the patient's cost. With that knowledge, I changed the script to the once-a-day Detrol LA, as there is no need to inconvenience the patient with complicated dosing unless there is significant cost savings.
So get to know your Pharmacist, & don't be afraid to breach financial questions. Realize that the best prices are likely found at large retail stores like WalMart & K-Mart, but the independent small pharmacy likely has a Pharmacist who owns the pharmacy & as such is begging to earn your business. Though he may not have the lowest prices (because he cannot buy in bulk quantities like the large retailers), he is likely to take more time to advise you as to your choices, which in the long-run might save you more money than if you had dealt with the large retailer!
Also, it usually feels as though the insurance company dictates our healthcare, but remember they only control us if we let them. We can use the doctors, pharmacists, physical therapists, etc. of our choosing. It might cost a bit more, but if you can afford it, you just might find that your health is worth that investment!
Belly Upset & Arthritis Meds:
Most medications to treat arthritis are non-steroidal anti-inflammatory drugs... or what doctors call NSAID's. They work by decreasing inflamation, which helps with the arthritis pain, but unfortunately they frequently cause stomach upset. So what do you do if you have arthritis but cannot tolerate an NSAID?
The first thing to do is to be sure you take the NSAID with food! NSAID's cause local stomach irritation, so putting food in the belly with the medicine will likely decrease this irritation. It does not always solve the problem though as NSAID's also cause a decrease in the protective lining of the stomach, resulting in more susceptibility to the irritating effects of the stomach's own hydrochloric acid (which it produces). Also, though Advil (= Motrin or Ibuprofen) is a great NSAID, it must be taken 3 times per day. On the other hand, DayPro (= Oxaprozin) is a once-a-day NSAID. By taking the DayPro less often, it is often better tolerated, so consider giving it a try.
If that does not work, perhaps you should change to Tylenol, as it is not an NSAID, & does not have GI (gastrointestinal) side-effects. However, it is also not an anti-inflamatory, so it might not help the pain. Some people are lucky though & do get significant pain relief, so why not try it?
If Tylenol does not help, there are other options. Adding a proton pump inhibitor (= PPI), such as Prilosec to your daily routine will cause the stomach to produce less stomach acid, thus you will more likely tolerate the NSAID. In other words, the stomach can tolerate some irritation... it's own acid or the NSAID. So if you must take the NSAID, get rid of the acid by taking a PPI as well.
If you still find problems with the NSAID, you might need to change it to a COX-2 inhibitor such as Celebrex. This medicine does not cause a decrease in the protective lining of the stomach, but does decrease inflamation. Thus Celebrex is a great arthritic medicine, but it is much more expensive than most NSAID's. If you have a Sulfa allergy, you also cannot take Celebrex.
So if Celebrex is not an option for you, perhaps you should change your NSAID to Mobic, which is somewhere between an NSAID & a COX-2 inhibitor. In other words, it is likely safer than the usual NSAID, but not as safe as Celebrex, but it has a generic version (= Meloxicam) which is certainly cheaper than Celebrex.
Some people get relief with a topical NSAID such as Voltaren gel. Since it does not get into the stomach, it should be better tolerated, but it still can cause trouble, especially if you take the maximum doses which will still potentially decrease that protective lining of the stomach. It works best for joints that are close to the skin, such as fingers, elbows, ankles, & knees. The shoulder & hip joints are further from the skin, so the topical treatment does not penetrate them as well. Voltaren gel is also pretty expensive, but it will soon lose it's patent... so watch for the generic soon.
As a last thought, there is an odd drug called Cytotec which can be added to your NSAID. Cytotec coats the stomach & thus protects it. Though this sounds like a great idea, it comes with wierd side-effects, such as diarrhea & malabsorption of your other meds. It basically binds to your stomach as well as to anything in there, so you must take all other pills several hours before or after you take Cytotec. Cytotec is combined with the NSAID Voltaren & called Arthrotec, which is a great product to treat arthritis yet protect the belly. Arthrotec is very expensive however, so you might ask your doctor to give you the Cytotec generic (= Misoprostol) separate from the NSAID as that is almost certainly a lot cheaper than the one combo product... as is usually the case!
Okay, one more option of which I have just become aware! Apparently Cymbalta (= Duloxetine) which is an anti-depressant in the SNRI class has received approval as treatment for arthritis pain. As it is an anti-depressant, it does not have the typical GI (gastrointestinal) side-effects caused by the NSAID's. It is also used to treat fibromyalgia pain & even neuropathic (= nerve) pain, so it tackles many types of pain. Because of this, Cymbalta might help people who have multiple types of pain as well as those who have concommitant depression. After all, chronic pain often causes depression, & often depression causes pain to hurt more... so one medication which treats both is fabulous!
Hospitalization & List of Home Meds:
When you get admitted to the hospital, the nurses insist upon getting a very detailed list of all of your home medications, including herbs & supplements as well. They must know the dose of the products, as well as how often you take them. Why do they care so much?
Well, there has been much talk about the medication errors that occur in the hospital, so in response to this, the government has charged the hospital (& thus the nurse) with getting the patient's home medication list so the physician can then simply decide which of those meds is to be continued during the hospital stay. First, I would like to say that this has lead to more medication errors than you can imagine! The nurses are not allowed to admit the patient or render care until the list is created, yet they often do not contact me to assist with its creation! So, this is compiled from the patient's best recall or most recent list, which is often not correct. I thus advise that you carry a very up-to-date list, & if you are not sure, insist that the nurse contact your doctor or family member... don't guess!
Also, once this list is created, it is presented to the physician for him to approve the meds that he wants you to take during your hospitalization, & to discontinue those that he feels are unnecessary. This process also lends itself to problems. Often doctors simply continue every medicine or supplement unless there is a specific reason to stop it. In the old days, we did the opposite... we only ordered the medicines you absolutely needed! So you now get many meds during your hospital stay, whereas in the past you only got the few you desperately needed. Many of your home meds are not stocked by the hospital pharmacy & are thus substituted automatically with a similar but not identical product. This can cause side-effects which can complicate your care & are difficult to identify. Think about what you do instinctively when you are ill... you usually take only the medications that you think are absolutely necessary. Though you sometimes don't make the proper choices, you at least try!
So when you go to the hospital, bring your medicines in the bottles, so the nurse can check them, & also note any changes that are not listed on the bottles! Also, when your physician sees you in the hospital, be sure to ask him to give you only the most necessary of these meds, so your body & belly will not be taxed trying to deal with unneeded meds or herbs!
That concludes this blog, but please don't forget to check out the radio show... on Fridays at 1:00-1:45 PM Eastern time. Listen locally to WTAN 1340-AM, or try the computer where you can listen live or to the podcast... www.SkipShow.com. As always, feel free to ask questions or make comments via phone: (727)-441-3000 or toll-free (866)-TAN-1340, or via e-mail: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Earth Day:
Sunday April 22, 2012 we celebrated Earth Day. This is a day upon which we seek to do something good for Mother Earth. It began as a celebration on April 22, 1970, & it was this event which lead to the creation of the Environmental Protection Agency (EPA). In other words, until 1970 there was no agency to oversee the health of our environment. In the 42 years that we have celebrated Earth Day, we have actually celebrated the healthier environment which it has provided, & we have sought ways to improve it even more. Things you can do to celebrate Earth Day include: bike to work, buy local products, use less plastics, use less petroleum products, recycle, plant a tree or garden, invest in renewable energy, or clean litter or trash from a park or roadside. I hope that you found time to celebrate this year, but if you did not, put the date on your calendar for 2013... or better yet, celebrate in your own way by making small changes to your routine daily! After all, without a healthy Earth, is it really possible for you & I to be healthy?
OTC Med More Expensive Than Prescription Med?:
Prilosec is an H2-blocker. It causes your stomach to produce less acid, thus it is used to treat stomach ulcers & gastroesophageal reflux (GERD). Many people take it, but many do not know that it is cheaper if you get a prescription from your doctor. There is a generic for Prilosec... called Omeprazole... which can be gotten from the pharmacy with a prescription. The generic prescription version costs about $15 for a 90-day supply at WalMart & K-Mart, whereas the name-brand Prilosec OTC costs about $44 for the same 90-day supply.
The point is that just because a medicine can be purchased over-the-counter does not mean that it cannot be purchased with a prescription, & often times for significantly less! Be sure to ask your doctor &/or pharmacist for advice if you take an OTC med frequently, as you might save money if you get a prescription for it. And don't worry about the insurance saying that they will not pay for it because you can get it over-the-counter. Simply tell the Pharmacist that you want to be "self-pay" for this medicine, & simply pay for it yourself... you'll still save money in the long-run!
Several medications should work this way, so be sure to inquire about them:
1) Prilosec (= Omeprazole) - for treatment of ulcers & GERD,
2) Zantac (= Ranitidine) - a weaker medicine to treat ulcers & GERD,
3) Claritin (= Loratidine) - a non-drowsy anti-histamine to treat allergies,
4) Motrin (= Ibuprofen) - an anti-inflammatory medicine to treat pain... works best if you ask for the 600 or 800 mg strength,
5) Miralax (= Glycolax) - a laxative for chronic constipation.
Pharmacists:
Your Pharmacist is an invaluable part of your health... & finances! He helps me to take care of you by helping to coordinate your care, as I am not always privie to the medication changes ordered by your other physicians. He also watches for drug interactions & let's me know if he has concerns. I find however that the Pharmacist is not always forthcoming with advise in regards to the cost of medications. However, if you ASK about cost-effective options, he will often have some advise... so be bold & ask!
I recently thought that I would save my patient money by prescribing the old version of Detrol instead of the newer Detrol LA. The original Detrol is given as a 2 mg pill which is taken 2 times per day, whereas the newer version, Detrol LA, is "long-acting" so it is given as a 4 mg pill ONCE per day. I thought that the twice a day Detrol had a generic version, thus I thought it should be cheaper & wrote that prescription for my patient. Obviously I was mistaken, & thankfully the Pharmacist alerted me that my good intentions were not going to help with the patient's cost. With that knowledge, I changed the script to the once-a-day Detrol LA, as there is no need to inconvenience the patient with complicated dosing unless there is significant cost savings.
So get to know your Pharmacist, & don't be afraid to breach financial questions. Realize that the best prices are likely found at large retail stores like WalMart & K-Mart, but the independent small pharmacy likely has a Pharmacist who owns the pharmacy & as such is begging to earn your business. Though he may not have the lowest prices (because he cannot buy in bulk quantities like the large retailers), he is likely to take more time to advise you as to your choices, which in the long-run might save you more money than if you had dealt with the large retailer!
Also, it usually feels as though the insurance company dictates our healthcare, but remember they only control us if we let them. We can use the doctors, pharmacists, physical therapists, etc. of our choosing. It might cost a bit more, but if you can afford it, you just might find that your health is worth that investment!
Belly Upset & Arthritis Meds:
Most medications to treat arthritis are non-steroidal anti-inflammatory drugs... or what doctors call NSAID's. They work by decreasing inflamation, which helps with the arthritis pain, but unfortunately they frequently cause stomach upset. So what do you do if you have arthritis but cannot tolerate an NSAID?
The first thing to do is to be sure you take the NSAID with food! NSAID's cause local stomach irritation, so putting food in the belly with the medicine will likely decrease this irritation. It does not always solve the problem though as NSAID's also cause a decrease in the protective lining of the stomach, resulting in more susceptibility to the irritating effects of the stomach's own hydrochloric acid (which it produces). Also, though Advil (= Motrin or Ibuprofen) is a great NSAID, it must be taken 3 times per day. On the other hand, DayPro (= Oxaprozin) is a once-a-day NSAID. By taking the DayPro less often, it is often better tolerated, so consider giving it a try.
If that does not work, perhaps you should change to Tylenol, as it is not an NSAID, & does not have GI (gastrointestinal) side-effects. However, it is also not an anti-inflamatory, so it might not help the pain. Some people are lucky though & do get significant pain relief, so why not try it?
If Tylenol does not help, there are other options. Adding a proton pump inhibitor (= PPI), such as Prilosec to your daily routine will cause the stomach to produce less stomach acid, thus you will more likely tolerate the NSAID. In other words, the stomach can tolerate some irritation... it's own acid or the NSAID. So if you must take the NSAID, get rid of the acid by taking a PPI as well.
If you still find problems with the NSAID, you might need to change it to a COX-2 inhibitor such as Celebrex. This medicine does not cause a decrease in the protective lining of the stomach, but does decrease inflamation. Thus Celebrex is a great arthritic medicine, but it is much more expensive than most NSAID's. If you have a Sulfa allergy, you also cannot take Celebrex.
So if Celebrex is not an option for you, perhaps you should change your NSAID to Mobic, which is somewhere between an NSAID & a COX-2 inhibitor. In other words, it is likely safer than the usual NSAID, but not as safe as Celebrex, but it has a generic version (= Meloxicam) which is certainly cheaper than Celebrex.
Some people get relief with a topical NSAID such as Voltaren gel. Since it does not get into the stomach, it should be better tolerated, but it still can cause trouble, especially if you take the maximum doses which will still potentially decrease that protective lining of the stomach. It works best for joints that are close to the skin, such as fingers, elbows, ankles, & knees. The shoulder & hip joints are further from the skin, so the topical treatment does not penetrate them as well. Voltaren gel is also pretty expensive, but it will soon lose it's patent... so watch for the generic soon.
As a last thought, there is an odd drug called Cytotec which can be added to your NSAID. Cytotec coats the stomach & thus protects it. Though this sounds like a great idea, it comes with wierd side-effects, such as diarrhea & malabsorption of your other meds. It basically binds to your stomach as well as to anything in there, so you must take all other pills several hours before or after you take Cytotec. Cytotec is combined with the NSAID Voltaren & called Arthrotec, which is a great product to treat arthritis yet protect the belly. Arthrotec is very expensive however, so you might ask your doctor to give you the Cytotec generic (= Misoprostol) separate from the NSAID as that is almost certainly a lot cheaper than the one combo product... as is usually the case!
Okay, one more option of which I have just become aware! Apparently Cymbalta (= Duloxetine) which is an anti-depressant in the SNRI class has received approval as treatment for arthritis pain. As it is an anti-depressant, it does not have the typical GI (gastrointestinal) side-effects caused by the NSAID's. It is also used to treat fibromyalgia pain & even neuropathic (= nerve) pain, so it tackles many types of pain. Because of this, Cymbalta might help people who have multiple types of pain as well as those who have concommitant depression. After all, chronic pain often causes depression, & often depression causes pain to hurt more... so one medication which treats both is fabulous!
Hospitalization & List of Home Meds:
When you get admitted to the hospital, the nurses insist upon getting a very detailed list of all of your home medications, including herbs & supplements as well. They must know the dose of the products, as well as how often you take them. Why do they care so much?
Well, there has been much talk about the medication errors that occur in the hospital, so in response to this, the government has charged the hospital (& thus the nurse) with getting the patient's home medication list so the physician can then simply decide which of those meds is to be continued during the hospital stay. First, I would like to say that this has lead to more medication errors than you can imagine! The nurses are not allowed to admit the patient or render care until the list is created, yet they often do not contact me to assist with its creation! So, this is compiled from the patient's best recall or most recent list, which is often not correct. I thus advise that you carry a very up-to-date list, & if you are not sure, insist that the nurse contact your doctor or family member... don't guess!
Also, once this list is created, it is presented to the physician for him to approve the meds that he wants you to take during your hospitalization, & to discontinue those that he feels are unnecessary. This process also lends itself to problems. Often doctors simply continue every medicine or supplement unless there is a specific reason to stop it. In the old days, we did the opposite... we only ordered the medicines you absolutely needed! So you now get many meds during your hospital stay, whereas in the past you only got the few you desperately needed. Many of your home meds are not stocked by the hospital pharmacy & are thus substituted automatically with a similar but not identical product. This can cause side-effects which can complicate your care & are difficult to identify. Think about what you do instinctively when you are ill... you usually take only the medications that you think are absolutely necessary. Though you sometimes don't make the proper choices, you at least try!
So when you go to the hospital, bring your medicines in the bottles, so the nurse can check them, & also note any changes that are not listed on the bottles! Also, when your physician sees you in the hospital, be sure to ask him to give you only the most necessary of these meds, so your body & belly will not be taxed trying to deal with unneeded meds or herbs!
That concludes this blog, but please don't forget to check out the radio show... on Fridays at 1:00-1:45 PM Eastern time. Listen locally to WTAN 1340-AM, or try the computer where you can listen live or to the podcast... www.SkipShow.com. As always, feel free to ask questions or make comments via phone: (727)-441-3000 or toll-free (866)-TAN-1340, or via e-mail: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Medical Research; FDA Approves "Amyvid" to Help Diagnose Alzheimer's Disease.
This blog reviews the data discussed on the April 13, 2012 Let's Talk Medical with Doctor Gigi. You can check out the podcast via www.SkipShow.com if you prefer the spoken word.
Medical Research:
Skip noted that he had heard advertisements for healthy subjects to do cancer-related research, & wondered how in depth the research could be if they simply wanted "healthy" subjects. In all fairness, some research is done simply to look for trends or even for genetic markers, so they do need large groups of people to participate, & generally all they need is a blood sample &/or a questionnaire completed. Others trials involve medications or equipment, thus they are more stringent. All participation in trials is considered voluntary, as no one can make you participate in medical research!
Regardless of the study, all clinical trials are over-seen by the FDA, which is of course a part of our government. They don't care what is done to a patient or person during a trial, but they do care that the patient's rights & welfare are protected. To that end, they care mostly about the "Informed Consent." This is the paper which tells you who sponsors the study, who the doctors are & how to contact them in case of an emergency, what the drug(s) is that is under study, what the known side-effects of that drug are, what is required in the way of appointments & data collection, as well as blood collections & procedures that are to be done. After reading this informed consent, the FDA considers you to be educated or informed, & after you sign it, they consider that you have given consent to proceed in the trial. Thus the paper is called an "informed consent." As stated before, the FDA doesn't care so much about the specifics of a study (or what we do to you), but they do want to be sure you knew what we planned to do to you & that with knowledge you agree to continue. Of course, you can always leave a study at any time by "withdrawing consent," which means you no longer wish to be in the study. The doctor tries hard to select people who will complete the trial, as usually data is not useful unless the patient completes the study. Those who do not complete are a financial loss to the pharmaceutical company, but of course everybody has the right to leave a study at any time... and of course, as a physician, my job is to take care of the patient first, & the study second. This means that my primary responsibility is to the patient's health, not to the pharmaceutical company!
To get into any trial, the patient must have all the inclusion criteria & none of the exclusion criteria. These are a variety of factors which vary from study to study & which help identify appropriate people for the trial. All information given to the study staff is evaluated to see if you can be included or need to be excluded. These criteria are written in stone, & the study staff & doctor cannot make exceptions. In fact we get in big trouble if we mess up on inclusion & exclusion criteria, so please be honest with all of your answers to our questions, especially as these criteria help protect you by keeping you out of studies which might be bad for your health!
Lastly, remember that if you decide to participate in a clinical trial, do your best to do everything exactly as they ask you to. The FDA expects perfection, both from the patient & from the study staff. To do less than that is to potentially get a bad drug to the market, or perhaps keep a good drug off the market!
FDA Approves "Amyvid" to Help Diagnose Alzheimer's Disease:
Speaking of clinical trials, as many of you know, I do clinical trials part-time. I am proud to see that one of our clinical trials seems to have helped get a new PET scan dye to the market! The FDA just approved Amyvid which is a product we studied at Meridien Research in St. Petersburg.
First, to understand the excitement surrounding this product you must first understand that Alzheimer's disease is not only very common, but it is a "diagnosis of exclusion." This means that we cannot verify the diagnosis with a test, so instead we seek to exclude other diseases, & if none of them are present we presume that the patient has Alzheimer's. Truly, the only way to confirm the diagnosis of Alzheimer's is to do an autopsy... not a very good option to say the least as it is then too late to treat the patient! At autopsy they should find beta-amyloid which produces hard plaques which degrade the nerve cells (=neurons) of the brain. This beta-amyloid is not found exclusively in Alzheimer's patient's brains, but it is considered a hallmark finding of the disease.
Amyvid is a dye which lights up beta-amyloid when given in conjunction with a PET scan. Thus a PET scan with Amyvid can potentially differentiate Alzheimer's disease from other forms of dementia by identifying the hallmark abnormality noted in that disease. Thus if the test shows beta-amyloid, the diagnosis of Alzheimer's is likely, whereas an absence of beta-amyloid would require further evaluation for other diseases.
As a side note, remember that if a person cannot hear or see properly this can make him appear demented or confused. So be sure to check your loved ones' hearing & vision if you feel he is getting confused or forgetful!
Thanks again for your interest in what I have to say, & if you find it helpful, please share with your friends & family. Also, consider being a "follower" so you will get further blogs when completed! And don't forget the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the St. Petersburg/Tampa area. If you can't catch the station, find us on the web via www.SkipShow.com where you can listen live, or check out the podcasts at any time! We also need your questions & input, so get in touch with me: DoctorGigi@SkipShow.com. If you feel the desire to talk to me live, call during the show: (727)-441-3000 or toll-free at (866)-TAN-1340.
Have a great week, & here's to our health!
Doctor Gigi
Medical Research:
Skip noted that he had heard advertisements for healthy subjects to do cancer-related research, & wondered how in depth the research could be if they simply wanted "healthy" subjects. In all fairness, some research is done simply to look for trends or even for genetic markers, so they do need large groups of people to participate, & generally all they need is a blood sample &/or a questionnaire completed. Others trials involve medications or equipment, thus they are more stringent. All participation in trials is considered voluntary, as no one can make you participate in medical research!
Regardless of the study, all clinical trials are over-seen by the FDA, which is of course a part of our government. They don't care what is done to a patient or person during a trial, but they do care that the patient's rights & welfare are protected. To that end, they care mostly about the "Informed Consent." This is the paper which tells you who sponsors the study, who the doctors are & how to contact them in case of an emergency, what the drug(s) is that is under study, what the known side-effects of that drug are, what is required in the way of appointments & data collection, as well as blood collections & procedures that are to be done. After reading this informed consent, the FDA considers you to be educated or informed, & after you sign it, they consider that you have given consent to proceed in the trial. Thus the paper is called an "informed consent." As stated before, the FDA doesn't care so much about the specifics of a study (or what we do to you), but they do want to be sure you knew what we planned to do to you & that with knowledge you agree to continue. Of course, you can always leave a study at any time by "withdrawing consent," which means you no longer wish to be in the study. The doctor tries hard to select people who will complete the trial, as usually data is not useful unless the patient completes the study. Those who do not complete are a financial loss to the pharmaceutical company, but of course everybody has the right to leave a study at any time... and of course, as a physician, my job is to take care of the patient first, & the study second. This means that my primary responsibility is to the patient's health, not to the pharmaceutical company!
To get into any trial, the patient must have all the inclusion criteria & none of the exclusion criteria. These are a variety of factors which vary from study to study & which help identify appropriate people for the trial. All information given to the study staff is evaluated to see if you can be included or need to be excluded. These criteria are written in stone, & the study staff & doctor cannot make exceptions. In fact we get in big trouble if we mess up on inclusion & exclusion criteria, so please be honest with all of your answers to our questions, especially as these criteria help protect you by keeping you out of studies which might be bad for your health!
Lastly, remember that if you decide to participate in a clinical trial, do your best to do everything exactly as they ask you to. The FDA expects perfection, both from the patient & from the study staff. To do less than that is to potentially get a bad drug to the market, or perhaps keep a good drug off the market!
FDA Approves "Amyvid" to Help Diagnose Alzheimer's Disease:
Speaking of clinical trials, as many of you know, I do clinical trials part-time. I am proud to see that one of our clinical trials seems to have helped get a new PET scan dye to the market! The FDA just approved Amyvid which is a product we studied at Meridien Research in St. Petersburg.
First, to understand the excitement surrounding this product you must first understand that Alzheimer's disease is not only very common, but it is a "diagnosis of exclusion." This means that we cannot verify the diagnosis with a test, so instead we seek to exclude other diseases, & if none of them are present we presume that the patient has Alzheimer's. Truly, the only way to confirm the diagnosis of Alzheimer's is to do an autopsy... not a very good option to say the least as it is then too late to treat the patient! At autopsy they should find beta-amyloid which produces hard plaques which degrade the nerve cells (=neurons) of the brain. This beta-amyloid is not found exclusively in Alzheimer's patient's brains, but it is considered a hallmark finding of the disease.
Amyvid is a dye which lights up beta-amyloid when given in conjunction with a PET scan. Thus a PET scan with Amyvid can potentially differentiate Alzheimer's disease from other forms of dementia by identifying the hallmark abnormality noted in that disease. Thus if the test shows beta-amyloid, the diagnosis of Alzheimer's is likely, whereas an absence of beta-amyloid would require further evaluation for other diseases.
As a side note, remember that if a person cannot hear or see properly this can make him appear demented or confused. So be sure to check your loved ones' hearing & vision if you feel he is getting confused or forgetful!
Thanks again for your interest in what I have to say, & if you find it helpful, please share with your friends & family. Also, consider being a "follower" so you will get further blogs when completed! And don't forget the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the St. Petersburg/Tampa area. If you can't catch the station, find us on the web via www.SkipShow.com where you can listen live, or check out the podcasts at any time! We also need your questions & input, so get in touch with me: DoctorGigi@SkipShow.com. If you feel the desire to talk to me live, call during the show: (727)-441-3000 or toll-free at (866)-TAN-1340.
Have a great week, & here's to our health!
Doctor Gigi
Thursday, April 12, 2012
Doctors Unappreciated; World Health Day; Dangerous Meds; Bone Marrow Donation; Pink Eye; Tick-borne Illnesses; Amberen & Weight Loss
Finally have the computer stuff corrected, so here is the summary of the April 6, 2012 show:
Doctors Unappreciated:
We previously discussed that March 30th is Doctors Day... a day on which we celebrate physicians. Yet, in a recent survey 71% of doctors polled indicated they feel unappreciated. 14% feel appreciated, & 14% are not sure. I think this reflects the frustration that doctors AND patients feel in the present medical system. Doctors have lost control of their profession, & thus have lost their autonomy. We are taught to be independent yet cooperative, but most of us were not taught to be employees. We are used to being "the boss," yet many of us have sold our practices & are employees of hospitals or other large businesses. Our decisions are constantly questioned by non-medical people who read protocols & expect us to care for patients as though they are all the same! We no longer control our schedules, & many physicians have such heavy schedules that they must feel like they are on a production line. Doctors hate this system as much as patients do, but we seem somewhat helpless to change it. So, at least be a good patient by preparing for your visit so you can make the most of your short face-to-face time with your doctor. Prepare a list of your concerns, bring your meds or a list (be sure to include the name, dose, & how you take it), know your pharmacy phone number, & try to be concise. These efforts will help both you & your physician be more satisfied with your interaction. And don't forget to thank your doctor, as he likely does more for you behind the scenes than you realize!
World Health Day:
The World Health Organization was founded on April 7, 1948, & they celebrate their anniversary with World Health Day every April 7th. Each year there is a theme, & the theme for 2012 is "Ageing & Health." Their focus this year is on how humans can stay well as we age. As the world population ages, health issues become more important, so the WHO wants to help us stay well as we age so we can have a better quality of life & consume healthcare in a cost-effective manner.
Surprisingly Dangerous Medicines:
I recently read an article about the dangers associated with some very common medications. The list included:
1) Mineral oil - which when taken in liquid form can run down the back of your throat into your lungs, resulting in "oil pneumonitis" - so if you take any liquid oil product orally, be sure to mix it well with solid food which will absorb it so it can be fully swallowed & not remain in the throat (like grease on a dirty glass) where it can run by gravity into the lungs.
2) Rolaids/Tums - which are used for heartburn, but which contain calcium which can cause you to develop kidney stones.
3) Diuretics - which cause the body to eliminate fluid, but in so doing can dehydrate you &/or cause high potassium (Aldactone does this) or low potassium (Lasix does this).
4) Metformin - which is used very often to treat diabetes, but which can cause liver problems, &
5) Selective serotonin reuptake inhibitor (SSRI) anti-depressants - which cause an increase in serotonin which generally helps with depression. However they should not be taken with other products that increase serotonin, as this excess serotonin can be toxic, causing "serotonin syndrome" which is manifested as muscle twitches, sweating, poor coordination, agitation, diarrhea, & occassionally death. So if you take an SSRI such as Prozac, Zoloft, Paxil, Celexa, or Lexapro, you should avoid St. John's wort (an herbal product) & Dextromethorphan (an OTC cough suppressant).
I feel that the biggest point this makes is that everything has potential side-effects. So the decision to use a medication must be based upon the risk vs. benefit ratio. In other words, do the benefits outweigh the risks? The answer will vary person to person & situation to situation, so be sure to discuss your situation with your physician. Also, realize that when your doctor asks for follow-up visits or bloodwork, he is likely monitoring for these potential side-effects.
Bone Marrow & Stem Cell Donation:
So I had to do some research for this as I have never given my bone marrow nor have any of my patients... to my knowledge. I do know the importance of donors however, as without an appropriate donor, a person in need will die. Unfortunately this was the case for the niece of my long-term employee many years ago. She was in desperate need of a bone marrow donor, but a good match could not be found. As her illness worsened, the physicians decided to try the transplant with the best match they could find... though they realized it would not likely have a good outcome. Sadly, this beautiful 12 year old little girl died shortly after her body rejected the transplant.
So many years later, I am still trying to learn more about bone marrow donation, & the question we had regarding the same has prodded me to do the research for both you & myself. First, I would recommend that you go to the website www.GiftOfLife.org as they have most everything you need in the way of education. They indicated that you need to give a swab of your cheek to begin the process, & this can be done by requesting a kit from them or by going to a community drive. I always thought that you could do it through the local Blood Bank, but I did not see that in the website, so perhaps you can call the blood bank to ask. There is a fee of $54 to process your sample & place you in the registry (which is a worldwide registry), but if you are chosen to donate, all further costs are picked up by them & you subsequently have no other fees to pay. You must be between the ages of 18-60, & should be in general good health. Once your sample is in the registry, they will constantly check for matches, so you might match in a few days, or a few years, or perhaps never. They will call you if you look like a good match, & at that point you will need to give a blood sample. If the tests on that blood are good, you will then have an exam, & if that goes well, they will set you up for the true donation. Apparently most people donate stem cells, though a few give bone marrow. The difference is that the bone marrow donor just has a needle stuck into a bone & the bone marrow is aspirated (=sucked out). Of course this is a simple procedure which is done with local anesthesia. To donate stem cells is a bit more complicated. It appears that you are given medicine which causes stem cells to leave the bone marrow & enter your blood circulation, where those stem cells are harvested in a process similar to donating plasma. Though it is more complicated, it does not require anesthesia.
Though you are not obligated to donate when you are contacted, of course it would be hard to say no... especially as you will only get the call when you have already been identified as a potential to save someone's life! Remember also that although you might offer to be the donor today, someday you or someone you love might be the recipient, so register today!
Pink Eye = Conjunctivitis:
Pink eye is the common term for conjunctivitis, which is an inflamation of the conjunctiva of the eye. It is generally manifested by redness of the eye associated with discomfort or itching, & crusting or discharge from the eye, & sensitivity to light. The common causes are: allergy, infection, & irritation.
Generally if it is an allergy, it should be bilateral (both eyes), & likely associated with runny or itchy eyes & nose. It also is likely going to occur at the same time each year, as likely pollen might be the cause. There are allergy eye drops available, such as Optivar & Alocril, though they do require a prescription.
Infection can be viral or bacterial. Viral infections are more common & often occur when you have an upper respiratory infection or "cold." These infections are very virulent & spread easily, thus we ask that you do not rub your affected eye as you can easily spread it to your other eye. Also, you often are not allowed to work or attend school until the redness resolves, as otherwise many people might get this infection from you. Fortunately viral conjunctivitis resolves spontaneously, but often the doctor cannot be certain that it is not a bacterial infection unless he does a culture of the eye, as viruses don't grow on a routine culture, but bacteria do. So in theory, a culture is helpful, but it is often not done with the first episode of conjunctivitis.
Many physicians will even treat with an antibiotic (for a bacterial infection) without a culture, as it seems harmless enough to do so... & cost-effective. But, remember that conjunctivitis can be caused by irritants. Occassionally eye medicines, including antibiotics, are irritating to the eyes... thus they worsen the inflamation & thus worsen the conjunctivitis! Also, smoke & chlorine act as irritants & can cause symptoms of conjunctivitis. Treatment for irritant pink eye is to eliminate the irritant, rather than using medicine, although sometimes steroid drops or anti-inflamatory drops are used to speed improvement.
So if you have pink eye, it is likely going to get better without treatment, but you can certainly see your doctor for an evaluation which can help determine the cause, which will then dictate the treatment. Also, if you are an adult with a painful red eye, you MUST see an Ophthalmologist to be certain you do not have glaucoma (which can lead to blindness if untreated). Also, any change in your vision MUST be evaluated by an Ophthalmologist as well!
Tick-borne Illness:
Tick-borne illnesses are those illnesses carried by ticks. They include many diseases such as: Lyme disease, Rocky-Mountain Spotted Fever, Tularemia, & Colorado Tick Fever. Specific ticks carry certain diseases, & they tend to live in certain regions. Therefore, Lyme disease which is carried by the deer tick, is more prevalent in the Northeastern United States as that is where the deer tick thrives. By the same token, Rocky-Mountain Spotted Fever & Colorado Tick Fever are carried by ticks that thrive in the Colorado mountains. It is important to know that though this is generally the truth, occassionally ticks get transported to new areas, & we do sometimes see outbreaks in abnormal areas. There have been rare cases of Lyme disease in Florida, but it is certainly not common. The deer tick is very tiny... about the size of the dot on an "i"... so the tick is usually not seen. Instead, the bite results in a classic rash which looks like a bull's eye, with circles of red, then white, then red, then white. If you have this classic rash, you should get a blood test to confirm the Lyme infection, & if this is positive, you will be treated with an antibiotic. Local physicians usually know the illnesses which are likely to occur in their hometowns, so a local physician should be consulted if you have a tick bite or odd rash.
But remember that the best thing you can do to prevent tick-borne illnesses is to prevent getting bitten by the ticks! This means that you should wear long sleeves & long pants, & you should tuck your shirt in your pants, & your pants in your socks. Then spray yourself well with a repellant containing DEET.
As one last helpful hint, if you find a tick embedded in your skin, don't pull if off, as often the head will stay embedded & can lead to infection. Instead, grasp the tick with a pair of tweezers & gently unscrew it by twisting the whole tick counter-clockwise. Since the tick has embedded his head by literally screwing it into your skin, this method will unscrew it, thus removing the head cleanly!
Amberen & Weight Loss:
There was a listener who reportedly heard a commercial for Amberen, an herbal supplement generally used for menopausal symptoms, in which they claimed that Amberen will balance your hormones & thus lead to impressive weight loss. First, I will say that menopause does cause a hormonal imbalance, but this does not necessarily cause weight gain, so correcting the imbalance does not necessarily lead to weight loss... so the premise is incorrect from the start. Also, just because they say this in a commercial does not mean it is true.
We addressed a similar issue in October of 2011, when we spoke about the DSHEA Act of 1994. This is the Dietary Supplement Health & Education Act which dictates oversight of dietary supplements. It was passed after much debate, but it basically classifies dietary supplements as FOOD products, thus though they are regulated by the Food & Drug Administration (FDA), they are treated as FOOD rather than as drugs. This allows them to be manufactured with lax regulation & thus contamination is frequent, & bio-availability is variable. I recommend that you only purchase supplements which have the USP (United States Pharmacopeia) seal on the label, as this shows that the supplement has been voluntarily tested for integrity, purity, dissolution, & safe manufacturing.
The DSHEA Act does dictate that the product cannot make false claims on the label, though apparently the companies get around this by putting their claims in audible commercials. So although you might hear wild claims about these products & how they might cure this or that, you will not likely find the false claims in writing, especially on the label. If indeed a supplement was to label itself as a "treatment" for a disease, the FDA would consider this a DRUG, & they would then have to do clinical trials to prove safety & efficacy.
So read THE LABEL of your supplements carefully, & if the label does not reflect what the commercial claimed, then don't believe the commercial! Also, be skeptical & read between the lines. I'm not certain, but a brief look at Amberen's website showed it's claims that it helps balance hormones & thus helps improve menopausal symptoms. There was information about how hormone imbalance (& thus menopause) can cause weight gain, then there was information about how Amberen fixes that imbalance, but they leave it to YOU to make the supposition that Amberen therefore causes weight loss. In other words, I never found a sentence that specifically says that Amberen CAUSES weight loss... it just says hormone imbalance causes weight gain, & that Amberen helps with the imbalance. They let you conclude that Amberen therefore causes weight loss. Very clever, but misleading advertisement, so be careful!!!
In closing, don't forget the radio show... Let's Talk Medical with Doctor Gigi, as that is the foundation for this blog. We are live on Fridays at 1:00-1:45 PM Eastern time, & can be heard on WTAN 1340-AM or on www.SkipShow.com. The podcasts are listed on the website, & go back as far as Sept. 2011... just look for a Friday podcast. If you or your friends have medical concerns, please feel free to call or e-mail me: (727)-441-3000 or (866)-TAN-1340 which is toll-free or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Doctors Unappreciated:
We previously discussed that March 30th is Doctors Day... a day on which we celebrate physicians. Yet, in a recent survey 71% of doctors polled indicated they feel unappreciated. 14% feel appreciated, & 14% are not sure. I think this reflects the frustration that doctors AND patients feel in the present medical system. Doctors have lost control of their profession, & thus have lost their autonomy. We are taught to be independent yet cooperative, but most of us were not taught to be employees. We are used to being "the boss," yet many of us have sold our practices & are employees of hospitals or other large businesses. Our decisions are constantly questioned by non-medical people who read protocols & expect us to care for patients as though they are all the same! We no longer control our schedules, & many physicians have such heavy schedules that they must feel like they are on a production line. Doctors hate this system as much as patients do, but we seem somewhat helpless to change it. So, at least be a good patient by preparing for your visit so you can make the most of your short face-to-face time with your doctor. Prepare a list of your concerns, bring your meds or a list (be sure to include the name, dose, & how you take it), know your pharmacy phone number, & try to be concise. These efforts will help both you & your physician be more satisfied with your interaction. And don't forget to thank your doctor, as he likely does more for you behind the scenes than you realize!
World Health Day:
The World Health Organization was founded on April 7, 1948, & they celebrate their anniversary with World Health Day every April 7th. Each year there is a theme, & the theme for 2012 is "Ageing & Health." Their focus this year is on how humans can stay well as we age. As the world population ages, health issues become more important, so the WHO wants to help us stay well as we age so we can have a better quality of life & consume healthcare in a cost-effective manner.
Surprisingly Dangerous Medicines:
I recently read an article about the dangers associated with some very common medications. The list included:
1) Mineral oil - which when taken in liquid form can run down the back of your throat into your lungs, resulting in "oil pneumonitis" - so if you take any liquid oil product orally, be sure to mix it well with solid food which will absorb it so it can be fully swallowed & not remain in the throat (like grease on a dirty glass) where it can run by gravity into the lungs.
2) Rolaids/Tums - which are used for heartburn, but which contain calcium which can cause you to develop kidney stones.
3) Diuretics - which cause the body to eliminate fluid, but in so doing can dehydrate you &/or cause high potassium (Aldactone does this) or low potassium (Lasix does this).
4) Metformin - which is used very often to treat diabetes, but which can cause liver problems, &
5) Selective serotonin reuptake inhibitor (SSRI) anti-depressants - which cause an increase in serotonin which generally helps with depression. However they should not be taken with other products that increase serotonin, as this excess serotonin can be toxic, causing "serotonin syndrome" which is manifested as muscle twitches, sweating, poor coordination, agitation, diarrhea, & occassionally death. So if you take an SSRI such as Prozac, Zoloft, Paxil, Celexa, or Lexapro, you should avoid St. John's wort (an herbal product) & Dextromethorphan (an OTC cough suppressant).
I feel that the biggest point this makes is that everything has potential side-effects. So the decision to use a medication must be based upon the risk vs. benefit ratio. In other words, do the benefits outweigh the risks? The answer will vary person to person & situation to situation, so be sure to discuss your situation with your physician. Also, realize that when your doctor asks for follow-up visits or bloodwork, he is likely monitoring for these potential side-effects.
Bone Marrow & Stem Cell Donation:
So I had to do some research for this as I have never given my bone marrow nor have any of my patients... to my knowledge. I do know the importance of donors however, as without an appropriate donor, a person in need will die. Unfortunately this was the case for the niece of my long-term employee many years ago. She was in desperate need of a bone marrow donor, but a good match could not be found. As her illness worsened, the physicians decided to try the transplant with the best match they could find... though they realized it would not likely have a good outcome. Sadly, this beautiful 12 year old little girl died shortly after her body rejected the transplant.
So many years later, I am still trying to learn more about bone marrow donation, & the question we had regarding the same has prodded me to do the research for both you & myself. First, I would recommend that you go to the website www.GiftOfLife.org as they have most everything you need in the way of education. They indicated that you need to give a swab of your cheek to begin the process, & this can be done by requesting a kit from them or by going to a community drive. I always thought that you could do it through the local Blood Bank, but I did not see that in the website, so perhaps you can call the blood bank to ask. There is a fee of $54 to process your sample & place you in the registry (which is a worldwide registry), but if you are chosen to donate, all further costs are picked up by them & you subsequently have no other fees to pay. You must be between the ages of 18-60, & should be in general good health. Once your sample is in the registry, they will constantly check for matches, so you might match in a few days, or a few years, or perhaps never. They will call you if you look like a good match, & at that point you will need to give a blood sample. If the tests on that blood are good, you will then have an exam, & if that goes well, they will set you up for the true donation. Apparently most people donate stem cells, though a few give bone marrow. The difference is that the bone marrow donor just has a needle stuck into a bone & the bone marrow is aspirated (=sucked out). Of course this is a simple procedure which is done with local anesthesia. To donate stem cells is a bit more complicated. It appears that you are given medicine which causes stem cells to leave the bone marrow & enter your blood circulation, where those stem cells are harvested in a process similar to donating plasma. Though it is more complicated, it does not require anesthesia.
Though you are not obligated to donate when you are contacted, of course it would be hard to say no... especially as you will only get the call when you have already been identified as a potential to save someone's life! Remember also that although you might offer to be the donor today, someday you or someone you love might be the recipient, so register today!
Pink Eye = Conjunctivitis:
Pink eye is the common term for conjunctivitis, which is an inflamation of the conjunctiva of the eye. It is generally manifested by redness of the eye associated with discomfort or itching, & crusting or discharge from the eye, & sensitivity to light. The common causes are: allergy, infection, & irritation.
Generally if it is an allergy, it should be bilateral (both eyes), & likely associated with runny or itchy eyes & nose. It also is likely going to occur at the same time each year, as likely pollen might be the cause. There are allergy eye drops available, such as Optivar & Alocril, though they do require a prescription.
Infection can be viral or bacterial. Viral infections are more common & often occur when you have an upper respiratory infection or "cold." These infections are very virulent & spread easily, thus we ask that you do not rub your affected eye as you can easily spread it to your other eye. Also, you often are not allowed to work or attend school until the redness resolves, as otherwise many people might get this infection from you. Fortunately viral conjunctivitis resolves spontaneously, but often the doctor cannot be certain that it is not a bacterial infection unless he does a culture of the eye, as viruses don't grow on a routine culture, but bacteria do. So in theory, a culture is helpful, but it is often not done with the first episode of conjunctivitis.
Many physicians will even treat with an antibiotic (for a bacterial infection) without a culture, as it seems harmless enough to do so... & cost-effective. But, remember that conjunctivitis can be caused by irritants. Occassionally eye medicines, including antibiotics, are irritating to the eyes... thus they worsen the inflamation & thus worsen the conjunctivitis! Also, smoke & chlorine act as irritants & can cause symptoms of conjunctivitis. Treatment for irritant pink eye is to eliminate the irritant, rather than using medicine, although sometimes steroid drops or anti-inflamatory drops are used to speed improvement.
So if you have pink eye, it is likely going to get better without treatment, but you can certainly see your doctor for an evaluation which can help determine the cause, which will then dictate the treatment. Also, if you are an adult with a painful red eye, you MUST see an Ophthalmologist to be certain you do not have glaucoma (which can lead to blindness if untreated). Also, any change in your vision MUST be evaluated by an Ophthalmologist as well!
Tick-borne Illness:
Tick-borne illnesses are those illnesses carried by ticks. They include many diseases such as: Lyme disease, Rocky-Mountain Spotted Fever, Tularemia, & Colorado Tick Fever. Specific ticks carry certain diseases, & they tend to live in certain regions. Therefore, Lyme disease which is carried by the deer tick, is more prevalent in the Northeastern United States as that is where the deer tick thrives. By the same token, Rocky-Mountain Spotted Fever & Colorado Tick Fever are carried by ticks that thrive in the Colorado mountains. It is important to know that though this is generally the truth, occassionally ticks get transported to new areas, & we do sometimes see outbreaks in abnormal areas. There have been rare cases of Lyme disease in Florida, but it is certainly not common. The deer tick is very tiny... about the size of the dot on an "i"... so the tick is usually not seen. Instead, the bite results in a classic rash which looks like a bull's eye, with circles of red, then white, then red, then white. If you have this classic rash, you should get a blood test to confirm the Lyme infection, & if this is positive, you will be treated with an antibiotic. Local physicians usually know the illnesses which are likely to occur in their hometowns, so a local physician should be consulted if you have a tick bite or odd rash.
But remember that the best thing you can do to prevent tick-borne illnesses is to prevent getting bitten by the ticks! This means that you should wear long sleeves & long pants, & you should tuck your shirt in your pants, & your pants in your socks. Then spray yourself well with a repellant containing DEET.
As one last helpful hint, if you find a tick embedded in your skin, don't pull if off, as often the head will stay embedded & can lead to infection. Instead, grasp the tick with a pair of tweezers & gently unscrew it by twisting the whole tick counter-clockwise. Since the tick has embedded his head by literally screwing it into your skin, this method will unscrew it, thus removing the head cleanly!
Amberen & Weight Loss:
There was a listener who reportedly heard a commercial for Amberen, an herbal supplement generally used for menopausal symptoms, in which they claimed that Amberen will balance your hormones & thus lead to impressive weight loss. First, I will say that menopause does cause a hormonal imbalance, but this does not necessarily cause weight gain, so correcting the imbalance does not necessarily lead to weight loss... so the premise is incorrect from the start. Also, just because they say this in a commercial does not mean it is true.
We addressed a similar issue in October of 2011, when we spoke about the DSHEA Act of 1994. This is the Dietary Supplement Health & Education Act which dictates oversight of dietary supplements. It was passed after much debate, but it basically classifies dietary supplements as FOOD products, thus though they are regulated by the Food & Drug Administration (FDA), they are treated as FOOD rather than as drugs. This allows them to be manufactured with lax regulation & thus contamination is frequent, & bio-availability is variable. I recommend that you only purchase supplements which have the USP (United States Pharmacopeia) seal on the label, as this shows that the supplement has been voluntarily tested for integrity, purity, dissolution, & safe manufacturing.
The DSHEA Act does dictate that the product cannot make false claims on the label, though apparently the companies get around this by putting their claims in audible commercials. So although you might hear wild claims about these products & how they might cure this or that, you will not likely find the false claims in writing, especially on the label. If indeed a supplement was to label itself as a "treatment" for a disease, the FDA would consider this a DRUG, & they would then have to do clinical trials to prove safety & efficacy.
So read THE LABEL of your supplements carefully, & if the label does not reflect what the commercial claimed, then don't believe the commercial! Also, be skeptical & read between the lines. I'm not certain, but a brief look at Amberen's website showed it's claims that it helps balance hormones & thus helps improve menopausal symptoms. There was information about how hormone imbalance (& thus menopause) can cause weight gain, then there was information about how Amberen fixes that imbalance, but they leave it to YOU to make the supposition that Amberen therefore causes weight loss. In other words, I never found a sentence that specifically says that Amberen CAUSES weight loss... it just says hormone imbalance causes weight gain, & that Amberen helps with the imbalance. They let you conclude that Amberen therefore causes weight loss. Very clever, but misleading advertisement, so be careful!!!
In closing, don't forget the radio show... Let's Talk Medical with Doctor Gigi, as that is the foundation for this blog. We are live on Fridays at 1:00-1:45 PM Eastern time, & can be heard on WTAN 1340-AM or on www.SkipShow.com. The podcasts are listed on the website, & go back as far as Sept. 2011... just look for a Friday podcast. If you or your friends have medical concerns, please feel free to call or e-mail me: (727)-441-3000 or (866)-TAN-1340 which is toll-free or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Sunday, April 1, 2012
National Doctors' Day 3/30; Match Day 3/15; Replacing Body Parts; The Importance of Skin; Testosterone Production in Women; Shot for Treatment of Cholesterol; Plastic Surgery & Grandma.
The following reflects subjects discussed live on Let's Talk Medical with Doctor Gigi on Friday March 30, 2012. Please feel free to listen to the podcast version via www.SkipShow.com.
National Doctors' Day - March 30:
March 30 is National Doctors' Day. It is the day that we as a nation thank physicians for the work they do. It began as a celebration in Georgia in 1933, & Congress recognized it as a national event in 1991. The reason it is celebrated on March 30 is because ether was first used as anesthesia on March 30, 1842. If you think about it, many of the wonderful things we do in modern medicine would be all but impossible without anesthesia. Just imagine having any surgical procedure without anesthesia! I guess we should honor this event, & certainly we need to remember that physicians are on the front line of public health. In the "old days" they provided care to people with TB & other infectious diseases, not always knowing if their health was at risk, as they often did not know the mode of transmission of these diseases. So was the case in the 1980's when we provided care on the front lines for people with HIV... before we fully understood this virus & how it is transmitted. I was a resident during this frightening time, & I do remember the hype, but I never remember withholding care due to fear for my own health! We are professionals who respond to the needs of our patients 24 hours a day, 7 days a week... often ignoring our own needs & those of our families. So on March 30, we as a nation thank the men & women who provide our medical care... & don't forget to thank the families who support them so they can care for you!
Match Day - March 15:
Students who graduate from medical school are called "Doctor"... but that is usually not the end of their studies. Most physicians go from medical school to a residency program where they study for 3-5 years more, after which they are considered a "Specialist" in whatever residency program they completed. I am a specialist in Family Practice (or Family Medicine), & I trained for 3 years post medical school to achieve this credential. So most of us know that there are residency programs for all specialties in the field of medicine, such as: Family Medicine, Internal Medicine, Pediatrics, Ob-Gyn, Surgery, Ophthalmology, Dermatology, Hematology-Oncology, & Orthopedics. What you might not know is that your doctor might not have become the specialist he really wanted to become. That is because there are a limited number of spots in each specialty each year, & each new doctor has to "match" his wishes with the choices of the residency programs. This is done through a program called "the Match," which is formally done every year on March 15th. Senior students in medical school take elective studies & interview at programs where they hope to obtain residency training. They then make a list of the programs they hope to attend, starting with their number 1 choice. The residency directors create a similar list, indicating the students they would like to train, starting with their number 1 choice. A computer program takes these two lists & creates a "match" between them. My list was short: 1) Family Practice at Bayfront Hospital in St. Petersburg, FL, 2) Family Practice at Earl K. Long Hospital in Baton Rouge, LA, 3) Medicine-Pediatrics at Earl K. Long Hospital in Baton Rouge, LA. I don't know where I ranked on the list for Bayfront Family Practice, but I "matched" to that program... & thus I studied there for 3 years & became a Family Practitioner. If a medical student does not "match," he then gets to participate in the "Scramble," which involves getting on the phone to call residency programs with openings to see if you can quickly lock in a position. Those who participate in the Scramble often get an acceptable residency program, but some have to settle for a program or even a specialty that was not truly on their priority list. Thus a person can go to medical school & graduate after 4 years, but still not have the opportunity to become the specific type of doctor he wants to become! The most difficult program to get into when I was a student was Ophthalmology. Dermatology was also very competitive. So only the students in the top 10-15% of the class could become Ophthalmologists or Dermatologists. These programs are highly sought due to high income & great work hours, as there are not too many Eye or Skin emergencies!
I did find it interesting to note that in 2012 there are only 2,764 positions for Family Practice residents to train, & yet these spots were not filled by the Match as only 2,611 students "matched" in Family Medicine. It should also be noted that many of these spots were filled with "foreign medical graduates" which means that these students did not train at a medical school in the US. They may in fact be American, but the school they attended was out of the country... perhaps because they did not get accepted by an American medical school. So if the future of medicine is in the hands of primary care specialties... which include Family Medicine, Pediatrics, & Internal Medicine... isn't it frightening to see the small number of FP's trained yearly, & perhaps equally frightening that many have spent 1/2 of their medical training years out of the country? So do you want to know what happens to most US medical school graduates? Well of course, they choose to go into higher paying specialties with better life-styles! So the next time you hear the primary care doctors speaking out about how they are under-paid & under-valued, you will better understand why you should care!
Also, if you wonder why physicians seem to be somewhat absent from the political agenda which is trying to re-direct medical care, consider this. First, we really do spend an enormous amount of time taking care of patients. Secondly, there are only about 800,000 practicing physicians in the United States, yet there is a population of about 311,800,000 people in the US (according to the 2011 statistics). Thus there are 311 million more people than there are doctors, making us a very small minority, & truly one with a small voice! Intelligent people all have their own opinions, & it is almost impossible for physicians to agree on any one issue such as health care reform, but even if we did, I am not sure our voice would be heard. Oh, & remember, the AMA does not truly represent most physicians, as only about 17% of physicians belong to the AMA! They have their own agenda, & it should be noted that each Specialty in medicine has it's own agenda as well, especially to insure that their evaluations & treatments receive the highest compensation! So, I guess Physicians will not be in the forefront of political action... unfortunately... as I must ask, whose profession is it anyway??
Replacement of Body Parts:
With all the wonders in medicine, are there body parts that are not replaceable? Certainly the brain & spinal cord are on the top of the list, but I don't think we replace the stomach, the bowel, or the bladder, nor do we replace entire bones... at least to my knowledge. Sometimes we don't replace an organ, but instead we just replace the hormone or chemical it would produce, such as insulin to replace the pancreas, or thyroid hormone (like Synthroid) to replace the thyroid. I think the future of organ replacement lies in the creation of new organs from your own body. In other words, science will some day be able to use your own tissue to grow you new organs. I read that this has been done recently for a man who had bladder cancer. The doctors removed some healthy bladder cells & grew a new bladder which was transplanted into his body when his sick bladder was later removed!
And as a last thought, the skin is the largest organ of the human body, & I believe it is the one most taken for granted! But, you really do not want to have significant burns which necessitate skin grafts, as that is painful, & often the grafted skin is not as pliable or as cosmetic as you would like. So, take good care of your skin, & be sure to protect it from sun damage by using lots of sunscreen or protective clothing such as hats & shirts!
Testosterone Production by Women:
Men have testicles to produce testosterone, but obviously women do not. So Cindy asked where is testosterone produced in the female body. Well, I answered that the ovaries produce testosterone as well as estrogen & progesterone, but I must correct myself a bit. Though it is true that the ovaries produce all 3 of these hormones, I failed to remember that the adrenal glands also produce testosterone. So at menopause, when the ovaries either die or are surgically removed, the woman's testosterone level will decrease significantly, but there will still be some testosterone produced by the adrenal glands. These are little glands that sit on top of your kidneys, & though they are small they are mighty, as they produce several important hormones such as Cortisol & Epinephrine which help us cope with stress.
Shot for Treatment of high Cholesterol:
There was interest in a recent announcement regarding a new "shot" for high cholesterol treatment. This is a new medicine being studied in clinical trials, & it was given by injection every 2-4 weeks with promising results. It works by causing a decrease in a protein that inhibits degradation of LDL (= Lousy or bad cholesterol), thus the LDL is more vigorously broken down. This is a novel approach to treating hypercholesterolemia, so it is an exciting medicine. It is however just going into phase 2 trials, so it will be a while before we know if it really works & if it is safe. If it makes it to market, it will likely be an option for those who cannot tolerate statin medicines (which are the typical meds used to treat high cholesterol), or for those who have high cholesterol in spite of taking high dose statins. So, we wait...
Plastic Surgery & Grandma:
Should a 73 year old lady have plastic surgery? What if she wants a "nose job" & breast augmentation? Well, several factors need to be considered. First, it is truly her decision, as the choice to pursue cosmetic surgery is always personal. Secondly though, she must discuss this with her primary care physician & get medical "clearance" for the procedure. If she is healthy, she can then proceed, but I would recommend she have the procedure done in an out-patient surgery center & not in the Plastic Surgeon's office. The surgery center has multiple personnel to provide her with care, such as Anesthesiologists & nurses, & they insure that their staff (including the Plastic Surgeon) is appropriately credentialled. I believe that doctors who operate in these facilities practice more main-stream medicine, & are more likely to have the respect of their colleagues. Those who practice solely out of their offices do so without oversight from the outside world, & many of their colleagues can't truly attest to their skillfulness as they never witness them caring for patients. Also, if grandma has a complication, it would be beneficial to have the surgery center have an affiliation with a hospital where she could be admitted & stabilized... & it would be optimal if the Plastic Surgeon was on staff at that facility so he could be involved with her hospital care should that be necessary. I might also suggest that she pursue only one procedure at a time, thus limiting the time she is under anesthesia, as this will likely lead to a better outcome. In this case, I would do the "nose job" first, as this is the body part most seen by the public. If grandma does well with this, she can later pursue the breast augmentation (=enhancement or enlargement), but if she does not opt to pursue a second surgery, she can perhaps just get a better bra!
Have a wonderful week, & I hope you participated in Earth Hour on Saturday March 31st. I did participate, thus I turned out all of the lights in my home from 8:30-9:30PM. This provided me an opportunity to eat supper by candlelight & to spend an hour of quality time with my family! Perhaps we should have Earth Hour every night... or at least once per week!
Here's to our health!
Doctor Gigi
PS Remember you can tune into the radio show live on Fridays at 1:00PM Eastern time via WTAN 1340-AM in the St. Pete/Clearwater/Tampa area, or you can listen on the computer via www.SkipShow.com where you can listen live or to recorded podcasts. Also, keep those questions coming: (727)-441-3000 local, or toll-free at (866)-TAN-1340, or DoctorGigi@SkipShow.com.
National Doctors' Day - March 30:
March 30 is National Doctors' Day. It is the day that we as a nation thank physicians for the work they do. It began as a celebration in Georgia in 1933, & Congress recognized it as a national event in 1991. The reason it is celebrated on March 30 is because ether was first used as anesthesia on March 30, 1842. If you think about it, many of the wonderful things we do in modern medicine would be all but impossible without anesthesia. Just imagine having any surgical procedure without anesthesia! I guess we should honor this event, & certainly we need to remember that physicians are on the front line of public health. In the "old days" they provided care to people with TB & other infectious diseases, not always knowing if their health was at risk, as they often did not know the mode of transmission of these diseases. So was the case in the 1980's when we provided care on the front lines for people with HIV... before we fully understood this virus & how it is transmitted. I was a resident during this frightening time, & I do remember the hype, but I never remember withholding care due to fear for my own health! We are professionals who respond to the needs of our patients 24 hours a day, 7 days a week... often ignoring our own needs & those of our families. So on March 30, we as a nation thank the men & women who provide our medical care... & don't forget to thank the families who support them so they can care for you!
Match Day - March 15:
Students who graduate from medical school are called "Doctor"... but that is usually not the end of their studies. Most physicians go from medical school to a residency program where they study for 3-5 years more, after which they are considered a "Specialist" in whatever residency program they completed. I am a specialist in Family Practice (or Family Medicine), & I trained for 3 years post medical school to achieve this credential. So most of us know that there are residency programs for all specialties in the field of medicine, such as: Family Medicine, Internal Medicine, Pediatrics, Ob-Gyn, Surgery, Ophthalmology, Dermatology, Hematology-Oncology, & Orthopedics. What you might not know is that your doctor might not have become the specialist he really wanted to become. That is because there are a limited number of spots in each specialty each year, & each new doctor has to "match" his wishes with the choices of the residency programs. This is done through a program called "the Match," which is formally done every year on March 15th. Senior students in medical school take elective studies & interview at programs where they hope to obtain residency training. They then make a list of the programs they hope to attend, starting with their number 1 choice. The residency directors create a similar list, indicating the students they would like to train, starting with their number 1 choice. A computer program takes these two lists & creates a "match" between them. My list was short: 1) Family Practice at Bayfront Hospital in St. Petersburg, FL, 2) Family Practice at Earl K. Long Hospital in Baton Rouge, LA, 3) Medicine-Pediatrics at Earl K. Long Hospital in Baton Rouge, LA. I don't know where I ranked on the list for Bayfront Family Practice, but I "matched" to that program... & thus I studied there for 3 years & became a Family Practitioner. If a medical student does not "match," he then gets to participate in the "Scramble," which involves getting on the phone to call residency programs with openings to see if you can quickly lock in a position. Those who participate in the Scramble often get an acceptable residency program, but some have to settle for a program or even a specialty that was not truly on their priority list. Thus a person can go to medical school & graduate after 4 years, but still not have the opportunity to become the specific type of doctor he wants to become! The most difficult program to get into when I was a student was Ophthalmology. Dermatology was also very competitive. So only the students in the top 10-15% of the class could become Ophthalmologists or Dermatologists. These programs are highly sought due to high income & great work hours, as there are not too many Eye or Skin emergencies!
I did find it interesting to note that in 2012 there are only 2,764 positions for Family Practice residents to train, & yet these spots were not filled by the Match as only 2,611 students "matched" in Family Medicine. It should also be noted that many of these spots were filled with "foreign medical graduates" which means that these students did not train at a medical school in the US. They may in fact be American, but the school they attended was out of the country... perhaps because they did not get accepted by an American medical school. So if the future of medicine is in the hands of primary care specialties... which include Family Medicine, Pediatrics, & Internal Medicine... isn't it frightening to see the small number of FP's trained yearly, & perhaps equally frightening that many have spent 1/2 of their medical training years out of the country? So do you want to know what happens to most US medical school graduates? Well of course, they choose to go into higher paying specialties with better life-styles! So the next time you hear the primary care doctors speaking out about how they are under-paid & under-valued, you will better understand why you should care!
Also, if you wonder why physicians seem to be somewhat absent from the political agenda which is trying to re-direct medical care, consider this. First, we really do spend an enormous amount of time taking care of patients. Secondly, there are only about 800,000 practicing physicians in the United States, yet there is a population of about 311,800,000 people in the US (according to the 2011 statistics). Thus there are 311 million more people than there are doctors, making us a very small minority, & truly one with a small voice! Intelligent people all have their own opinions, & it is almost impossible for physicians to agree on any one issue such as health care reform, but even if we did, I am not sure our voice would be heard. Oh, & remember, the AMA does not truly represent most physicians, as only about 17% of physicians belong to the AMA! They have their own agenda, & it should be noted that each Specialty in medicine has it's own agenda as well, especially to insure that their evaluations & treatments receive the highest compensation! So, I guess Physicians will not be in the forefront of political action... unfortunately... as I must ask, whose profession is it anyway??
Replacement of Body Parts:
With all the wonders in medicine, are there body parts that are not replaceable? Certainly the brain & spinal cord are on the top of the list, but I don't think we replace the stomach, the bowel, or the bladder, nor do we replace entire bones... at least to my knowledge. Sometimes we don't replace an organ, but instead we just replace the hormone or chemical it would produce, such as insulin to replace the pancreas, or thyroid hormone (like Synthroid) to replace the thyroid. I think the future of organ replacement lies in the creation of new organs from your own body. In other words, science will some day be able to use your own tissue to grow you new organs. I read that this has been done recently for a man who had bladder cancer. The doctors removed some healthy bladder cells & grew a new bladder which was transplanted into his body when his sick bladder was later removed!
And as a last thought, the skin is the largest organ of the human body, & I believe it is the one most taken for granted! But, you really do not want to have significant burns which necessitate skin grafts, as that is painful, & often the grafted skin is not as pliable or as cosmetic as you would like. So, take good care of your skin, & be sure to protect it from sun damage by using lots of sunscreen or protective clothing such as hats & shirts!
Testosterone Production by Women:
Men have testicles to produce testosterone, but obviously women do not. So Cindy asked where is testosterone produced in the female body. Well, I answered that the ovaries produce testosterone as well as estrogen & progesterone, but I must correct myself a bit. Though it is true that the ovaries produce all 3 of these hormones, I failed to remember that the adrenal glands also produce testosterone. So at menopause, when the ovaries either die or are surgically removed, the woman's testosterone level will decrease significantly, but there will still be some testosterone produced by the adrenal glands. These are little glands that sit on top of your kidneys, & though they are small they are mighty, as they produce several important hormones such as Cortisol & Epinephrine which help us cope with stress.
Shot for Treatment of high Cholesterol:
There was interest in a recent announcement regarding a new "shot" for high cholesterol treatment. This is a new medicine being studied in clinical trials, & it was given by injection every 2-4 weeks with promising results. It works by causing a decrease in a protein that inhibits degradation of LDL (= Lousy or bad cholesterol), thus the LDL is more vigorously broken down. This is a novel approach to treating hypercholesterolemia, so it is an exciting medicine. It is however just going into phase 2 trials, so it will be a while before we know if it really works & if it is safe. If it makes it to market, it will likely be an option for those who cannot tolerate statin medicines (which are the typical meds used to treat high cholesterol), or for those who have high cholesterol in spite of taking high dose statins. So, we wait...
Plastic Surgery & Grandma:
Should a 73 year old lady have plastic surgery? What if she wants a "nose job" & breast augmentation? Well, several factors need to be considered. First, it is truly her decision, as the choice to pursue cosmetic surgery is always personal. Secondly though, she must discuss this with her primary care physician & get medical "clearance" for the procedure. If she is healthy, she can then proceed, but I would recommend she have the procedure done in an out-patient surgery center & not in the Plastic Surgeon's office. The surgery center has multiple personnel to provide her with care, such as Anesthesiologists & nurses, & they insure that their staff (including the Plastic Surgeon) is appropriately credentialled. I believe that doctors who operate in these facilities practice more main-stream medicine, & are more likely to have the respect of their colleagues. Those who practice solely out of their offices do so without oversight from the outside world, & many of their colleagues can't truly attest to their skillfulness as they never witness them caring for patients. Also, if grandma has a complication, it would be beneficial to have the surgery center have an affiliation with a hospital where she could be admitted & stabilized... & it would be optimal if the Plastic Surgeon was on staff at that facility so he could be involved with her hospital care should that be necessary. I might also suggest that she pursue only one procedure at a time, thus limiting the time she is under anesthesia, as this will likely lead to a better outcome. In this case, I would do the "nose job" first, as this is the body part most seen by the public. If grandma does well with this, she can later pursue the breast augmentation (=enhancement or enlargement), but if she does not opt to pursue a second surgery, she can perhaps just get a better bra!
Have a wonderful week, & I hope you participated in Earth Hour on Saturday March 31st. I did participate, thus I turned out all of the lights in my home from 8:30-9:30PM. This provided me an opportunity to eat supper by candlelight & to spend an hour of quality time with my family! Perhaps we should have Earth Hour every night... or at least once per week!
Here's to our health!
Doctor Gigi
PS Remember you can tune into the radio show live on Fridays at 1:00PM Eastern time via WTAN 1340-AM in the St. Pete/Clearwater/Tampa area, or you can listen on the computer via www.SkipShow.com where you can listen live or to recorded podcasts. Also, keep those questions coming: (727)-441-3000 local, or toll-free at (866)-TAN-1340, or DoctorGigi@SkipShow.com.
Tuesday, March 27, 2012
Lessons Learned from Whitney Houston; Effects of Meds on Liver; Allergy & Blood Pressure; Commercial Disclaimers
This is written in reference to Let's Talk Medical with Doctor Gigi as it was broadcasted live on Friday March 23, 2012.
Lessons Learned from Whitney Houston:
First let me say that I absolutely loved Whitney Houston! She was a beautiful person with an unrivaled talent, & I am very saddened by her struggles in life & her untimely death!
Recently the autopsy results were released which showed what many of us expected: Whitney 's death was at least partially due to drugs. Though she had water in her lungs which showed that she "drowned," she also tested positive for a cocktail of drugs, both prescribed & illicit. The report showed she had Xanax, Flexeril, Benadryl, Marijuana, & Cocaine in her system. Xanax is an anti-anxiety medication which calms a person's "nerves," whereas Flexeril is a muscle-relaxant & Benadryl is a sedating anti-histamine. The first 2 are prescription meds, whereas Benadryl is over-the-counter (OTC). All are sedating products which means that they make you sleepy & relaxed... great idea if you're going to bed, but terrible idea if you're going to try to accomplish activities of daily living such as taking a bath or attending a party! Marijuana also has sedating properties, so you can easily see that Whitney was likely sleepy beyond belief, & in fact possibly nearly comatose which would have allowed her to slip quietly below the bathtub water without awakening, resulting in her breathing in water which resulted in her drowning. That is of course one possibility, though I propose a more ominous cause for Whitney's death. The cocaine which was found in her system, was the most deadly drug... not because it is illegal, but because of it's cardiac effects. You see, cocaine is like speed - it causes the blood pressure to go up & the heart to beat very fast. If the heart beats very fast, it never relaxes to fill with blood, & as a consequence, though the heart is beating, it is not pumping blood. After a brief time, the brain gets low on oxygen (we call this hypoxia) & this causes the person to pass out. Though your brain might not be functioning, the automatic functions such as breathing would continue. So I propose that Whitney took cocaine which caused a very fast heart beat causing the heart to pump ineffectively... causing her to pass out, at which point she went limp & slipped beneath the water, but she continued to take a few breaths... thus the autopsy showed that she drowned. For those who wonder why she could not arouse enough to get her head out of the water, I think this is a plausible explanation. Sadly, I will add that many addicts who "slip" often over-dose because they resume their drug use at the last dose they used... yet after a dose of sobriety they have lost their tolerance & cannot handle that high of a dose. So in Whitney's defense, perhaps this was a fresh "slip" with cocaine... unfortunately we will never know!
This whole issue brings up the fact that of course we should not be using drugs of abuse, but it also brings to light perhaps a much more rampant problem in our society... a lack of respect for medications as a whole! Many people every day do just what Whitney Houston did in regards to combining prescription & over-the-counter drugs without regard to the toxic effects of these combinations. Heath Ledger over-dosed on a combination of sleeping pills & other prescription drugs, but I am certain that he never intended to die. Michael Jackson was so desperate for sleep that he began to use medication that is only used as anesthesia for surgery... strange, but I also doubt he wanted to or expected to die! How many people, in a search for sleep or relief from pain, take multiple medications at doses higher than prescribed by their doctors? And how many of us take over-the-counter meds on top of prescription drugs without getting advice from our physicians? And this is not even addressing the sharing of drugs with our friends & family, much less the parties where teens each bring a pill from home & then take them just for fun! So, before we pass judgement on Whitney, perhaps we need to look at ourselves... & certainly we need to realize that medication is wonderful when used appropriately, but deadly when used inappropriatly! Always speak with your physician before you change doses of meds, add OTC meds, or "share" your meds! Be respectful, as it is not just illegal drugs that kill!
Effects of Medications on the Liver:
Dawn had a question regarding the effect of multiple medications on the liver. First, not every medication is metabolized by the liver, as many are degraded by the kidneys, & some by other metabolic processes. The problem occurs when a person takes multiple medicines that use the same pathway for metabolism, thus the liver might have a problem if you take several of the following: cholesterol medications (such as statins), diabetic medications (such as Metformin), rheumatologic meds (such as Methotrexate), anti-seizure meds (such as Tegretol or Depakote), or even Tylenol, as they are all "digested" by the liver. As you can see, these are very common meds, & often people take several of these at once. You should not worry about combining them, but you should speak with your doctor to insure that you get proper monitoring, which generally involves blood tests such as an AST or ALT (previously known as an SGOT or SGPT respectively). If these are elevated, your liver is showing signs of being irritated, & your doctor will probably first do further labwork to rule out viral hepatitis as a cause... & he might even do an ultrasound of your liver & gallbladder if you have abdominal pain or other symptoms. If there is no other explanation for the increased liver tests, he will likely try to decrease or stop one of the medications that requires the liver to metabolize it. Generally the damage is not permanent, & getting rid of the offending agent or agents usually results in the liver healing quickly. Of course, if you have a sick liver due to Hepatitis or cirrhosis, you have to be even more careful with medications. As a last thought, remember that Tylenol & alcohol are both metabolized by the liver, so be sure to limit these products if you take prescription drugs that go through the liver. Similarly, anti-inflamatory meds (such as Aspirin, Ibuprofen=Advil, Naproxen=Aleve, & Meloxicam=Mobic) are degraded by the kidneys, so they should be used with caution if you have renal impairment or lots of meds that use the kidneys for degradation.
Allergy Season:
Of course we have all heard about the early Spring & it's high pollen levels, & many of us have been aware of this for several weeks as we have been suffering with allergy symptoms. These include itchy eyes & nose, watery eyes & nose, stuffy nose, & generally the feeling that you have a "cold" which comes & goes for weeks. There are many choices for treating these symptoms, but many people don't understand those options. In general, if you have a runny or itchy nose or eyes, try an anti-histamine as this type of medicine will dry things up & decrease the itchiness. There are great over-the-counter anti-histamines such as: Claritin (=Loratidine), Allegra (=Fexofenadine), Zyrtec, or even Benadryl. Claritin & Allegra are not likely to cause sedation, though Zyrtec might & Benadryl almost certainly will (so take them at night!). Also, note that the first 3 work for 24 hours, whereas Benadryl works for only 4-6 hours, so you will need to take it more than one time per day, & you will likely be very sleepy! On the other hand, if you have a stuffy nose, you probably want to try a decongestant such as Sudafed (=Pseudoephedrine) or Phenylephrine which are both OTC. You need to know however that decongestants often cause an increase in blood pressure, heart rate & anxiety, so you might want to ask your doctor if they are safe for you! If you cannot take decongestants, your doctor can prescribe Astelin (which tastes horrible but will both dry & unstuff your nose), or perhaps a nasal steroid such as Flonase (=Fluticasone), or even Singulair or Accolate which decrease inflamation in the respiratory tract. As a last thought, remember if a medicine name includes "D," that medication includes a decongestant, so beware that it might increase your blood pressure, make your heart beat fast, &/or cause you to feel anxious! Such is the case with Claritin D, Allegra D, & even Mucinex D (which has a decongestant, whereas Mucinex DM has a cough suppressant called Dextromethorphan).
A cost-saving tip: Claritin is over-the-counter, but you can buy the generic version (Loratidine) from the Pharmacy with a prescription. The Loratidine from the Pharmacy should cost only $4 for 30 pills at WalMart, KMart, Sweetbay, Publix, Target, Sam's Club, & Costco. Thus the prescription med is a lot cheaper than the OTC med, so ask your doctor for a prescription! This is the case with several meds, so ask your doctor or Pharmacist, or even check the $4 WalMart list!
Medication Side-effects on Commercials:
A listener commented that he doesn't understand how the FDA would ever approve medications given the horrible side-effects listed on commercials. Well, I certainly understand the comment, but there is some information that lay people need to know. When a drug is being tested in clinical trials, the patients are told to report any & all changes in their health while enrolled in the study. Thus headaches & "flu" are frequently reported, as are heartburn & back pain. Obviously these are common problems in the general population, so it is no wonder why they are frequently reported. Realize that these reported "adverse events" are then listed on the drug's list of "side-effects" even though cause & effect have not been proven! Therefore drugs which are studied during the flu season, often list "flu" as a side-effect. Again, that does not mean that the drug "caused" the flu, though the commercial will not make that distinction as the FDA does not allow that! If you have concerns, ask your doctor which side-effects are most likely, as we know that information & use it to help us prescribe appropriately.
Also, remember that some disease processes, rather than the medicines themselves, cause the side-effect. You might remember the recent concerns involving Zoloft which was accused of causing people, especially teens, to commit suicide. Though I can't prove it, I would suggest that the failure of Zoloft to fully treat the depression is more likely what caused the person to commit suicide as depression itself is usually the cause for suicide. In my opinion, the failure of Zoloft to work well or to be appropriately managed is a better explanation for this "side-effect." Similarly, diabetics are more likely to have heart attacks & strokes than the general public, so it is likely that diabetic meds will show more of these adverse events than meds like antacids which are used in healthy people as well as diabetics. There is a question in many people's minds as to whether or not statin medications (which are used to treat high cholesterol) cause forgetfulness. The problem is that once again, high cholesterol itself can cause mini strokes which can cause forgetfulness... so if a person with high cholesterol takes a statin & gets confused or forgetful, do we blame the medicine or the high cholesterol itself? Obviously, if you stop the statin & the patient's memory returns to normal, I would be convinced that the statin was the culprit, but if nothing changes, I would resume the statin medication to help lower the cholesterol & hopefully decrease the risk of further cardiovascular events, including tiny strokes!
So take the commercial disclaimers with a grain of salt! Talk to your doctor to get more appropriate information & to make better decisions. Remember, if you read the side-effects of aspirin, Tylenol, birth control pills, or even alcohol, you would likely never take any of them!
On that note, I'll end, so here's to our health!
Doctor Gigi
PS Don't forget to check out the live radio show on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1:00PM Eastern time, or on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. And I would love to hear from you regarding any medical concerns or comments you might have. You can reach me via phone during the radio show (866-TAN-1340) or any time via e-mail (DoctorGigi@SkipShow.com).
Lessons Learned from Whitney Houston:
First let me say that I absolutely loved Whitney Houston! She was a beautiful person with an unrivaled talent, & I am very saddened by her struggles in life & her untimely death!
Recently the autopsy results were released which showed what many of us expected: Whitney 's death was at least partially due to drugs. Though she had water in her lungs which showed that she "drowned," she also tested positive for a cocktail of drugs, both prescribed & illicit. The report showed she had Xanax, Flexeril, Benadryl, Marijuana, & Cocaine in her system. Xanax is an anti-anxiety medication which calms a person's "nerves," whereas Flexeril is a muscle-relaxant & Benadryl is a sedating anti-histamine. The first 2 are prescription meds, whereas Benadryl is over-the-counter (OTC). All are sedating products which means that they make you sleepy & relaxed... great idea if you're going to bed, but terrible idea if you're going to try to accomplish activities of daily living such as taking a bath or attending a party! Marijuana also has sedating properties, so you can easily see that Whitney was likely sleepy beyond belief, & in fact possibly nearly comatose which would have allowed her to slip quietly below the bathtub water without awakening, resulting in her breathing in water which resulted in her drowning. That is of course one possibility, though I propose a more ominous cause for Whitney's death. The cocaine which was found in her system, was the most deadly drug... not because it is illegal, but because of it's cardiac effects. You see, cocaine is like speed - it causes the blood pressure to go up & the heart to beat very fast. If the heart beats very fast, it never relaxes to fill with blood, & as a consequence, though the heart is beating, it is not pumping blood. After a brief time, the brain gets low on oxygen (we call this hypoxia) & this causes the person to pass out. Though your brain might not be functioning, the automatic functions such as breathing would continue. So I propose that Whitney took cocaine which caused a very fast heart beat causing the heart to pump ineffectively... causing her to pass out, at which point she went limp & slipped beneath the water, but she continued to take a few breaths... thus the autopsy showed that she drowned. For those who wonder why she could not arouse enough to get her head out of the water, I think this is a plausible explanation. Sadly, I will add that many addicts who "slip" often over-dose because they resume their drug use at the last dose they used... yet after a dose of sobriety they have lost their tolerance & cannot handle that high of a dose. So in Whitney's defense, perhaps this was a fresh "slip" with cocaine... unfortunately we will never know!
This whole issue brings up the fact that of course we should not be using drugs of abuse, but it also brings to light perhaps a much more rampant problem in our society... a lack of respect for medications as a whole! Many people every day do just what Whitney Houston did in regards to combining prescription & over-the-counter drugs without regard to the toxic effects of these combinations. Heath Ledger over-dosed on a combination of sleeping pills & other prescription drugs, but I am certain that he never intended to die. Michael Jackson was so desperate for sleep that he began to use medication that is only used as anesthesia for surgery... strange, but I also doubt he wanted to or expected to die! How many people, in a search for sleep or relief from pain, take multiple medications at doses higher than prescribed by their doctors? And how many of us take over-the-counter meds on top of prescription drugs without getting advice from our physicians? And this is not even addressing the sharing of drugs with our friends & family, much less the parties where teens each bring a pill from home & then take them just for fun! So, before we pass judgement on Whitney, perhaps we need to look at ourselves... & certainly we need to realize that medication is wonderful when used appropriately, but deadly when used inappropriatly! Always speak with your physician before you change doses of meds, add OTC meds, or "share" your meds! Be respectful, as it is not just illegal drugs that kill!
Effects of Medications on the Liver:
Dawn had a question regarding the effect of multiple medications on the liver. First, not every medication is metabolized by the liver, as many are degraded by the kidneys, & some by other metabolic processes. The problem occurs when a person takes multiple medicines that use the same pathway for metabolism, thus the liver might have a problem if you take several of the following: cholesterol medications (such as statins), diabetic medications (such as Metformin), rheumatologic meds (such as Methotrexate), anti-seizure meds (such as Tegretol or Depakote), or even Tylenol, as they are all "digested" by the liver. As you can see, these are very common meds, & often people take several of these at once. You should not worry about combining them, but you should speak with your doctor to insure that you get proper monitoring, which generally involves blood tests such as an AST or ALT (previously known as an SGOT or SGPT respectively). If these are elevated, your liver is showing signs of being irritated, & your doctor will probably first do further labwork to rule out viral hepatitis as a cause... & he might even do an ultrasound of your liver & gallbladder if you have abdominal pain or other symptoms. If there is no other explanation for the increased liver tests, he will likely try to decrease or stop one of the medications that requires the liver to metabolize it. Generally the damage is not permanent, & getting rid of the offending agent or agents usually results in the liver healing quickly. Of course, if you have a sick liver due to Hepatitis or cirrhosis, you have to be even more careful with medications. As a last thought, remember that Tylenol & alcohol are both metabolized by the liver, so be sure to limit these products if you take prescription drugs that go through the liver. Similarly, anti-inflamatory meds (such as Aspirin, Ibuprofen=Advil, Naproxen=Aleve, & Meloxicam=Mobic) are degraded by the kidneys, so they should be used with caution if you have renal impairment or lots of meds that use the kidneys for degradation.
Allergy Season:
Of course we have all heard about the early Spring & it's high pollen levels, & many of us have been aware of this for several weeks as we have been suffering with allergy symptoms. These include itchy eyes & nose, watery eyes & nose, stuffy nose, & generally the feeling that you have a "cold" which comes & goes for weeks. There are many choices for treating these symptoms, but many people don't understand those options. In general, if you have a runny or itchy nose or eyes, try an anti-histamine as this type of medicine will dry things up & decrease the itchiness. There are great over-the-counter anti-histamines such as: Claritin (=Loratidine), Allegra (=Fexofenadine), Zyrtec, or even Benadryl. Claritin & Allegra are not likely to cause sedation, though Zyrtec might & Benadryl almost certainly will (so take them at night!). Also, note that the first 3 work for 24 hours, whereas Benadryl works for only 4-6 hours, so you will need to take it more than one time per day, & you will likely be very sleepy! On the other hand, if you have a stuffy nose, you probably want to try a decongestant such as Sudafed (=Pseudoephedrine) or Phenylephrine which are both OTC. You need to know however that decongestants often cause an increase in blood pressure, heart rate & anxiety, so you might want to ask your doctor if they are safe for you! If you cannot take decongestants, your doctor can prescribe Astelin (which tastes horrible but will both dry & unstuff your nose), or perhaps a nasal steroid such as Flonase (=Fluticasone), or even Singulair or Accolate which decrease inflamation in the respiratory tract. As a last thought, remember if a medicine name includes "D," that medication includes a decongestant, so beware that it might increase your blood pressure, make your heart beat fast, &/or cause you to feel anxious! Such is the case with Claritin D, Allegra D, & even Mucinex D (which has a decongestant, whereas Mucinex DM has a cough suppressant called Dextromethorphan).
A cost-saving tip: Claritin is over-the-counter, but you can buy the generic version (Loratidine) from the Pharmacy with a prescription. The Loratidine from the Pharmacy should cost only $4 for 30 pills at WalMart, KMart, Sweetbay, Publix, Target, Sam's Club, & Costco. Thus the prescription med is a lot cheaper than the OTC med, so ask your doctor for a prescription! This is the case with several meds, so ask your doctor or Pharmacist, or even check the $4 WalMart list!
Medication Side-effects on Commercials:
A listener commented that he doesn't understand how the FDA would ever approve medications given the horrible side-effects listed on commercials. Well, I certainly understand the comment, but there is some information that lay people need to know. When a drug is being tested in clinical trials, the patients are told to report any & all changes in their health while enrolled in the study. Thus headaches & "flu" are frequently reported, as are heartburn & back pain. Obviously these are common problems in the general population, so it is no wonder why they are frequently reported. Realize that these reported "adverse events" are then listed on the drug's list of "side-effects" even though cause & effect have not been proven! Therefore drugs which are studied during the flu season, often list "flu" as a side-effect. Again, that does not mean that the drug "caused" the flu, though the commercial will not make that distinction as the FDA does not allow that! If you have concerns, ask your doctor which side-effects are most likely, as we know that information & use it to help us prescribe appropriately.
Also, remember that some disease processes, rather than the medicines themselves, cause the side-effect. You might remember the recent concerns involving Zoloft which was accused of causing people, especially teens, to commit suicide. Though I can't prove it, I would suggest that the failure of Zoloft to fully treat the depression is more likely what caused the person to commit suicide as depression itself is usually the cause for suicide. In my opinion, the failure of Zoloft to work well or to be appropriately managed is a better explanation for this "side-effect." Similarly, diabetics are more likely to have heart attacks & strokes than the general public, so it is likely that diabetic meds will show more of these adverse events than meds like antacids which are used in healthy people as well as diabetics. There is a question in many people's minds as to whether or not statin medications (which are used to treat high cholesterol) cause forgetfulness. The problem is that once again, high cholesterol itself can cause mini strokes which can cause forgetfulness... so if a person with high cholesterol takes a statin & gets confused or forgetful, do we blame the medicine or the high cholesterol itself? Obviously, if you stop the statin & the patient's memory returns to normal, I would be convinced that the statin was the culprit, but if nothing changes, I would resume the statin medication to help lower the cholesterol & hopefully decrease the risk of further cardiovascular events, including tiny strokes!
So take the commercial disclaimers with a grain of salt! Talk to your doctor to get more appropriate information & to make better decisions. Remember, if you read the side-effects of aspirin, Tylenol, birth control pills, or even alcohol, you would likely never take any of them!
On that note, I'll end, so here's to our health!
Doctor Gigi
PS Don't forget to check out the live radio show on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1:00PM Eastern time, or on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. And I would love to hear from you regarding any medical concerns or comments you might have. You can reach me via phone during the radio show (866-TAN-1340) or any time via e-mail (DoctorGigi@SkipShow.com).
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