October 20th, 2014 | The Blog
The cold and season is approaching or actually active in some places. It is difficult to know at what point, if any, in the illness that medical evaluation is needed. Patients are often sent home with a proclaimed virus so are hesitant to even make the effort to get to the doctor.
One important caveat to note is that strep infections do not present in any specific season, they circulate among the population throughout the year.
Strep Throat Facts
Strep throat is caused by a bacteria, not a virus. The bacteria is called Group A streptococcus.
It is important to have a prolonged sore throat checked. Strep can evolve into a serious illness. How often is a strep test positive? Less than one in four strep tests, when a patient has a sore throat, prove the presence of the bacteria. The one in four positive cases results in about 10% of cases in adults and 30% in children.
So when is it the right time to go to the doctor? Boston Children’s Hospital has developed a risk assessment tool, which tracks a patient’s symptoms along with the incidence of strep infections in the area where they live. It will work in a similar fashion to the current flu tracker app.
The new app, which is still in the throes of development, measures a home score, which is a combination of patient symptoms and demographic data regarding local strep throat activity. The score is calculated using these patient symptoms:
A low score indicates a low risk of the infection and potentially prevents an unwarranted trip to the doctor.
If the geographic area is rampant with strep and the patient presents with a combination of identified symptoms, the likelihood of having a strep throat is naturally increased. At this juncture, professional medical evaluation is warranted.
The app allows patients and parents of young children to make an informed decision about seeking further medical evaluation.
A higher risk of having a positive strep test was noted in patients who have a sore throat with an accompanying fever but no cough. This patient population, especially those under 15 years old, should seek medical care. The American Academy of Pediatrics recommends that any patient under 15 years old with a sore throat should get it checked by a physician. This age group more commonly carries bacterial infections.
If the strep evaluation app is consistently used, it can potentially prevent about 230,000 doctor?s office visits annually. On the other hand, about 8,500 actual strep cases could also be missed.
October 14th, 2014 | The Blog
Hypertension or high blood pressure is a serious medical condition, which warrants the attention of a qualified healthcare professional.? There are about 1/3 of Americans who are currently diagnosed with hypertension. Surprisingly, 90% of them developed hypertension after age 55.
High blood pressure can cause a stroke or other health problem, especially heart disease.
There are relatively new guidelines to determine if a patient needs to treat their hypertension or not. The new guidelines will reduce the number of older Americans, specifically those over 60 years old, who take anti-hypertensive medicine.
First, let?s be aware of the 10-year-old recommendation to treat hypertension for those over 60 years of age. It used to be 140/90 mmHg.
A report in a recent Journal of the American Medical Association states that no medication is needed until blood pressure reaches 150/90. There is no benefit to keeping the blood pressure at 140, instead of 150.
The side effects associated with blood pressure medications taken by an elderly population are a far greater risk than of a 150/90 reading. The risks include dizziness and lightheadedness, which can lead to a fall and subsequent bone fractures.
Secondly, let?s look at the guidelines for diabetes of any age or those with kidney disease. The recommended blood pressure used to be below 130mmHG but the new guidelines suggest that below 140 mmHg is adequate.
Lastly, recommendations for the younger population remain unchanged. Blood pressure should be maintained at 140/90 or below for this group.
The First Line of Defense
Lifestyle changes should be the first line of defense in lowering blood pressure. These measures include:
If these things work, medications can be avoided. They should be continued even when anti-hypertensive medications are added into the medical regime.
Blood Pressure Medication
Cardiologists, primary care physicians or family practitioners regulate hypertension medications. The simplified guidelines are intended to keep the suggested treatments the same, across the board.
There are four classes of medications for high blood pressure. They include:
Calcium channel blockers and ACE inhibitors are most effective at lowering blood pressure.
There remains a need to clarify the specific treatment protocols for patients who have issues beyond simple hypertension. Those who have congestive heart failure (CHF), coronary artery disease (CAD) and/or cardiac arrhythmias are not specifically detailed in the new guidelines.
Unfortunately, no major medical group issued the new guidelines so some cardiologists are concerned. The National Heart, Lung and Blood Institute (NHLBI), for unknown reasons, pulled out of the reporting process.
October 9th, 2014 | The Blog
Glaucoma is the leading cause of irreversible blindness in the world. It is an eye disease in which the ocular pressure is elevated and causes damage to the optic nerve.
The disease is asymptomatic until the end stage when vision is irreversibly diminished. Damage to the optic nerve causes vision loss and blindness.
The key to treating glaucoma is early detection so the proper and effective eye drops can be prescribed and administered to lower the ocular pressure.
Traditional Glaucoma Treatment
Glaucoma is routinely treated by medications, laser treatments and conventional surgery. A brief overview of each approach includes:
Looking at the Medication Administration-Specifically, Eye Drops
Eye drops like latanoprost or Xalatan are effective in treating glaucoma. They lower the eye pressure and prevent vision loss. These drugs do not reverse glaucoma.
The only way they are truly effective is if the patient is compliant with the drug administration. Poor patient compliance limits the benefits of the drugs. A recent study shows that eye drop compliance in glaucoma patients is only slightly higher than 50%.
The side effects of the drugs like burning and stinging add to the poor compliance rate. Patients cannot sense any positive feedback like pain management or immediately clearer vision after taking the drops so often do not bother to take them.
New Treatment Option
A new treatment option to increase compliance with the eye medications is a contact lens that dispenses latanoprost and other eye medications. Boston Children?s Hospital, in collaboration with the Massachusetts Institute of Technology (MIT) has developed this contact lens concept.
The contact delivers the drugs in a large quantity for a long period of time at a relatively consistent rate, according to the development team at Boston Children?s Hospital.
The contact lens is a pairing of two polymers, which encapsulate the drug and modulate its release into the eye.
The contact lenses will be available in prescription form for those who are near or far sighted. This benefit will also increase compliance.
The U.S. Food and Drug Administration (FDA) do not yet approve this drug-eluting contact lens for use.
October 1st, 2014 | The Blog
The Enterovirus D68 is usually a rare illness but has seen a rapid increase in cases over the recent weeks, according to the U.S. Centers for Disease Control (CDC).
The Enterovirus D68 was first identified in 1962 in California. Thereafter, it was rarely seen or diagnosed until about 2009 when there were cases reported mostly in Japan, the Philippines and the Netherlands.
Generally, enteroviruses affect 10 to 15 million people in the U.S. every year. These illnesses are typically mild and often without any overt or untoward symptoms.
Who is Affected?
The current Enterovirus D68 respiratory virus is affecting children across the country. The virus started to evolve in the Midwest during the month of August and is spreading east.
The patient population for the Enterovirus D68 (EV-D68) is children and teenagers. The primary group affected by the illness is 2 to 6 year olds. Of those who contract the virus, about 68% have a history of asthma or wheezing.
With the cold and virus season hitting its stride in the month of September, it seems that the EV-68 is taking the lead from the basics of the common cold virus.
The Symptoms of Enterovirus D68
The illness causes a severe respiratory infection, which has required many hospitalizations including admission to intensive care units for some patients.
A runny nose and/or the sniffles do not identify the virus. Difficulty breathing does define EV-D68. It commands immediate medical attention.
The symptoms include:
Most people recuperate from the Enterovirus D68. A few need to be hospitalized but the recent uptick in cases has resulted in more hospitalizations for supportive care. While there is no cure for the illness, oxygen therapy is helpful.
The real prevention of spreading the virus comes with basic infection control common sense around this cold and flu season:
Children with asthma need to be sure that it is well controlled during the active virus season. Extra caution should be taken to watch this population closely. It is very important that asthmatics take their daily medications everyday.
If an asthmatic child starts to develop cold-like symptoms, they should be closely monitored and seek medical care if respiratory distress develops.
As of now, there have been no deaths reported due to the illness. Children recuperate from EV-D68, although some have a more difficult road to recovery than others.
September 24th, 2014 | The Blog
Let’s talk antibiotics. When needed to treat a bacterial infection, antibiotics are usually curative.
With the season of colds, flus and other contagious illnesses fast approaching, this is a good time to talk about the use and abuse of antibiotics. Everyone moves to inside activities and germs are more readily shared, like it or not.
There is a time and place for antibiotic use and a mission to prevent antibiotic misuse and overuse in the country
Just like all other living organisms, bacteria seek to grow and thrive. So, the more often they are exposed to antibiotics, the more opportunities they have to adapt to them and build up a resistance to them. This renders the antibiotics less effective, especially when they are really needed.
This cycle of exposure and growing resistance due to misuse and overuse of antibiotics leads to the general public’s lowered ability to fight against infections.
When to Use Antibiotics
Antibiotics are meant to treat bacterial infections. Period.
When Not to Use Antibiotics
Antibiotics do not treat viruses. A virus, not bacteria, causes the common cold and most other respiratory infections. Antibiotics will not help in this medical situation.
Problems Created by Antibiotics
Antibiotic resistance is a big and growing public health issue. Over time, this is a situation created by the overuse of antibiotics.
Common side effects of antibiotics can range from an upset stomach and diarrhea to a skin rash. Serious and potentially fatal reactions, from the sloughing skin of Stevens Johnson Syndrome to anaphylaxis, can also occur from antibiotics. Children, taking a new antibiotic for the first time sometimes end up making an emergency room visit due to a bad drug reaction.
Taking leftover antibiotics from a previous illness or someone else’s prescription for antibiotics is a bad decision. Specific antibiotics are prescribed for a specific illness and should not be crossed over with other illnesses or people. This is a dangerous practice.
Unless a prescribed antibiotic prescription is taken as directed and until it is gone, a bacterial infection will not be fully treated. It can recur and/or worsen without the full and proper treatment. Patients must be educated to take the entire prescription of an antibiotic to achieve the intended results.
Interestingly, 50% of prescribed antibiotics, whether inpatient or outpatient, are not indicated or necessary. One major example is the patient who sees their PCP for a common cold and leaves the office with an antibiotic prescription. This is a common occurrence in the general population.
When antibiotics are indicated, they are a good and proper treatment. When they are unnecessarily prescribed, they create a public health threat of resistant bacteria.
September 15th, 2014 | The Blog
Sleep apnea affects all facets of life, by day and by night. It is important to diagnose and treat sleep apnea. Management of the condition improves the quality of life and general wellness.
Sleep apnea studies are traditionally done in a hospital setting. There are sensors, electrodes, microphones and infrared cameras involved in the process. Sleep technicians monitor the patient throughout the process, which can be uncomfortable because someone watches them sleep.
Some interesting statistics about sleep apnea include:
The warning signs of sleep apnea include:
The biggest concern:
Sleep apnea can be fatal. When sleep apnea occurs, the brain does not get sufficient oxygen. When this happens throughout the night, the risk of having a stroke is four times greater than someone without sleep apnea.
An Updated Process
There is a new home sleep test, manufactured by NovaSom, which eliminates hospitalization. Instead of someone watching the patient sleep, the test is done in the privacy of the patient’s home.
How it Works:
The Benefits of the Home Test
The cost of a home test is dramatically less than the traditional hospital-based test. The home sleep test cost averages $300 versus the hospital cost of about $3000.
The testing device is more portable so allows the patient to turn onto either side to sleep. In the hospital, patients are restricted to sleeping only on their back because of the equipment configuration.
If a piece of equipment comes loose, there is an audible reminder to check it for proper placement.
What the Home Test Does Not Do
The NovaSom home test does not record brain waves or activity. The hospital-based test does record these. What is the concern?
A home sleep apnea test can be inaccurate if the patient lies awake all night staring into the darkness because the brain waves are an indication of whether they are actually asleep or not. While lying awake, sleep apnea is not a problem so this could give an inaccurate assessment of the patient.
Who Should Not Use the Home Test?
Those with some medical conditions are not candidates for the home test. They include:
Sleep apnea is measured by the number of times a person stops or almost stops breathing for at least 10 seconds per hour. The data collected represents the following results:
When apnea occurs, the oxygen level in the body drops significantly. The normal oxygen level is at least 90%. With sleep apnea, it can drop into the 70% range.
The equipment also monitors snoring. In this case, snoring is qualified as any loud breathing, not just the traditional snoring sound. The NovaSom monitor has a very sound sensitive microphone.
Some sleep specialists project that hospital-based sleep apnea tests derive higher rates of the condition because the patient has to sleep on their back to accommodate the equipment. This back-lying position further closes an already narrow upper airway.
Treatment Options After Diagnosis
The treatment options for sleep apnea include:
The treatment downsides include:
Patients dislike wearing the CPAP; it is cumbersome and restrictive
So what really works? Lifestyle changes that include weight management and less alcohol intake are key factors in reducing sleep apnea.
September 9th, 2014 | The Blog
Who reads food labels anyway? Actually, according to a recent survey, less than 50% of Americans actually regularly read food labels.
Nutrition (food) labels tell the story. They are an important source of information that every consumer should read. It is essential to know how to read, but more importantly, how to understand the information on a food label.
The U.S. Food and Drug Administration (FDA) controls and updates any and all changes made to food labels. They have recently made some changes in an effort to simplify the standard food labels.
The upcoming FDA-approved changes to food labels will include:
Now, What Will be Removed From the Label?
Calories from fat will be removed because the type of fat is more important than the amount of fat.
What They Say
In addition to the aforementioned changes, the other information listed on food labels includes:
The percentage of each content item (such as protein, fiber or potassium), which an individual needs on a daily basis, and the amount that each serving of the food contains is listed beside the item on the label.
It is important to disregard the information on the front of the package labeling as being a factual guide for the nutrition content. The front of most packaging is designed to catch the consumer?s attention, not give solid nutrition facts about the food item. Examples of the misleading labeling include descriptions like light, healthy, low-fat, all natural and 100% natural.
Important Quirky Facts to Remember
Some food items (like cereal) list the serving size by weight. Given that, the serving size for healthy cereals such as Cheerios looks much larger than that of a crunchy, sweeter, albeit healthy, granola. It is important to watch the serving size in items such as this.
Individual serving-size containers definitely help the consumer with portion control and their quest to limit overeating.
Some products, like a 20-ounce soda and a bag of crunchy, salty snacks, will show calories per bottle or bag. Many consumers currently think that one serving is the entire package, especially when the item is snack-sized. This is a misleading notion because even a snack-sized bag can contain 2 or 3 servings. Be sure to read the label.
Food labels contain a lot of information that goes unread. Watching the daily intake of each component listed on a food label will lead to healthier eating and, ultimately, help with overall wellness in most consumers.
September 3rd, 2014 | The Blog
There has been a significant rise in childhood food allergies, especially nuts, over the past generation. This has prompted many studies about whether or not a pregnant woman should include nuts in her diet or not. The question remains unanswered, despite the research findings.
In years past, physicians used to believe that the best way to reverse the up-ticking trend in food allergies was to have babies avoid exposure to the popular allergens like nuts while in utero and during the first few years of life. Women were encouraged to avoid eating peanuts and tree nuts, even if they have no personal allergy.
The Updated Nut Allergy Theory
The previous practice and benefits of avoiding nuts during pregnancy has been somewhat disproved.
Current research, done by Boston Children’s Hospital, finds that babies born to women who consumed peanuts, almonds or other nuts on a daily basis during pregnancy are 30% less likely to develop peanut or tree nut allergies than those whose mother rarely ate nuts during pregnancy.
While the study shows strong support for pregnant women eating nuts, the study leaders have not made a firm declaration to change the universal practice of nut avoidance.
Women with and without nut allergies themselves were studied in the research.
Babies born to women with nut allergies who ate safe nuts during pregnancy?or those they were not allergic to nuts have a slight increase in nut allergies. It proved to be a non-significant increase. The data was compared to the statistics found in women with nut allergies who ate no nuts at all during their pregnancy.
The research is inconclusive with regard to a firm recommendation as to whether or not women should eat nuts during their pregnancy to protect their babies. The one conclusion the study derived is that women should not be afraid to eat nuts during their pregnancy, if they wish to do so.
It is important to note that peanuts are a good source of protein and also provides folic acid in the woman’s diet. Folic acid is important to prevent neural tube defects in the unborn. There are clear and present benefits to eating nuts, including peanuts, while pregnant.
The decision to be a nut eater or a nut avoider is left up to each woman during her pregnancy. Medical input from the attending obstetrician and involved pediatrician will help make the decision about whether to imbibe or not.
August 25th, 2014 | The Blog
Parkinson’s disease (PD) is a progressive nervous system disorder. It slowly and adversely affects a person’s movement. PD also:
Medications, which have many potential and potent side effects, are currently used to control the symptoms of PD. There is no cure for Parkinson’s disease.
Hyposmia is a Clue
Interestingly, almost all patients with PD have a decreased sense of smell or hyposmia. This is one of the first clinical symptoms of the disease, although not fully recognized or fully evaluated by the medical community as a whole.
It is important to note that not everyone with a decreased sense of smell has or develops Parkinson’s disease. There are many other causes that can make a patient lose their sense of smell.
New Diagnostic Tools for Parkinson’s Disease
Once hyposmia is established in the clinical setting, further testing is available to determine if the patient is on the path to developing PD. These studies will help to identify patients who will likely develop clinical symptoms of PD. The tests include:
The single photon emission computed tomography (DAT-SPECT) is done after DaTscan or I-ioflupane in injected into the patient’s vein to enhance imaging. The DaTscan is visualized and recorded by a special gamma camera.
The U.S. Food and Drug Administration (FDA) have approved DaTscan, a radiopharmaceutical agent. The side effects of this agent include:
Those with a DATdeficiency went on to develop PD in 61% of those tested. Their clinical symptoms developed within four years of testing.
The Benefits of Knowing
The clinical application of the new diagnostic tools remains limited to research-only casess at this time. It remains to be determined if the general population who appears to be at risk of developing PD, according to testing outcomes, would benefit from medication treatment trials. The medications would provide neuro-preventive potential to those at risk.
The International Parkinson’s and Movement Disorder Society (MDS) speculates that treating patients in neuro-protective medication trials will have greater success in treating PD than waiting to treat those who present for treatment with clinical features (tremors, gait issues, inability to swing arms when walking, blank facial expression) of Parkinson’s disease.
One Caveat to the Story
There is also research afoot regarding whether there is a link between hyposmia and Alzheimer’s disease. Currently, the loss of smell in patients suspected of developing Alzheimer’s disease leads to further cognitive testing to solidify a positive diagnosis.
Loss of smell is associated with the first cranial nerve, which is one of the first points impacted by cognitive decline.
Again, early diagnosis of the disease would support earlier treatment intervention to slow the process. Medications are especially helpful in treating early symptoms of Alzheimer’s disease.
More research on the subjects, both Parkinson’s disease and Alzheimer’s disease, is pending.
August 11th, 2014 | The Blog
A hysterectomy is done for a variety of medical reasons. Sometimes it is done to remove fibroids, endometriosis or for other reasons. There might be a cancer diagnosis or not.
It is important to note that this blog discussion focuses on laproscopic hysterectomies, not the traditional open abdominal surgery.
Laproscopic vs. Traditional Open Surgery
Open abdominal surgery requires a 3 to 7-inch incision. There is a longer recovery than laproscopic surgery but it allows the uterus to be removed intact.
Laproscopic surgery is done through several tiny incisions on the abdomen. It allows faster recovery than traditional open surgery. The uterus or fibroids must be cut into small pieces, which are then removed through the tiny incisions on the abdomen.
Recent research shows that a surgical device used during a laparoscopic hysterectomy might spread cancer in the patient’s body. The American Medical Association (AMA) has published a report about the device and called it?risky. The U.S. Food and Drug Administration (FDA) advised physicians to stop using it.
The device, which is causing all of the concern, is a laparoscopic power morcellator. A morcellator utilizes spinning blades to slice uterine fibroids or the entire uterus into fragments that can be removed through the small laproscopic incisions.
The morcellator has been in use in the U.S.for about 20 years but there is very little data about it available prior to the current cancer concerns.
A recent study found that 1 in 368 women who have a hysterectomy actually have hidden or undiagnosed uterine cancer. The most common cancers of concern are uterine sarcoma and endometrial cancer.
The morcellator can spread previously undetected cancerous tissue inside the body. When the uterus or other tissue is morcellated, pieces of the tissue can errantly remain in the body. If they are cancerous, this can spread the disease.
A Suggested Solution
If the uterus is placed inside a protective bag before morcellating, stray tissue pieces remain contained and cannot escape to other areas of the body. There are some U.S. hospitals that have recently started this extra precautionary measure.
Supporters of the morcellator argue that banning it is the wrong decision. They say that more women will have unnecessary traditional abdominal hysterectomies, which result in more significant scars, longer recovery time and the risk of more surgical complications.
Opponents of the device argue that the risk of using the morcellator is too high for an elective procedure. They say that there are alternatives to using the device, which should be considered.
Interestingly, in a recent study of 230,000 laparoscopic or minimally invasive hysterectomies, only 16% of them were performed with the morcellator after the safety of the device came into question.
The largest manufacturer of the device is Johnson & Johnson. The company recently suspended sales of the morcellator based on the FDA recommendation.
The FDA is considering whether to restrict or possibly ban the use of morcellators. A decision will be announced within this year.