August 24th, 2015 | The Blog
Heart failure is a serious condition in which a patient’s heart does not pump enough blood through the body. The symptoms of heart failure include but are not limited to:
Patients can become very uncomfortable, especially with regard to their breathing status very quickly with this condition.
Heart Failure Facts
Heart failure can happen for many reasons including after a heart attack and high blood pressure among the main causes. There are 5.1 million people in the U.S. who suffer from heart failure.
This condition is a major cause of physical disability and death among adult patients, according to FDA authorities.
Typical Treatment of Heart Failure
Common treatment for heart failure includes beta-blockers, diuretics, digoxin and other medications. Other possible treatments for the condition include coronary artery bypass surgery, heart valve surgery and a left ventricular assist device (LVAD), which is a treatment option in extreme cases while awaiting heart transplant.
A patient’s treatment plan depends solely upon the acuity of their ?symptoms in addition to an evaluation of their past plan of care to determine what was effective and what did not offer relief of their symptoms.
New treatment of heart failure
The U.S. Food and Drug Administration (FDA) recently approved a new drug, which is also in a new class of drugs, to treat heart failure. The drug, Ernesto or sacubitril/varsatan, has been found to significantly lower the number of hospitalizations and rate of death due to heart failure.
Ernesto is the first drug in a newly established class of drugs called angiotensin receptor neprilysin inhibitors or ARNIs. It is often prescribed along with some of the standard heart failure treatments like beta-blockers and diuretics.
Ernesto Side Effects
The side effects of Ernesto include low blood pressure, elevated blood potassium level and impaired kidney function in some patients. Some patients suffered a more serious side effect called angioedema.
Angioedema presents with swelling of the lips or face and is a serious, life-threatening side effect of the new drug. Studies show that patients with a previous history of angioedema and black patients are at a greater risk than others of developing this serious side effect. This condition warrants 911 medical attention.
Patients taking ACE inhibitors should not take Ernesto because they are at an increased risk of developing angioedema. ACE inhibitors include but are not limited to these drugs:
Also, women who become pregnant should stop taking the drug immediately.
Taking the drug as prescribed and close follow-up with the prescribing physical is critical to the success of this treatment protocol. Patients should be instructed to call their physician for any change or worsening of heart failure symptoms when starting the new medication.
According to the clinical trials done with Ernesto, the number of hospitalizations and rate of death are lower than without taking the drug. Given the positive results of the clinical trial, the FDA?fast tracked the approval of the drug for use in the general population.
August 10th, 2015 | The Blog
Yogurt is a staple in the American diet. It is consumed as a snack or can be a meal, especially when coupled with some fresh berries and/or some delicious granola. Some yogurt brands come with the add-ins included. There are so many varieties of yogurt on the market; there is something to please everyone’s taste buds and dietary restrictions or choices.
There is the traditional spoon-eaten yogurt and also squeeze tubes and other handy delivery systems to make yogurt easy to eat on-the-go.
What Is Yogurt?
The base of yogurt is milk or cream, usually pasteurized, which is then fermented with a variety of live (active) bacteria cultures. The most common live culture in yogurt is Lactobacillus bulgaricus, although there are others used in some brands. The mixture is then incubated at a specified temperature to enhance bacteria growth.
The bacteria works to change the natural sugars in the yogurt to lactic acid. Lactic acid gives yogurt the classic tanginess, which is associated with it. The process continues by straining the mixture to remove excess fluid from the yogurt. This leaves the end product with a creamy consistency.
Is Yogurt a Healthy Diet Choice?
There is such a variety of yogurt on the market that the buyer?s choice determines whether or not their choice is healthy. Many yogurts are high in protein, low in sugar and have no chemical additives. Others are full of sugar and contain additives and preservatives.
Certainly, any patient who is lactose intolerant should not eat yogurt, as it is a dairy product containing milk or cream.
There are many types of yogurt available. Here are a few of the most popular types of yogurt:
Low-fat or non-fat
Low fat yogurt is made with 2% milk and non-fat is made with skim or 0% milk.
This type of yogurt is traditionally thicker than regular yogurt. It is made by further straining regular yogurt to get a more concentrated and therefore higher protein product. The additional straining lowers the calcium content of Greek yogurt.
Greek yogurt is available in full fat, low fat and 0% fat options.
This is an Icelandic-style yogurt that uses four times the amount of milk to make than regular yogurt uses. It is high protein with two to three times more protein than in regular yogurt.
Buyers beware. According to the National Yogurt Association (NYA), not all frozen yogurt contains live and active cultures because some are processed on heat that is too high for them to survive. It is important to check the label for the NYA Live & Active Cultures seal.
Also, frozen yogurt, by virtue of being a frozen dessert treat, traditionally has higher sugar content than non-frozen yogurt.
There are some soy and coconut milk yogurts available for patients who are lactose intolerant.
Pros and Cons of Eating Yogurt
The bottom line is that yogurt is a generally healthy choice. Watch the sugar content and keep it under 10 grams per serving.
August 6th, 2015 | The Blog
The shingles vaccine is not always 100% effective in preventing the disease. But, even if a vaccinated patient develops shingles, having had the vaccine can reduce the risk of long-term post-herpetic neuralgia (PHN) or pain. A recent study by the U.S. Center for Disease Control and Prevention (CDC) evaluated the effect of the shingles vaccine with regard to PHN.
What Is Shingles?
Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After a patient has chickenpox, the varicella-zoster virus remains in their body but it is dormant for a period of time. It usually does not cause any health problems until the patient is somewhere over 50 years of age, if ever.
As patients age, the varicella-zoster virus can reappear as shingles. It is important to note that most shingles patients are over 50 years old but anyone who has had chickenpox, even at a much younger age, is actually at risk of developing the disease.
There is no cure for shingles; the acute symptoms of the virus have to take their course. Once the acute illness has passed, many patients suffer from post-herpetic neuralgia, which can be very uncomfortable.
Treatment for Shingles
For the most effective results, it is important to seek early treatment intervention for shingles. Some anti-viral medications can help to battle the virus and possibly prevent some of the potential and often painful PHN, according to the U.S National Institutes of Health (NIH).
The Shingles Vaccine
All adults over age 60 years should be vaccinated with Zostavax, the shingles vaccine developed by Merck. It is best to be vaccinated between the ages of 60 to 69 years. Older individuals can also receive the vaccine, although the protection is lessened over age 69.
Zostavax is a live vaccine, which has lowered the cases of herpes zoster or shingles by 51.3% in adults over the age of 60 years, according to the manufacturer. It also reduces the risk of PHN by about 67%. It is effective for at least six years after administered and maybe longer.
PHN is usually very uncomfortable. Unvaccinated patients have more PHN than vaccinated patients, which is a good reason for eligible patients to receive the vaccine. Here are some statistics to convince the general population about the importance and benefits of being vaccinated against shingles:
Unvaccinated patients who report PHN:
Vaccinated patients who report PHN:
Interestingly, it is recommended that even patients who have already had shingles be vaccinated, if they have not done so already. It can prevent them from developing another case of the illness at a future time. There is no specific waiting time after having shingles before a patient can be vaccinated, although it is recommended that the shingles rash be gone before being immunized.
The bottom line is this: the shingles vaccine reduces the risk of long-term post-herpetic neuralgia significantly, especially in women. The study authors report, in a recent edition of the Journal of Infectious Diseases, that the difference in the reported PHN is probably due to the difference in if and when men and women actually seek medical care for the chronic PHN.
July 27th, 2015 | The Blog
Melanoma is a sometimes deadly and always dreaded form of skin cancer. It is the third most common cancer in people, especially young women, from the ages of 15 to 39 years old. Young women account for about 66% of the cases of melanoma in the U.S.
What is Melanoma?
Melanoma is a skin cancer that starts in the cells of the skin (melanocytes) that produce melanin, which gives the skin its color. It can start on any area of the skin, including areas that are not exposed to the sun.
It is a very virulent strain of skin cancer so early diagnosis is key to treating and curing melanoma, which often grows and spreads to other parts of the body. The spread of melanoma makes treatment much more difficult to treat. According to the American Cancer Society, melanoma accounts for 10,000 of the 13,000 skin cancer deaths every year in the U.S.
The Increased Number of Cases
Since the 1970’s, there has been a dramatic increase in the number of cases of melanoma in the U.S. The greatest increase, a dramatic 250%, has been diagnosed specifically among children and young adults. This is an alarming statistic.
The most susceptible population seems to be young women, who represent about two-thirds of the diagnosed melanoma cases. The main cause of the uptick in melanoma cases is being associated with the unsafe tanning practices that this particular population follows, which include sunbathing and the increase in indoor tanning. Indoor tanning is just as dangerous, with regard to developing skin cancer, as the natural ultraviolet rays (UV rays) from the sun.
The Survival Rates for Melanoma
Despite the increased number of melanoma cases, there is good news in the survival rate statistics for the sometimes-deadly disease. The survival rate after diagnosis was only about 85% in the mid-1970 but moving forward from 2011, it has increased to about a 95% survival rate.
Treatment choices for melanoma depend upon the stage of the disease and if there has been any metastasis to other areas of the body.The treatment options include, but are not limited to, surgical removal of the tumor and any associated lymph nodes,?chemotherapy, radiation, biotherapy or immunotherapy and targeted drug therapy. Sometimes, a combination of treatments is the best option for effective recovery.
Addressing the Problem
The risk of developing melanoma, which has become a national health concern, needs to be openly addressed by parents, healthcare providers, health educators and anyone else with a voice to, especially, the younger population.
There needs to be increased awareness of the potential dangers from sun exposure and also lessons in effective prevention techniques, such as conscientious and consistent use of sunscreen, not being outside in direct sun exposure during the peak hours of 10 AM to 2 PM, frequent self skin checks to determine any change in a mole or pigmented area on the skin, annual professional skin checks and, preferably, avoidance of sun exposure.
Genetic and environmental risks of developing this type of skin cancer, melanoma, should be evaluated. Skin cancer screenings, which foster early detection, are vital to prevention of this potentially deadly disease.
Prevention is critical and can help to reduce and, hopefully, keep the melanoma statistics lower than the current trend of the disease.
July 23rd, 2015 | The Blog
The yearly flu vaccine formula is the U.S Centers for Disease Control and Prevention’s (CDC) best guess to protect everyone from the flu. The vaccine’s composition is determined months ahead of the upcoming flu season, so it really is a guess about what flu stains will be actively and virulently circulating each year.
The flu vaccine formula is determined in about February of the current year and vaccine manufacturing begins in the early summer months, in order to give the pharmaceutical companies enough time to manufacture the millions of doses needed to protect the U.S. population.
2014-2015 Flu Vaccine
The 2014-2015 flu vaccine was less than a perfect match for the circulating influenza strains so the CDC is making adjustments for the upcoming 2015-2016 flu season. The actual threat and then presence of the H3N2 strain was not determined until the summer of 2014, hence it was not included in the 2014-2015 vaccine. Once it was determined to be a health threat, there was not sufficient time to incorporate the H3N2 strain into last year’s flu vaccine.
The 2014-2015 vaccine was determined to be only 18.6% effective against the H3N2 virus, which was the season’s most virulent strain of influenza. Deaths from the H3N2 flu strain were unusually high, especially among the elderly and pediatric populations.
2015-2016 Flu Vaccine
According to the CDC, as stated in a recent Morbidity and Mortality Weekly Report, components of the 2015-2016 season vaccine have been changed to more optimally match circulating viruses. There will be broader protection against the flu with the updated 2015-2016 vaccine composition.
The 2015-2016 flu vaccine will protect against the currently predicted strains that are circulating, which include two influenza type A viruses, H1N1 (the cause of the 2009 pandemic flu) and H3N2, plus an influenza B virus making it a quadrivalent vaccine.
There is no guarantee, according to authorities at the U.S. Centers for Disease and Prevention, that another, unpredicted flu strain, which is not included in the 2015-2016 vaccine, will emerge and gain strength leaving the population unprotected against it.
Quadrivalent Flu Vaccine
There is and has been a quadrivalent flu vaccine available in the past, which protects against four flu viruses, instead of the traditional three viruses found in the most commonly administered immunizations. This vaccine covers two influenza A viruses and two influenza B viruses. It is especially recommended for those at a high risk of complications from the flu, which include immuno-suppressed, elderly and others with chronic medical conditions.
Who Should Be Vaccinated?
The CDC recommends that everyone 6 months and older be vaccinated against the flu every year. There are exceptions to this recommendation, which should be discussed with every patient’s primary care physician.
The current year’s flu vaccine is usually available sometime in September. There should be lines of patients waiting to be immunized as soon as the vaccine is available.
An important caveat of which to be aware is that, even if the vaccine is not a perfect match to the circulating flu viruses, it remains the best protection available against the sometimes-deadly influenza viruses, whatever they might be in a given year.
July 16th, 2015 | The Blog
There are a lot of patients who declare that they eat a gluten-free diet, whether diagnosed with celiac disease or not. Gluten clearly causes many gastrointestinal issues but it is an imperative diet omission for anyone who is diagnosed with celiac disease.
There are almost 3 million Americans who are actually diagnosed with celiac disease. Those patients must avoid all gluten in their diet.
Many food products are labeled as “gluten-free,” but are they truly void of gluten? The U.S. Food and Drug Administration (FDA) is making a special effort to be sure that they are.
Many food products are labeled as “gluten free,” but are they truly void of gluten? The US Food and Drug Administration (FDA) is making a special effort to be sure that they are absolutely gluten-free.
Gluten is a collection of proteins that are found in wheat, rye, barley and crossbreeds of each of these grains. It helps baked goods to have a light and flaky texture.
Celiac Disease Explained
Celiac disease is an autoimmune disease, which has no cure but is most simply and initially treated by eating a “gluten-free” diet.
Gluten is disruptive for patients with celiac disease. It enhances the production of antibodies that negatively affect and potentially damage the lining of the small intestine. This, in turn, lowers the patient’s ability to absorb important nutrients from their usual diet. When important nutrients are not absorbed, there are serious impending and potential health risks including osteoporosis, infertility, intestinal cancers and more.
Avoiding gluten helps patients with celiac disease to have better control of their symptoms. The symptoms include abdominal pain, bloating, diarrhea, weight loss, fatigue, rashes and other long-term medical problems.
FDA and Gluten-Free
The FDA is working to be sure that food labels that read “gluten-free” truly meet the criteria of their definition, which is less than 20 parts per million of gluten. Other label wording like “no gluten”, “free of gluten” and “without gluten”must also meet the full “gluten-free” FDA requirements.
Until recently, the FDA did not regulate any of the “gluten-free” foods; instead, manufacturers had their own interpretation of the term and labeled foods as “gluten-free” at will.
It is important that patients who do not have professionally diagnosed celiac disease to continue to eat gluten so they do not develop a nutrient deficiency. In this world of self-diagnosis, there are many patients whom have declared themselves “gluten-free” without a confirmed diagnosis by a qualified physician.
Many gluten-free foods are higher in calorie than non-gluten-free choices. This fact can lead to weight gain, which should be monitored in the long-term.
The U.S. government is taking celiac disease very seriously. There are standards to which all food manufacturers will be held accountable, according to the FDA regulations.?Food manufacturers must adhere to the “gluten-free” regulations imposed by the U.S Food and Drug Administration in order to keep the affected population healthy and safe.
July 10th, 2015 | The Blog
Cancer and heart disease kill more Americans than any other medical conditions. But interestingly, they are not as expensive to treat and care for as dementia, especially Alzheimer’s disease.
There are an estimated 4.1 million, according to the National Institute on Aging survey, to 5.2 million, according to the Alzheimer’s Association, Americans suffering from some form of dementia. Astoundingly, Alzheimer’s disease costs U.S. families and patients, collectively, somewhere between $157 and $215 billion each year to treat.
The high cost of care for dementia patients is compared to $102 billion spent to treat heart disease and $77 billion spent to treat cancer each year in the U.S.
Alzheimer’s Disease Facts and Figures
There are many numbers assigned to general dementia and Alzheimer’s disease. The most poignant facts include the following:
What Costs So Much?
Patients with Alzheimer’s disease are often on prescribed a variety of medications to help control their symptoms. There are currently no drugs to actually halt or reverse the symptoms of dementia and there is no cure for the disease.
The cost of the drugs and other necessary medical treatments do not mount up the cost to treat the disease as much as the care each patient needs to navigate through everyday life.
While the true cost of dementia care includes everything from medications to nursing home care, the cost would be higher than the authorities state except the statistics do not include informal care and lost wages for family members of dementia patients. The cost of informal care by family members was determined by what the cost for a home health aide would have been for the same number of hours spent with the patient. This expenditure added $41,000 to $56,000 more per patient per year to the cost for dementia patient care.
Dementia robs a patient of their ability to make independent decisions, perform activities of daily living and maintain meaningful interpersonal relationships.
The number of cases of Alzheimer’s disease is trending upward in the U.S., mostly due to a rapidly aging population and fewer young people. It is important to work on two approaches to dealing with the dreaded disease:
Alzheimer’s disease acutely and adversely affects the patient but also impacts the family, friends and caregivers of the patient. Moving forward, it is important to find the best plan of care to suit the needs of all those involved in each patient’s care.
June 29th, 2015 | The Blog
The past winter weather was harsh, in so many ways. The cold temperatures and the extreme piles of snow made it a record-breaking season in many parts of the country. We will continue to feel the effects, especially, of the record-breaking snow as we pass through the summer months. How is this possible, you ask?
The tiniest of ticks, those troublesome and disease-laden insects, benefitted from the deep snow cover over the winter months. The deep snow cover actually protects tiny insects from the effects of frigid air temperatures. Snow works as an insulating blanket to prevent the ticks from freezing and dying.
There is a potential for a higher population of ticks this summer because of the snow protection. The ticks are protected by deep snow cover and do not die off so they go on to survive the summer season ahead.
This phenomenon might be countered by the increasingly arid or dry conditions that have evolved over the recent spring season. The dry conditions can work to keep the tick population better controlled.
Which way will it go? According to public health official, it is too early to tell, for sure.
Ticks are everywhere, in the woods and in rural and suburban areas. Ticks carry Lyme disease. There are two primary types of ticks:
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 300,000 Americans are diagnosed with Lyme disease every year.
Prevention is the best advice to control the Lyme disease epidemic, especially in the Northeast and upper Midwest areas of the country. Some important prevention tips include:
Lyme disease symptoms include, but are not limited to:
Advanced and untreated cases of Lyme disease can lead to more alarming symptoms including, but not limited to:
Other Tick-Borne Diseases
Lyme disease is the primary tick-borne disease but there are other concerning illnesses that they can spread, anaplasmosis and babesiosis. Currently, there are 604 cases of anaplasmosis and 520 cases of babesiosis reported in the U.S. each year.
Both diseases can present as flu-like symptoms and potentially lead to death, especially in the elderly population or anyone with a weakened immune system. There is treatment available for these two tick-borne diseases.
One other tick-borne disease, according to the CDC, is Powassan virus. There have been 75 reported cases in the U.S. The symptoms of this disease include:
Unfortunately, there is no current treatment for Powassan virus.
It is important to be aware of the potentially serious and active Lyme disease season that lies ahead. Again, prevention is key to stopping cases of Lyme disease from climbing any higher. Be aware, be alert and be sure to do a full skin check when coming inside from the wonderful outside activities of summer. You will be glad that you did.
June 25th, 2015 | The Blog
Pain is real but controlling pain can become unreal. In this world of chronic pain coupled with a rising trend in addiction, there is great concern. It is often difficult to relieve pain without the health risks related to potentially addicting drugs.
Chronic pain comes in all forms from back pain to headaches to joint pain and more. About 50% of Americans report that they experience some sort of chronic pain. The Institute of Medicine confirms that about 116 million adults suffer from chronic pain each year.
The U.S. Food and Drug Administration (FDA) recently added warnings to extended-release opiates like OxyContin and Opana ER stating that they should be used only as a last choice of pain treatment. Despite the old adage that, if taken according to a prescription, pain medication is safe, the statement is untrue. Even when taken as directed, there are still an addiction risk, accidental overdoses and potential death from these drugs.
The next step down in medication includes non-steroidal anti-inflammatory drugs like ibuprofen and naproxen. These medications can increase the risk of GI problems like ulcers and internal bleeding. Even acetaminophen, when taken in high doses, can cause liver damage.
Deaths related to drug overdose have increased three-fold over the past quarter century, during which there was a dramatic increase in prescribed opiates. There have been over 1,500 acetaminophen-related deaths in the U.S. over the past 10 years.
Drug Free Solutions for Chronic Pain
Something needs to be done, something drug free, to control chronic pain. What is the solution?
Some doctors have turned to stress management and alternative/integrative medicine. What is available to help control chronic pain? These treatments can be used alone or in combination, depending upon each individual case.
Medical insurance coverage for the drug-free pain control is sometimes a challenge to get approved. Currently, evaluation and mediation counseling are the easiest to get covered while yoga and acupuncture, because they are administered by someone other than a licensed physician, are more difficult to get covered.
Other drug free pain remedies include:
The Benefits of Drug Free Pain Control
The replacement therapies do not have any side effects, like drugs do. Many of the suggested therapies are self-help techniques, which can be done at home after proper instruction by a therapist.
Physicians are ever more aware of the evolution of drug addiction in the U.S. Drug free chronic pain control techniques need to be of paramount importance to control the alarming rising addiction statistics. This will save a lot of health problems, heartache and, most importantly, the effort will save lives.
June 16th, 2015 | The Blog
Suicide is the 8th leading cause of death in the US. Over 1% of all deaths in the US are the result of suicide. About 30,000 Americans die by suicide every year and another 500,000 unsuccessfully attempt to kill themselves.
Attempted suicide versus completed suicide is at least 10:1. About 30% to 40% of those who successfully kill themselves have made a previous attempt.
The age of suicide victims rises with aging. About 40% of suicide victims are over 60 years old. The rate of suicide is even higher after age 75 at which time it rises to about three times higher than the average rate.
Suicide is not discriminating. It can affect the elderly, children, wealthy, poor, celebrity and those who are unknown. Some people have a greater risk than others.
Suicide is the result of a serious mental or emotional disorder. 30% to 70% of suicide victims in the US have severe depression or bipolar disorder. Substance abuse is another big influence on suicide rates; about half of all suicides involve substance abuse.
There are many clues and indicators about a patient’s suicide risk. They include, but are not limited to:
Blood Test Predictor
How else can a patient’s suicide risk be predicted? According to Johns Hopkins University School of Medicine, there is a genetic marker linked to a patient’s susceptibility for suicide. This marker could be used to develop a suicide-diagnosing blood test.
The research documented that there is reduced activity of the SKA2 gene in patients who died from suicide. The SKA2 helps the body respond to stress and controls impulsive behavior. Patients with less active SKA2 genes where more prone to commit suicide than others in the study. The reduced activity is the result of a chemical change, specifically the addition of methyl groups.
Patients with sluggish SKA2 are not able to stop negative thoughts and fears. Patients with higher levels of methylation were found to be more likely suicide victims.
Blood Test Accuracy
Researchers predicted a person’s suicidal thoughts with 80% accuracy with the blood test.
Testing military veterans upon arrival home from deployment and others possibly at risk can help to predict the likelihood of suicide. This blood test can possibly save lives.
Another important use for this blood test is psychiatric emergency room evaluation. It can also be helpful in deciding if certain medications, which have been linked to suicidal thought, are a good choice for some patients. The test will help the prescribing MD and patient make informed treatment decisions before starting a new medication regime.
The Final Word?
So how does this blood test really work? Actual chemical changes to the SKA2 gene, which is directly linked to the body’s stress response, might predict a patient’s risk of attempting suicide.