December 2nd, 2013 | The Blog
There are significant changes to the cholesterol treatment guidelines. Significant enough that the number of Americans taking cholesterol-lowering statin drugs could potentially double. How is that possible?
Current Statin Usage
Currently, there are 36 million Americans taking cholesterol-lowering statin drugs.
Who is in the high-risk category and takes the most statins?
The usual course of statin treatment starts when the bad cholesterol hits a target number. According to the National Cholesterol Education Program, when the bad or LDL cholesterol reaches 130 mg/dL, statins are indicated to get the number below 100 mg/dL. Some physicians target lowering the LDL to 60 or 70mg/dL, which is an impossible task without taking statins.
Potential Statin Usage
Under the new guidelines, the number of American who can subsequently end up taking statins is 72 million. This is about 30% of the American adults.
The most commonly prescribed statins are: atorvastatin or Lipitor, rosuvastatin or Crestor and simvastatin or Zocor. The new guidelines strongly encourage physicians not to use drugs, other than the proven-effective statins, to reduce the risk of heart attack and stroke.
The cost for statin therapy ranges from $4-$150 per month.
Who Developed the New Guidelines?
One in three Americans die from a heart attack or stroke, according to Dr. Sidney Smith of the University of North Carolina, one of the guideline authors. Something within the healthcare system needed to change in order to lower this staggering statistic.
The guidelines were commanded by the National Heart, Lung and Blood Institute, a federal agency but were actually developed by two prestigious and well-respected groups, the American College of Cardiology and the American Heart Association. The basis of the guidelines is founded in the timeliest research on cardiac disease and stroke prevention.
The new guidelines lower the threshold for patients who are determined to have a significant risk for a heart attack or stroke. This includes patients who do not have elevated cholesterol levels.
The equation for the new guidelines to determine a patient’s risk of having a heart attack or stroke in the next 10 years include the following factors:
According to the new guidelines, statins are recommended for:
In simple terms, treatment with statins is suggested for:
Overall, statins are considered relatively safe. Obviously, treating more patients increases the risks associated with taking statins, especially when the dose is increased. They potential side effects include:
The muscle aches and pains can usually be reduced by lowering the dose of the statin or switching to a different statin.
It is important to note that statin therapy is a lifelong commitment to the drug.
Taking statins to lower cholesterol is a combination therapy. Lifestyle changes, including dietary intake, weight loss, blood pressure control and exercise, are imperative.
According to recent data, taking statins to lower cholesterol reduces the risk of suffering a heart attack, stroke or needing a future interventional cardiac procedure by 25%.
If no heart disease is diagnosed, taking stains lowers the annual risk of heart complications by 0.4%. If there is a history of previous heart disease, the annual risk is reduced by 1.1%. Type 2 diabetics taking statins have a 1% lower risk of cardiac complications.
It is imperative to discuss the pros and cons of statin therapy, based upon the new guidelines and a patient’s personal medical history,with a board certified cardiologist before starting a the course of treatment.
November 25th, 2013 | The Blog
Vision is vitally important to everyone. Preserving vision is priority to all. A regular, annual or biannual eye examination, with a qualified ophthalmologist or other eye specialist, is the first line of defense in preventing, diagnosing and treating degenerative eye disease.
But what happens if there is a degenerative eye disease or dramatic vision change found during a vision exam? First there are further evaluation studies and then follow-up appointments. Patients also need to self-check vision for subtle and dramatic changes several times a week and in extreme cases, on a daily basis. This is the case especially when age-related macular degeneration has been diagnosed.
The Current Standard
The standard for detecting changes in degenerative eye disease is the Amsler Grid, a paper eye chart. This chart is the common diagnostic tool but does not always give the most definitive results. Timely treatment of degenerative eye disease is critical to receiving successful treatment. Many new therapies have been developed over the past 10 years but timely implementation is critical for any of them to be effective.
The New Option
The U.S. Food and Drug Administration (FDA) recently approved new software for the iPhone 4S called myVisionTrack, which allows patients to do a simple vision test at home. At the present time, the new app is only approved for the iPhone 4S but the developing company, Vital Art and Science (VAS), is working to expand the app to all smartphone platforms.
There are over 40 million people worldwide who have a variety of degenerative eye diseases. Patients with diabetic retinopathy (DR) or age related macular degeneration (AMD) are the target users of this new app.
How the App Works
The myVisionTrack app functions by using global shape-discrimination to evaluate changes in the user’s vision. It should be used on a regular basis in between scheduled professional eye visits. The suggested frequency of self-testing is often twice a week or more, as indicated by the attending ophthalmology specialist.
Once the patient self-tests, the results are stored by myVisionTrack and compared to previous test results. If there is a significant change noted, the information is sent to the attending physician’s office or a central service center to be forwarded to the doctor.
The App Itself
myVisionTrack is trademarked and provides the user with accurate and portable information to monitor vision changes and retinal disease at home or anywhere. Check out http://myvisiontrack.com for more information about this new smartphone app. The app will be commercially available sometime during the last quarter of 2013.
November 18th, 2013 | The Blog
As of this moment in time, there is no proven or effective medical cure for a hangover. But, there is a new glimmer of hope for those who imbibe a bit too much. A recent, 2013, study done in China suggests a very surprising cure for the common hangover. The current research was revealed in the September 2013 issue of Food and Function.
Drinking Alcohol Explained
The human liver processes alcohol or, more clinically, ethanol into chemical byproducts. The byproducts are acetaldehyde and acetate. Acetaldehyde causes the typical hangover symptoms while the acetate offers the benefit of increased energy levels.
According to the Mayo Clinic, alcohol consumption causes many changes to the human body, which contribute to the symptoms of a hangover:
Everyone who indulges too much with their alcohol intake experiences a different combination of hangover symptoms. These are the most common hangover symptoms and complaints:
The best analogy describing a hangover is, feeling like you were run over by a bus the night before. This statement says it all.
In days-gone-by, the typical cure for a hangover included lots of coffee, ibuprofen and/or acetaminophen and a day in bed with the shades pulled down.
Recent research suggests that Sprite, a non-caffeinated, sugary beverage might be the cure that everyone has been awaiting. An interesting fun fact about Sprite is that, in China where the study was done, it is called Xue bi.
The study found that Sprite works to curb symptoms of a hangover better than 56 other beverages and herbal teas that were used in the study.
How It Works
So how does it work? Non-caffeinated, sugary drinks accelerate the breakdown of alcohol from acetaldehyde, a toxic byproduct, to acetate. Acetaldehyde causes nausea and other hangover symptoms. Acetate does not cause any of those typical hangover symptoms.
Sprite speeds up alcohol metabolism to lower acetaldehyde and increase acetate. Hence, hangover symptoms are lessened.
While Sprite has yet to be called a miracle cure for the common hangover, evidence points to a good possibility of it help in relieving the symptoms of a long night of imbibing or just plain drinking too much.
What are you drinking tonight? Drink responsibly at all times. Try your usual alcoholic drink with a Sprite chaser in the morning, if you happen to overdo it a little.
November 11th, 2013 | The Blog
Sleep apnea is a serious sleep disorder symptom. It is just that, apnea or cessation of breathing, albeit temporary.
About 3% to 7% of American adults suffer from obstructive sleep apnea.
Obstructive Sleep Apnea (OSA)
When the muscles in the back of the throat close, the upper airway becomes blocked. This causes an interruption in the normal breathing pattern. This can occur a few times a night or many times during a sleep period.
OSA is a physical condition with many far-reaching health ramifications:
Increased risk for health problems like cardiovascular disease, diabetes and some cancers
Obesity is one of the foremost risk factors for obstructive sleep apnea (OSA) in adults. Visceral fat, the kind that collects within the abdominal cavity and surrounds the organs, creates a significant risk.
In addition to obstructive sleep apnea (OSA), a high concentration of visceral fat increases the risk of other medical problems like cardiovascular disease and Type 2 diabetes.
Studies show that there is a direct link between obstructive sleep apnea and visceral fat, especially in males.
To begin with, men most usually have more visceral fat than women. This accounts for lower blood oxygen levels, which is a typical indicator of sleep apnea.
Men also carried higher levels of lipids in their blood, as in high cholesterol and high triglycerides.
Now, Onto the Women
Interestingly, the other type of fat, subcutaneous fat, which is found just beneath the skin on the abdomen, hips, thighs and other visible areas of the body, is associated with sleep apnea in women.
Of course, visceral fat in women plays a role in OSA but it is a greater risk to males.
It is important to note that women are more likely to go undiagnosed, which puts them at a greater risk of complications from OSA. The mortality rate is higher when OSA is left untreated. Again, men have a higher overall mortality rate from OSA than women.
Continuous Positive Airway Pressure (CPAP) therapy is an effective, long-term OSA treatment. It is the major therapy recommended for patients with significant visceral fat.
CPAP increases the air pressure in the throat to keep the throat open when a patient breathes in. The device is used every night while sleeping.
Maintaining a healthy weight, with special attention to the abdominal area, is critical to treating OSA. Not only is it important for proper rest but also for general good health and wellness.
Treating OSA is critical to maintaining overall health and avoiding medical complications. Consultation with a sleep disorder specialist and an overnight sleep study, during which the patient’s sleep cycle is monitored and recorded, is the first step towards treating a potentially serious medical condition.
November 4th, 2013 | The Blog
Vitamins are essential to the health and well-being of the human body. There are many myths and truths surrounding what is right or wrong with a daily vitamin regime.
It is important to consult a physician before starting a new vitamin supplement plan.
Here is a look at what works and what does not:
Vitamin C can prevent a cold
False! Researchers have determined that high doses of vitamin C do not prevent colds nor does it lessen the intensity of the symptoms. At best, vitamin C can help lessen the duration of a cold.
The recommended daily adult dose of vitamin C is 75 to 90 mg.
Excellent sources of vitamin C include:
Vitamins reduce age-related vision loss
True! Macular degeneration is the leading cause of vision loss in patients over 65 years of age. The vitamins zeaxanthin and lutein, which are found in fruits and vegetables, can help reduce the risk of age-related macular degeneration.
Vitamins C and E and zinc also help to reduce the risk of age-related vision loss.
There are vitamins essential to basic health.
True! There are 13 vitamins essential to human health. While a well-balanced diet is designed to meet the needs, some experts believe that vitamin supplements are necessary to round out the recommended daily allowances suggested by the U.S. Food and Drug Administration (FDA).
Vitamin B12 provides an energy boost.
False! B12 deficiency can cause anemia, not weakness. The symptoms of anemia include:
A diet rich in meat, fish and dairy provides an adequate B12 intake.
Vitamins and minerals add to bone strength.
True! The traditional calcium and vitamin D intake of a well-balanced diet is essential to healthy bones. Other nutrients that add to bone strength are: magnesium, potassium and vitamin K.
Vitamins and minerals are the same thing.
False! Vitamins originate from pants or animals. Minerals are products of the earth.
Vitamins provide growth, digestion and nerve function. They are identified by a letter such as A, B, C, D, E and K.
Minerals help with blood clotting, building strong bones and carrying oxygen throughout the human body. Examples of minerals include: calcium and iron.
There are some cases where a multivitamin supplement is indicated.
True! There are certain conditions in which supplemental vitamins are beneficial:
Vegans can suffer a vitamin and mineral deficit.
True! Patients on a vegan diet usually have no problem getting sufficient vitamin C, vitamin E and potassium. The most common deficit they suffer is with the important vitamin B12. B12 is most commonly found in animal source foods, including meat, eggs and dairy product, which are not part of a vegan diet.
High doses of vitamins and minerals are safe.
False! Taking too many vitamins and minerals can be toxic, even though they are found in foods. Some examples of dangerous levels include too much:
Vitamin A: causes nausea, vomiting and potential liver damage
Vitamin D: causes weakness, heart rhythm irregularities and confusion
Fat soluble vitamins A, D, E and K: cause potential liver and kidney damage
Iron is important for everyone.
True! Pregnant women need more iron than any other population, 27 mg per day, followed by premenopausal women who need 18 mg of iron a day. Iron is lost during menstruation. Men need only 8 mg a day.
Taking a daily multivitamin is the best way to get the proper vitamins and minerals.
False! There is a mixed review of this statement. One group of health experts states that there is no health benefit to taking a daily multivitamin for a healthy person. The contrasting group states that a multivitamin compensates for any otherwise missing vitamins and minerals in a person?s diet.? Both groups do agree that the best source of vitamins and minerals is a healthy diet.
B vitamins are essential to good health.
True! B vitamins help to convert food into energy, among other uses. B vitamins include B12, thiamin, riboflavin, niacin, pyridoxine and cobalamin.
The food sources for B vitamins include:
Vitamin D is impacted by exposure to the sun.
True! Human skin makes vitamin D when it is exposed to the sun. Some patients need vitamin D supplements to prevent a deficiency. They include:
Folic acid is essential.
True! Folic acid prevents neural tube defects, which result in serious birth defects. It is especially important that women who are planning on getting pregnant have adequate folic acid intake, usually through taking a supplement as recommended by their physician.
There is a mineral to help regulate blood pressure.
True! Potassium is an important mineral to reduce the systolic or top blood pressure, which is when the heart is contracted. Adults need 4,700 mg of potassium per day. A supplement is rarely needed because potassium is found in many foods including:
Vitamins and minerals are essential to keep the human body functioning at capacity. Supplements are sometimes, but not always, needed. The best individual recommendation for supplemental use of vitamins and minerals is through consultation with a healthcare provider.
October 28th, 2013 | The Blog
Headaches come in a wide variety of intensity. There are mild headaches and disabling migraine headaches. Physicians are charged with the duty of classifying headaches.
Recently, a new headache classification system, the International Classification of Headache Disorders, Third Edition (ICHD-III beta version), was published.
This edition is not the final word on headaches; it is a work-in-progress publication. There will be field-testing, comment collection and error corrections made over the next several years, before the final edition is completed. Only minor modifications are expected.
The current, third edition, has had some amendments since the last printing. The changes include:
This is a headache that occurs for at least 15 days of the month for more than 3 months. Previously, a migraine was diagnosed if it occurred once a year, once a month, once a week or once a day.
Other migraine classification criteria include:
Other Primary Headaches
There are 4 subgroups for primary headaches:
The changes in this category include:
The main categories for secondary headaches include:
and those due to:
This is a headache that has moderate to severe intensity and lasts 5 minutes to 72 hours. It is accompanied by photophobia and visual aura. While this headache type overlaps the specific migraine with brainstem aura, so some neurologists do not agree with the addition of this category to the classification system.
Menstruation Related Migraine
This is a controversial headache category that is important but it only applies to women, not men. It is listed in the classification’s appendix and not the more detailed main body, for that reason.
The goal of the new classification system is to attach a diagnosis to every headache with which a patient presents. Some patients end up with multiple headache diagnoses, based on the new classification system.
October 21st, 2013 | The Blog
Temporary tattoos are just that, temporary. Or so, that is what was first thought. The U.S. Food and Drug Administration (FDA) issued a recent warning about the dangers of this art form.
Temporary tattoos do not pierce the skin. Rather, a henna-like dye tints the skin’s surface in the desired design. These art forms usually last from three days to several weeks, depending upon the type of dye used.
Traditional henna creates a reddish-brown coloring on the skin. It is derived from flowering plants grown in the subtropical regions of Africa and Asia. The modern ink trend is black henna, which is not a pure substance. It is usually a blend of red plant-based dye plus a variety of other ingredients or it is just plain dark hair dye. Hair dye, especially the black pigment, contains p-phenylenediamine (PPD) found in coal-tar dye. PPD commonly causes skin reactions even when used for its intended purpose.
It is important to note that pure henna tattoos do not usually cause allergic skin reactions. The additional ingredients mixed into the henna to produce darker images are the usual culprits that cause an allergic reaction.
The Department of Public Health in most states regulates permanent tattoo parlors. The concerning issue is that they do not oversee establishments where temporary tattoos are applied.
Severe skin reactions have been reported in some cases. Unfortunately, the reactions far outlast the duration of the tattoos. They include, but are not limited to:
The adverse skin reactions can happen immediately after the temporary tattoo is applied or not for weeks later.
Topical steroids often calm a skin reaction to temporary tattoo dye. In certain cases, some wearers need more intense medical treatment, including oral antibiotics.
It appears that the red henna dye used for temporary tattoos does not cause the troubling allergic skin reactions caused by the currently popular black henna. The reason: red henna is a pure plant-based dye while black henna has many unknown ingredients, which are used to make the temporary tattoo as dark and as lasting as possible.
Temporary tattoos are growing in popularity at social events and also just to have the experience of wearing skin ink. It is important to question the tattoo artist about the dye ingredients and purity before proceeding with the process.
October 14th, 2013 | The Blog
Whether it is spring or fall, allergies are a problem for many patients. Almost 20% of Americans suffer from allergies. They can be allergic to one thing or to a compilation of several different things.
What is an allergy? Simply stated, it is an abnormal response by the immune system to an otherwise harmless substance. The common substances include pollen, animal dander or a variety of foods.
Different substances trigger allergies for different patients. The symptoms of an allergic reaction range from a mild runny nose to life-threatening anaphylaxis. The most common allergy triggers include, but are not limited to:
Trees, grasses and weeds all act as a trigger for hay fever and/or seasonal allergies. The typical symptoms include:
Treatments include decongestants, antihistamines, allergy shots and staying in a controlled environment when pollen counts are high.
The oil glands in an animal’s skin and their saliva secrete a protein, which can cause allergic reactions in some patients. The allergic response is slow to develop, sometimes taking up to two years, and almost as slow to abate, several months, after being away from the animal exposure.
If a patient is adamant about having a pet, despite the consequences, there are some important guidelines to suggest:
Dust mites are gross. They are microscopic organisms that live in house dust. They multiply in humid conditions and feed primarily on dead shin cells from humans or animals.
Protection from dust mite allergies includes:
Insect stings can cause a range of symptoms. The reaction to a sting can be redness or swelling at the site, nausea, fatigue and/or a low grade fever to anaphylaxis.
If a patient suffers difficulty breathing, swelling around the face, throat or mouth, racing pulse, rash or hives, dizziness or hypotension, emergency treatment is indicated. Some patients require an Epi-Pen injection while waiting for a 911 response.
Molds develop into allergens. Inhaling or touching mold can trigger an allergic reaction in some patients.
Mold breeds on moisture so it is often found in basements and bathrooms, as well as in grass and mulch.
It is important to avoid activities that can trigger a response, such as raking leaves. Ventilating and dehumidifying moist areas of the home are a good way to avoid mold.
Food allergies can be severe. The most common allergens include:
The symptoms of a reaction include respiratory difficulty, hives, vomiting, diarrhea and swelling around the mouth. Some patients require Epi-Pen treatment while awaiting a 911 response.
The best treatment is to avoid ingesting all foods to which a patient is allergic.
Gloves, condoms and some medical devices contain latex and can trigger an allergic reaction. The common symptoms of a reaction include:
Again, a reaction can be mild to severe, sometimes requiring EpiPen administration. Wearing a Medic Alert bracelet is recommending in this situation.
Penicillin is a common drug on the list of medications to which a patient is allergic. The list of potential drug allergies is vast and varied. Drug reactions can be mild with hives and itchy eyes to an anaphylactic reaction requiring an EpiPen.
Treatment for mild drug reactions can include antihistamines or steroids. It is best to avoid taking the alleged drug.
Fragrances do not just indicate perfumes and colognes. They are also found in scented candles, cosmetics and household cleaning products. Mild to severe health issues can arise from a fragrance allergy. The symptoms usually abate when the sent dissipates.
Cockroaches are disgusting creatures. Their droppings contain a protein to which some patients can have an allergic response. They commonly infest homes in warm climates.
Eradicating the cockroaches from living quarters is done by the use of pesticides, keeping kitchen area clean and repairing cracks in walls, floors and windows.
While the list of potential allergens in unlimited, the aforementioned triggers are the ten most commonly reported. Consultation with a qualified allergy an immunology specialist is an important first step in determining the appropriate and safest treatment.
October 7th, 2013 | The Blog
The Affordable Care Act (ACA), aka Obama Care, was signed into law on March 23, 2010. It is the most significant overhaul in the U.S. healthcare system in almost 50 years.
Healthcare costs in the U.S. have recently increased by over 9% a year. Affordable insurance is defined as costing no more than 8% of a person’s annual income, if purchased through the federal government website, or 9.5% of family income when purchased through an employer.
The majority of the ACA takes effect by January 1, 2014. The law encourages medical insurance coverage for all Americans and calls for reform in many areas of the U.S. healthcare system.
About 15% of Americans are uninsured. The ACA makes health insurance affordable and reduces the overall cost of healthcare. It caps out-of-pocket costs and fully covers all preventive care.
The ACA contains ten titles, each of which addresses a different area of the healthcare system. Highlights of the law include:
The Impact of ACA
Most Americans must have health coverage in 2014 or pay and Individual Mandate or fee on their federal income tax return. The fee is: $95 per adult, $47.50 per child or 1% of the individual’s income, whichever is higher.
Exemptions from participation in the federal program include those on Medicare, Medicaid, COBRA, VA health coverage and job-based, personally purchased or retiree insurance. No coverage change needs to be made for any of these plans.
October 1, 2013 through March 31, 2014 is open enrollment on the federal Health Insurance Marketplace. Individual Americans making $45,960 or $94,200 for a family of four can shop for coverage options on the Marketplace. Young adults can stay on their parent’s health insurance until they are 26 years old.
The cost for medical insurance from the Marketplace averages under $100 for about half of the population. Smokers will pay up to 50% higher premiums than non-smokers.
Healthcare institutions and medical professionals are paid incentives by health insurance companies if they improve the quality of care. Keeping patients healthier through preventive care is an important component of the law.
On the Job Scene
The ACA changes insurance payments, especially Medicare, to hospitals and other healthcare institutions from a fee-for-service to an incentive for the delivery of quality medical care. This is a major step towards controlling healthcare costs.
Medicaid payments will be increased to match the fees that Medicare pays out to doctors. This represents an average 73% pay increase for primary care physicians. This change will help Medicaid patients more easily find a doctor who accepts their insurance.
More financial support for advanced practice and general nursing education will be available for nurses. There is a grant program to fund nurse-managed, specifically nurse practitioners, health clinics that will help alleviate the shortage of primary care physicians in the country.
Nurses working in hospitals will witness a higher census. Adequate nursing staff levels are needed to prevent patient complications. The ACA bases fiscal reimbursement to healthcare institutions on improved patient care and a lowered number of readmissions.
The End Result
The ACA provides all Americans with health insurance. It is the law or a tax is incurred.
October 1st, 2013 | The Blog
Breast cancer is the second leading cause of death in women in the United States. According to the American Cancer Society (ACS), about 232,340 new cases of invasive breast cancer and 64,640 new cases of carcinoma in situ (CIS) are diagnosed every year. About 1 in 8 women born in the U.S. today will develop breast cancer during their lifetime and there are about 39,620 deaths from breast cancer per year.
Breast Information Basics
The female breast has three basic components: glands, ducts and connective tissue. They each serve a specific purpose:
Breast composition differs between women.
Breast Cancer 101
There are different types of breast cancer, depending upon where in the breast the disease starts. It can start in the ducts or in the lobes of the breast.
The different kinds of breast cancer include:
Both types of invasive breast cancer can metastasize or spread to other parts of the body.
According to experts, new breast cancer cases have stabilized since 2005. The survival rates are better. Why? There are more targeted treatments, earlier detection and better breast awareness. The National Breast Cancer Awareness Month (NBCAM) has effectively impacted this effort.
National Breast Cancer Awareness Month (NBCAM)
Over the past 29 years, October has been the designated National Breast Cancer Awareness Month (NBCAM). It is a time for raising awareness, continuing to educate the public and raising funds needed to continue the ongoing research throughout the year.
There are important objectives for National Breast Cancer Awareness Month:
NBCAM is a collaborative educational effort among national public service organizations, professional medical organizations and government agencies. The American Cancer Society and the pharmaceutical giant, now AstraZeneca, were the primary founders.
Today, the Breast Cancer Research Foundation and the Susan G. Komen Foundation, with their symbolic pink ribbon campaigns, are major contributors to NBCAM.
The most effective diagnostic tool in the fight against of breast cancer is mammography. NBCAM is an effective forum to spread the word about the importance of regular mammograms. According to the ACS:
The Celebration and Events
In addition to educational information and awareness of the importance of mammography and early detection, NBCAM is an opportunistic time to raise funds for breast cancer research. Some of the nationwide fundraising events include:
The third Friday in October every year is National Mammography Day. This year, the day falls on October 18th.
Annual breast cancer screening with a mammogram after age 40 is an important diagnostic tool in the fight against the disease. Regular screening leads to early detection and early detection leads to better outcomes.