March 2nd, 2015 | The Blog
Look around the over-the-counter analgesic and fever aisle. There are so many different forms of medication available. There are tablets, caplets, softgels, gelcaps, liquids, powders, quick-dissolve tablets and chewables. While they are all effective, which one works the fastest?
The Absorption of Medication
After swallowing, traditional tablet forms are broken down into smaller particles, dissolved in the stomach and absorbed by the intestinal tract into the blood. Other forms of medications are absorbed faster because they do not need to be broken down as much as a solid tablet.
Pros and Cons
Here are a few of the pros and cons of the different forms of medications, which are readily available on the market:
Solid tablet or pill form
Patients and their healthcare providers choose different medication delivery forms based upon individual needs and preferences. There are a few factors that influence the decision:
The delivery choice does not significantly, although it does minimally in some cases, affect the absorption of any medication. The delivery form is a personal choice for personal reasons.
February 23rd, 2015 | The Blog
Long, lush eyelashes are the envy of the runway and the everyday woman. The current beauty trend is for bold eyebrows and stunningly full eyelashes. If you were not born with naturally long and thick eyelashes, you are now in luck. There is a new product available on the market.
SmartLash is a non-prescription, dermatologist recommended, eyelash enhancer. It is an affordable option for many patients.?Many healthcare providers suggest that patients seek the professional opinion of a qualified dermatologist before starting to use this product.
How It Works
Patients who use this product state that 4 weeks of regular use leads to fuller and longer eyelashes. SmartLash can also be used on the eyebrows to make them more shapely.
Most eyelash enhancers are made with prostaglandin, a hormone, which can cause darkened irises (the color around the pupil of the eye) and blurred vision. The darkened irises are an irreversible side effect of some of the more popular prescription enhancers like Latisse. SmartLash does not contain any hormones or parabens.
So what does this product contain??SmartLash contains a blend of polypeptides, amino acids and conditioning agents, which enhance lashes and help to prevent eyelash breakage.
The Mechanics of the Product
SmartLash is easy to use. Here is a simple explanation of how to use it:
Who Can Use SmartLash?
The product is user-friendly. Most people who have used SmartLash have not experienced any eye irritation or eyelid discoloration. Most patients with eye sensitivity can safely use it. It is also safe for most contact lens wearers.
The Effectiveness of the Product
The numbers collected through user studies tell the tale about SmartLash:
The Cost of Eyelash Enhancement
The cost is reasonable and the product is dermatologist recommended. SmartLash Eyelash Enhancer costs about $29.95 for a 0.16 ounce container.
The price (literally) of cosmetic enhancements must be weighed against the effectiveness of a product and the potential side effects with regular use.
SmartLash is not FDA approved but neither are many other cosmetic products regularly used in the US.?It is important to note that Latisse, a prescription product, is the only US Food and Drug Administration (FDA) approved eyelash enhancer. Latisse actually stimulates growth of eyelashes but does have some common side effect like darkening of the eyelids.
In The End
There needs to be a frank discussion between the patient and a qualified dermatologist about which eyelash enhancing product is the safest and most effective that individual’s use.
February 20th, 2015 | The Blog
People are living longer and this very fact impacts the number of joint replacements done in the US every year. This discussion focuses specifically on hip replacements in the US.
Hip Replacement Statistics
According to the US Centers for Disease Control and Prevention (CDC), over 332,000 total hip replacements are performed annually. The need to replace a hip joint can be a direct result of wear-and-tear or the result of a fall and subsequent hip fracture. Certainly, there are many individual reasons why a patient, with the guidance of their physician, chooses to undergo hip replacement surgery.
How Things Have Changed
The traditional or posterior hip replacement is performed by:
The updated anterior hip replacement:
Ideal Patients for the Surgery
The best candidate for an anterior hip replacement is:
It is important to note that patients with a more complex medical history and hip injury are best treated with the more traditional posterior approach to hip replacement.
Anterior Hip Replacement Recovery
The very remarkable and positive post-surgery changes with the anterior hip replacement technique is:
What about exercise after an anterior hip replacement? Patients can usually start:
Anterior Hip Replacement Popularity
The orthopedic surgeons who are trained in this approach are about 30% of all US orthopedic surgeons. The procedure takes intense training and a great deal of time to perfect. It is a more difficult procedure to perform than the posterior approach.
Of those limited number, who are trained in anterior hip replacement surgery techniques, the orthopedic surgeons report that up to 75% of their hip replacement patient population are undergoing this surgical approach. The percentage of patients with the anterior replacement is rising.
This is truly cutting edge surgery in the field of orthopedics. The bottom line for the patient is less pain after surgery and better mobility.
February 17th, 2015 | The Blog
With the recent measles outbreak in California, it is appropriate to have a discussion about adult immunizations. This discussion is best done in list form to keep the information concise.
It is important to note that many immunization-preventable diseases are far more serious when contracted by an adult than a child. Adults need updated immunizations for several main reasons, including:
Adult patient need to discuss their individual immunization needs with their primary care physician at their regular visits.
The following information has been condensed in order to briefly touch upon each important immunization. The US Centers for Disease Control and Prevention (CDC) is an outstanding source for further information.
Tetanus or lockjaw
Pertussis or whooping cough
Flu or Influenza
Pneumococcal disease or pneumonia
Varicella or chickenpox
Childhood immunizations are important for the health of the greater population as well as the individual child. Adult immunizations are important to maintain the health of the individual and their community.
It is important for every individual to discuss a plan for immunization with a primary care physician.
February 2nd, 2015 | The Blog
Clinical trials are important when a rare or life-threatening disease with no known cure rears its head. At this juncture, a clinical trial is sometimes the only treatment choice.
A clinical trial, according to www.clinicaltrials.gov, is a research study in which human volunteers are assigned an intervention (a medical product or procedure) according to a protocol. They are then evaluated for the biomedical effects and health outcomes.
Finding an appropriate clinical trial is not an easy task for the patient or their doctor. How does someone go about finding a clinical trial?
Clinical Trial Websites
The US government has a website called www.clinicaltrials.gov. This site is very technical and can be difficult to navigate. The drugs are listed by their original names, which are usually numbers and random letters.
A newer second clinical trial site is www.myclinicaltriallocator.com, which is far more user-friendly than the aforementioned government site. Dr. Bruce Moskowitz, an internist, designed this site with input from about 43 medical institutions, including Dana-Farber Cancer Institute in Boston and Massachusetts General Hospital.
The websites list where the trials are being conducted, both in the US and outside the country. They also have recruitment information, eligibility and contact information.
Many users state that there is different information about trials on each site and some trials are only listed on one of the sites. Patients are encouraged to search both sites to obtain complete information about a specific clinical trial.
The newer site actually links the user to the government site to make the cross-referencing easier.
Who Participates in Clinical Trials?
Most clinical trials are conducted to treat an existing medical condition. Some of those include:
Some trials use healthy participants to evaluate new drugs, devices or interventions. The healthy trials evaluate clinical techniques like blood testing and new imaging.
Looking at the Specifics
The US Food and Drug Administration (FDA) created the www.clinicaltrials.gov site in 1997 with the Modernization Act of 1997 (FDAMA). It became a public site in February 2000.
The National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains this popular site.? It acts as a registry and database for clinical trials. While all trials are not registered on this site, there are an abundance of choices. The site covers trials in all 50 states and 185 countries.
What information does the site post?
A principal investigator (PI), who is most often a physician, leads each clinical trial or clinical research study. Foundations, medical facilities, pharmaceutical companies, doctors and/or various federal agencies like the National Institutes of Health (NIH) and the Department of Veterans Affairs fund the clinical trials.
Participants are required to sign an informed consent to become a part of the study. They have the right to withdraw from all or a portion of the trial at any time. Too much alteration of the trial specifics can make the participant ineligible for the trial.
Trial Phases Explained
Once a clinical trial is submitted for human participation and evaluation, it is “phased” in through four phases.
Most trials compare the new drug or treatment against an already approved therapy but some choose to use a placebo comparison. Participants are informed if the PI chooses to use this method.
Experimental treatments are assessed and evaluated to determine the risks and effectiveness moving forward with the treatment of serious diseases like cancer.
January 29th, 2015 | The Blog
Measles or rubeola is a communicable viral disease. Before 1980, the year when measles immunization became widely available, there were 2.6 million deaths annually attributed to measles worldwide.
A heightened vaccination program has reduced the number of measles cases and lowered the subsequent deaths by 75% from 2000 to 2013. The number of prevented death is estimated at 15.6 million.
The Vaccine Debate
Measles is a vaccine-preventable childhood disease. The recent measles outbreak at Disneyland in California has brought to light the importance of being vaccinated against this potentially fatal disease.
How is Measles Transmitted?
While the disease is less common than it once was in the US, it is still widespread in less developed countries, especially Africa and Asia. Those people at greatest risk worldwide are the unvaccinated population, especially young children and pregnant women.
Measles is very infectious. A virus causes the illness, which is a member of the paramyxovirus family. It is transmitted by direct contact with an infected person and through the air. Sneezing, coughing and direct contact with infected secretions infects people.
Interestingly, the measles virus stays active and contagious in the air and on infected surfaces for up to 2 hours. The disease can be transmitted to another person for up to 4 days before the rash appears and up to 4 days after the rash erupts.
The first symptoms of measles appear about 10 to 12 days after exposure. The classic symptoms include:
A measles rash begins two to four days after fever onset and lasts for about 8 days. The rash usually starts on the back of the ears and within a few hours, it spreads to the head and neck and then covers the entire body. It can be itchy.
There is no anti-viral medication available to treat measles. The main course of treatment is supportive care as different symptoms develop. Depending upon the course of an individual?s illness, these are a few symptom-specific options:
Interestingly, vitamin A supplements have been shown a 50% reduction in the number of deaths from the disease. This is especially true in areas where affected children are generally malnourished.
Complications of the Illness
Measles complications range from mild to a very serious. They are more serious when experienced in an adult patient. The potential list includes:
Most measles-related deaths are due to a complication. Complications are most common in children under 5 years old and adults over the age of 20.
Immune deficient and malnourished people, especially vitamin A deficiency, are at a greater risk of developing complications.
Contracting measles while pregnant also increases a woman’s risk of serious complications. It also raises the risk of miscarriage or preterm delivery.
Most patients survive measles. There are 1 or 2 in 1,000 (0.1%-0.2%) cases that result in death, especially when encephalitis or brain inflammation is experienced.
It is important to note that once a person has measles, they develop a life-long immunity to the disease.
Prevention of the Disease
Increased immunization rates since 1980 has dropped measles deaths by 78%. The measles vaccine is most often given with the rubella and mumps vaccines (MMR) but can be given alone.
One dose of mumps, measles, rubella vaccine (MMR) is given at 12 to 15 months old and a second dose, which ensures immunity to the disease, can be given 4 weeks later but is usually administered at age 4 to 6 years old or just before starting kindergarten, according to the US Centers for Disease Control and Prevention (CDC). With only one dose of the vaccine, there are about 15% of children who do not develop sufficient immunity.
There are several organizations that comprise the Measles Initiative. They include the American Red Cross, The US Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). These organizations are working hard to keep the population safe and healthy throughout the world.
January 19th, 2015 | The Blog
Menopause and hot flashes go hand-in-hand. The warm surge of heat over-taking a woman’s body without warning is somewhat overwhelming and uncomfortable.
The treatment choices for hot flashes usually involve some type of hormone therapy, either oral, topical or vaginal. Hormone therapy has its advantages and its disadvantages. The choice to use this treatment option is based on each individual case after consultation with a qualified physician.
There is a new non-hormonal drug treatment choice, which shows great promise in treating hot flashes without the side effects of hormone therapy.
Non-Hormonal Hot Flash Drug
The new drug has been prescribed as the anti-depressant, Paxil, for several years. Renamed and given in a lower dose than used for anti-depressant purposes, Brisdelle is effective in treating systemic hot flashes.
Brisdelle is a generic drug made from paroxetine. While the lowest dose of Paxil is 10 mg, Brisdelle is even lower at 7.5 mg. The hope is that the lower dosing schedule will reduce side effects of the drug for women taking it to reduce hot flashes.
The use of this drug for hot flashes is US Food and Drug Administration (FDA) approved.
How It Works
About 75% of menopausal women, ages 45 to 55, experience hot flashes and night sweats. Hot flashes and night sweats are both considered vasomotor symptoms. These episodes often affect the quality of a woman’s life and can last for five years or longer, in some cases. At best, hot flashes are annoying and bothersome to the individual.
Brisdelle decreases the intensity and severity of hot flashes. Common side effects, present in less than 4% of patients, of the drug include:
Just like the increased risk of suicide warning on the antidepressant, Paxil, Brisdelle also lists this side effect. Since Brisdelle contains the same active ingredient as Paxil, it still carries an increased risk of suicide.
It is a selective serotonin inhibitor (SSRI), which is taken once a day at bedtime.
Who Really Benefits
Some women cannot use hormone therapy to treat hot flashes. Hormone therapy has its limits when it comes to treating women with a certain and/or significant medical history of any of the following:
Women who must exercise caution when deciding about using traditional hormone therapy include:
Women who cannot use hormonal therapy for the reasons listed above or do not want to use hormonal therapy for their own personal reasons, now have an alternate treatment option to deal with hot flashes.
The choice about if and how to treat hot flashes, commonly experienced with menopause, is one that should be made by each woman with the guidance of her physician. The risks and benefits of the drug must be evaluated and the decision to take the medication should be made on an individual basis.
January 12th, 2015 | The Blog
Ear infections are all too common. Adults can get ear infections but children are the most common patients. When a child gets a cold, 2/3 of the time, they end up with an ear infection.
Why Do Children Get So Many Ear Infections?
Two-thirds of children who get an ear infection end up with an ear infection. Why?
Types of Ear Infections
General ear infection symptoms include:
Babies additionally can get cranky, have trouble sleeping and often refuse to nurse or take a bottle because it hurts their ear(s) to swallow.
This is an infection in the outer ear. Not all swimmer?s ear is the result of swimming. Any defect in the ear, whether from a cotton swab or the ear staying too wet for too long after a shower or bath, can cause it. Wet ears breed bacteria and bacteria breeds infection. It is a plain and simple fact.
If the pressure in the eardrum builds up too much, the eardrum can rupture.
A ruptured eardrum heals itself in a few weeks. This does not affect hearing unless it is a repeated occurrence.
Making the Diagnosis
An otoscope is a tiny flashlight with a magnifying lens attached. This piece of equipment allows a healthcare professional to visualize the inside of the ear.
Treatment Options for Recurrent or Stubborn Ear Infections
Many physicians are reluctant to use antibiotics so as not to create the superbug. Some pediatricians suggest the wait and see philosophy because ear infections sometimes resolve on their own, since some are viral, not bacterial. Antibiotics do not treat viruses.
In some cases, antibiotics are the treatment of choice. This is when the ear infection is bacterial.
Small tubes are inserted through the eardrum(s) to drain fluid out of the middle ear. By relieving the pressure in the ear, pain and hearing issues can often be resolved.
Tubes are deliberately left in place for 8 to 18 months but often fall out of the ear on their own.
Enlarged tonsils apply pressure on the Eustachian tubes, which connect the middle ear to the throat. This pressure can cause recurrent ear infections.
Removing the tonsils can relieve the pressure and reduce the number of ear infections.
Ibuprofen and acetaminophen, both non-prescription pain medications, are usually sufficient to control ear discomfort in both children and adults.
Also, warm, moist compresses to the outside of the ear can offer palliative relief.
Allergy Testing, if indicated
Some middle ear infections can be caused by allergies, which irritate the Eustachian tubes. Allergy testing can lead to determining if allergy medications or allergy shots are indicated. Once the allergies are under control, there can be less ear infections.
Chronic Ear Infections
Repeated and chronic ear infections can cause eardrum scarring. This, in turn, can lead to hearing loss and speech problems. It is important to seek professional healthcare when an ear infection is in question.
Since the common cold virus is the most likely cause of an ear infection, it is important to try and avoid such illnesses. What everyone can do:
Not all ear infections are preventable but the aforementioned precautions can certainly help to reduce the number.
January 9th, 2015 | The Blog
Alzheimer’s disease is a scary diagnosis. It is scary for the patient and for the family and/or caregivers. What does the future hold? How will this disease unfold? What can be done to deal with the symptoms and ramifications, medical, social and financial, moving forward?
There is a 65 years young gentleman trying to find the answers to the many questions and concerns that surround Alzheimer’s disease. This man was diagnosed with early onset Alzheimer’s disease and is out to educate the greater population, while he can still do it.
Here is his story in a snippet:
How will his disease evolve?
The Facts About Alzheimer’s Disease
Alzheimer’s disease is a progressive, terminal brain disease that slowly destroys memory and thinking skills, according to this man’s description. It is caused by an abnormal protein that causes the nerve cells in the brain to shrivel and die.
There is a nonprofit organization, Alzheimer’s Association, which keeps the statistics on the disease. This organization raises funds to conduct research and to provide care to those suffering from the dreaded disease.
This is what their numbers reveal:
These are scary and concerning numbers. Some experts in the filed have coined this disease an epidemic.
The number of case grows because as the general population lives longer, the statistics also grow.
This Man’s Mission
The aforementioned Alzheimer’s patient is on a mission to get people to talk and ask me hard questions. He has traveled through the academic world and into the realm of the disease, through no choice of his own.
As simple signs of the disease overtook this man’s daily life, he decided to seek medical attention. He started to forget if he locked his car, had a couple of minor motor vehicle accidents and missed an airline flight by an hour. What was happening to him?
After a mini stroke or transient ischemic attack was ruled out, the grim diagnosis of Alzheimer’s disease was handed to him.
Treatment for the Disease
There is no cure, yet, for Alzheimer’s disease. There is no magical treatment to prevent the onset of the disease. For now, there are only some drugs, which temporarily slow the symptoms of the disease.
A lesson is there to be had from this brave gentleman who is on a mission to educate the general population, while he can still do it. He states that he is scared and frustrated but wants the world to talk about the disease and try to move forward with research and on the quest to find a cure.
Working diligently, this gentleman is on a mission of awareness and fundraising to stop a disease that has rocked his world and those around him. While trying to keep it positive in a public forum, he still deals with the consequences of the disease everyday of shortened life expectancy.
We all need to take a voice in this disease. If nothing else, act upon any change noted in a friend or loved one. Intercept, don’t look the other way. This gentleman has started the discussion. Now, we all need to continue it.
December 30th, 2014 | The Blog
Eat well, exercise, get plenty of sleep and take your daily multivitamin, right? Isn’t that what we all know to be the formula for staying healthy?
In my day, that was the advice that we all followed. Today, there is a growing case against the need to take a daily multivitamin.
The current thought or trend is that taking vitamin supplements can actually cause dreaded diseases, for which we are taking the multivitamin to avoid, like cancer.
Multivitamins By the Numbers
Interestingly, a vast number of Americans still do believe that taking daily vitamin supplements is crucial to good health. Here are some numeric facts about our vitamin-taking practices:
What a Multivitamin Does NOT Do
According to recently published studies, multivitamins are not a miracle drug and do not:
It is important to note that excess amounts of beta-carotene and vitamin E can actually cause cancer. Too much vitamin A can cause liver damage, which can lead to coma and subsequent death.
Why Do We Take Them?
It is believed that most people feel that more of something is always better and most of our moms always gave us a daily multivitamin. So, if there are sufficient vitamins and minerals in the food that we eat, then taking supplements will be even better, right?
Better general nutrition and vitamin-fortified foods in current day society have helped to prevent many true vitamin deficiencies of the past.
True Vitamin Deficiencies
There are exceptions to these study findings. If someone has a vitamin deficiency, of course, supplements will help. They should only be taken at the advice of a healthcare professional.
One example of a vitamin deficiency is scurvy, a vitamin C deficiency. In years past, citrus juice was used to treat people and then it was discovered that the reason it worked was the vitamin C content. Vitamin C supplements stepped into the treatment plan.
There are other vitamin deficiencies, which include:
These are all potential deficiencies but less common than in years past.
It is important that pregnant women take sufficient folic acid and iodine in order to prevent birth defects. Folic acid is important to prevent neural defects like spina bifida and iodine is important for fetal brain development, according to the Centers for Disease Control and Prevention (CDC).
The Bottom Line
According to the aforementioned studies and an editorial in the Annals of Internal Medicine, people should stop wasting money on vitamin and mineral supplements.
Everything in moderation. Life needs a balance. If a person eats a healthy diet, chances are that they do not need to take vitamin supplements. If they are not needed for a specifically diagnosed deficiency, they should not be taken.
The end decision should be made after a conversation between a patient and their primary care physician.