Doctors Unappreciated; World Health Day; Dangerous Meds; Bone Marrow Donation; Pink Eye; Tick-borne Illnesses; Amberen & Weight Loss
Finally have the computer stuff corrected, so here is the summary of the April 6, 2012 show:
Doctors Unappreciated:
We previously discussed that March 30th is Doctors Day... a day on which we celebrate physicians. Yet, in a recent survey 71% of doctors polled indicated they feel unappreciated. 14% feel appreciated, & 14% are not sure. I think this reflects the frustration that doctors AND patients feel in the present medical system. Doctors have lost control of their profession, & thus have lost their autonomy. We are taught to be independent yet cooperative, but most of us were not taught to be employees. We are used to being "the boss," yet many of us have sold our practices & are employees of hospitals or other large businesses. Our decisions are constantly questioned by non-medical people who read protocols & expect us to care for patients as though they are all the same! We no longer control our schedules, & many physicians have such heavy schedules that they must feel like they are on a production line. Doctors hate this system as much as patients do, but we seem somewhat helpless to change it. So, at least be a good patient by preparing for your visit so you can make the most of your short face-to-face time with your doctor. Prepare a list of your concerns, bring your meds or a list (be sure to include the name, dose, & how you take it), know your pharmacy phone number, & try to be concise. These efforts will help both you & your physician be more satisfied with your interaction. And don't forget to thank your doctor, as he likely does more for you behind the scenes than you realize!
World Health Day:
The World Health Organization was founded on April 7, 1948, & they celebrate their anniversary with World Health Day every April 7th. Each year there is a theme, & the theme for 2012 is "Ageing & Health." Their focus this year is on how humans can stay well as we age. As the world population ages, health issues become more important, so the WHO wants to help us stay well as we age so we can have a better quality of life & consume healthcare in a cost-effective manner.
Surprisingly Dangerous Medicines:
I recently read an article about the dangers associated with some very common medications. The list included:
1) Mineral oil - which when taken in liquid form can run down the back of your throat into your lungs, resulting in "oil pneumonitis" - so if you take any liquid oil product orally, be sure to mix it well with solid food which will absorb it so it can be fully swallowed & not remain in the throat (like grease on a dirty glass) where it can run by gravity into the lungs.
2) Rolaids/Tums - which are used for heartburn, but which contain calcium which can cause you to develop kidney stones.
3) Diuretics - which cause the body to eliminate fluid, but in so doing can dehydrate you &/or cause high potassium (Aldactone does this) or low potassium (Lasix does this).
4) Metformin - which is used very often to treat diabetes, but which can cause liver problems, &
5) Selective serotonin reuptake inhibitor (SSRI) anti-depressants - which cause an increase in serotonin which generally helps with depression. However they should not be taken with other products that increase serotonin, as this excess serotonin can be toxic, causing "serotonin syndrome" which is manifested as muscle twitches, sweating, poor coordination, agitation, diarrhea, & occassionally death. So if you take an SSRI such as Prozac, Zoloft, Paxil, Celexa, or Lexapro, you should avoid St. John's wort (an herbal product) & Dextromethorphan (an OTC cough suppressant).
I feel that the biggest point this makes is that everything has potential side-effects. So the decision to use a medication must be based upon the risk vs. benefit ratio. In other words, do the benefits outweigh the risks? The answer will vary person to person & situation to situation, so be sure to discuss your situation with your physician. Also, realize that when your doctor asks for follow-up visits or bloodwork, he is likely monitoring for these potential side-effects.
Bone Marrow & Stem Cell Donation:
So I had to do some research for this as I have never given my bone marrow nor have any of my patients... to my knowledge. I do know the importance of donors however, as without an appropriate donor, a person in need will die. Unfortunately this was the case for the niece of my long-term employee many years ago. She was in desperate need of a bone marrow donor, but a good match could not be found. As her illness worsened, the physicians decided to try the transplant with the best match they could find... though they realized it would not likely have a good outcome. Sadly, this beautiful 12 year old little girl died shortly after her body rejected the transplant.
So many years later, I am still trying to learn more about bone marrow donation, & the question we had regarding the same has prodded me to do the research for both you & myself. First, I would recommend that you go to the website www.GiftOfLife.org as they have most everything you need in the way of education. They indicated that you need to give a swab of your cheek to begin the process, & this can be done by requesting a kit from them or by going to a community drive. I always thought that you could do it through the local Blood Bank, but I did not see that in the website, so perhaps you can call the blood bank to ask. There is a fee of $54 to process your sample & place you in the registry (which is a worldwide registry), but if you are chosen to donate, all further costs are picked up by them & you subsequently have no other fees to pay. You must be between the ages of 18-60, & should be in general good health. Once your sample is in the registry, they will constantly check for matches, so you might match in a few days, or a few years, or perhaps never. They will call you if you look like a good match, & at that point you will need to give a blood sample. If the tests on that blood are good, you will then have an exam, & if that goes well, they will set you up for the true donation. Apparently most people donate stem cells, though a few give bone marrow. The difference is that the bone marrow donor just has a needle stuck into a bone & the bone marrow is aspirated (=sucked out). Of course this is a simple procedure which is done with local anesthesia. To donate stem cells is a bit more complicated. It appears that you are given medicine which causes stem cells to leave the bone marrow & enter your blood circulation, where those stem cells are harvested in a process similar to donating plasma. Though it is more complicated, it does not require anesthesia.
Though you are not obligated to donate when you are contacted, of course it would be hard to say no... especially as you will only get the call when you have already been identified as a potential to save someone's life! Remember also that although you might offer to be the donor today, someday you or someone you love might be the recipient, so register today!
Pink Eye = Conjunctivitis:
Pink eye is the common term for conjunctivitis, which is an inflamation of the conjunctiva of the eye. It is generally manifested by redness of the eye associated with discomfort or itching, & crusting or discharge from the eye, & sensitivity to light. The common causes are: allergy, infection, & irritation.
Generally if it is an allergy, it should be bilateral (both eyes), & likely associated with runny or itchy eyes & nose. It also is likely going to occur at the same time each year, as likely pollen might be the cause. There are allergy eye drops available, such as Optivar & Alocril, though they do require a prescription.
Infection can be viral or bacterial. Viral infections are more common & often occur when you have an upper respiratory infection or "cold." These infections are very virulent & spread easily, thus we ask that you do not rub your affected eye as you can easily spread it to your other eye. Also, you often are not allowed to work or attend school until the redness resolves, as otherwise many people might get this infection from you. Fortunately viral conjunctivitis resolves spontaneously, but often the doctor cannot be certain that it is not a bacterial infection unless he does a culture of the eye, as viruses don't grow on a routine culture, but bacteria do. So in theory, a culture is helpful, but it is often not done with the first episode of conjunctivitis.
Many physicians will even treat with an antibiotic (for a bacterial infection) without a culture, as it seems harmless enough to do so... & cost-effective. But, remember that conjunctivitis can be caused by irritants. Occassionally eye medicines, including antibiotics, are irritating to the eyes... thus they worsen the inflamation & thus worsen the conjunctivitis! Also, smoke & chlorine act as irritants & can cause symptoms of conjunctivitis. Treatment for irritant pink eye is to eliminate the irritant, rather than using medicine, although sometimes steroid drops or anti-inflamatory drops are used to speed improvement.
So if you have pink eye, it is likely going to get better without treatment, but you can certainly see your doctor for an evaluation which can help determine the cause, which will then dictate the treatment. Also, if you are an adult with a painful red eye, you MUST see an Ophthalmologist to be certain you do not have glaucoma (which can lead to blindness if untreated). Also, any change in your vision MUST be evaluated by an Ophthalmologist as well!
Tick-borne Illness:
Tick-borne illnesses are those illnesses carried by ticks. They include many diseases such as: Lyme disease, Rocky-Mountain Spotted Fever, Tularemia, & Colorado Tick Fever. Specific ticks carry certain diseases, & they tend to live in certain regions. Therefore, Lyme disease which is carried by the deer tick, is more prevalent in the Northeastern United States as that is where the deer tick thrives. By the same token, Rocky-Mountain Spotted Fever & Colorado Tick Fever are carried by ticks that thrive in the Colorado mountains. It is important to know that though this is generally the truth, occassionally ticks get transported to new areas, & we do sometimes see outbreaks in abnormal areas. There have been rare cases of Lyme disease in Florida, but it is certainly not common. The deer tick is very tiny... about the size of the dot on an "i"... so the tick is usually not seen. Instead, the bite results in a classic rash which looks like a bull's eye, with circles of red, then white, then red, then white. If you have this classic rash, you should get a blood test to confirm the Lyme infection, & if this is positive, you will be treated with an antibiotic. Local physicians usually know the illnesses which are likely to occur in their hometowns, so a local physician should be consulted if you have a tick bite or odd rash.
But remember that the best thing you can do to prevent tick-borne illnesses is to prevent getting bitten by the ticks! This means that you should wear long sleeves & long pants, & you should tuck your shirt in your pants, & your pants in your socks. Then spray yourself well with a repellant containing DEET.
As one last helpful hint, if you find a tick embedded in your skin, don't pull if off, as often the head will stay embedded & can lead to infection. Instead, grasp the tick with a pair of tweezers & gently unscrew it by twisting the whole tick counter-clockwise. Since the tick has embedded his head by literally screwing it into your skin, this method will unscrew it, thus removing the head cleanly!
Amberen & Weight Loss:
There was a listener who reportedly heard a commercial for Amberen, an herbal supplement generally used for menopausal symptoms, in which they claimed that Amberen will balance your hormones & thus lead to impressive weight loss. First, I will say that menopause does cause a hormonal imbalance, but this does not necessarily cause weight gain, so correcting the imbalance does not necessarily lead to weight loss... so the premise is incorrect from the start. Also, just because they say this in a commercial does not mean it is true.
We addressed a similar issue in October of 2011, when we spoke about the DSHEA Act of 1994. This is the Dietary Supplement Health & Education Act which dictates oversight of dietary supplements. It was passed after much debate, but it basically classifies dietary supplements as FOOD products, thus though they are regulated by the Food & Drug Administration (FDA), they are treated as FOOD rather than as drugs. This allows them to be manufactured with lax regulation & thus contamination is frequent, & bio-availability is variable. I recommend that you only purchase supplements which have the USP (United States Pharmacopeia) seal on the label, as this shows that the supplement has been voluntarily tested for integrity, purity, dissolution, & safe manufacturing.
The DSHEA Act does dictate that the product cannot make false claims on the label, though apparently the companies get around this by putting their claims in audible commercials. So although you might hear wild claims about these products & how they might cure this or that, you will not likely find the false claims in writing, especially on the label. If indeed a supplement was to label itself as a "treatment" for a disease, the FDA would consider this a DRUG, & they would then have to do clinical trials to prove safety & efficacy.
So read THE LABEL of your supplements carefully, & if the label does not reflect what the commercial claimed, then don't believe the commercial! Also, be skeptical & read between the lines. I'm not certain, but a brief look at Amberen's website showed it's claims that it helps balance hormones & thus helps improve menopausal symptoms. There was information about how hormone imbalance (& thus menopause) can cause weight gain, then there was information about how Amberen fixes that imbalance, but they leave it to YOU to make the supposition that Amberen therefore causes weight loss. In other words, I never found a sentence that specifically says that Amberen CAUSES weight loss... it just says hormone imbalance causes weight gain, & that Amberen helps with the imbalance. They let you conclude that Amberen therefore causes weight loss. Very clever, but misleading advertisement, so be careful!!!
In closing, don't forget the radio show... Let's Talk Medical with Doctor Gigi, as that is the foundation for this blog. We are live on Fridays at 1:00-1:45 PM Eastern time, & can be heard on WTAN 1340-AM or on www.SkipShow.com. The podcasts are listed on the website, & go back as far as Sept. 2011... just look for a Friday podcast. If you or your friends have medical concerns, please feel free to call or e-mail me: (727)-441-3000 or (866)-TAN-1340 which is toll-free or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Doctors Unappreciated:
We previously discussed that March 30th is Doctors Day... a day on which we celebrate physicians. Yet, in a recent survey 71% of doctors polled indicated they feel unappreciated. 14% feel appreciated, & 14% are not sure. I think this reflects the frustration that doctors AND patients feel in the present medical system. Doctors have lost control of their profession, & thus have lost their autonomy. We are taught to be independent yet cooperative, but most of us were not taught to be employees. We are used to being "the boss," yet many of us have sold our practices & are employees of hospitals or other large businesses. Our decisions are constantly questioned by non-medical people who read protocols & expect us to care for patients as though they are all the same! We no longer control our schedules, & many physicians have such heavy schedules that they must feel like they are on a production line. Doctors hate this system as much as patients do, but we seem somewhat helpless to change it. So, at least be a good patient by preparing for your visit so you can make the most of your short face-to-face time with your doctor. Prepare a list of your concerns, bring your meds or a list (be sure to include the name, dose, & how you take it), know your pharmacy phone number, & try to be concise. These efforts will help both you & your physician be more satisfied with your interaction. And don't forget to thank your doctor, as he likely does more for you behind the scenes than you realize!
World Health Day:
The World Health Organization was founded on April 7, 1948, & they celebrate their anniversary with World Health Day every April 7th. Each year there is a theme, & the theme for 2012 is "Ageing & Health." Their focus this year is on how humans can stay well as we age. As the world population ages, health issues become more important, so the WHO wants to help us stay well as we age so we can have a better quality of life & consume healthcare in a cost-effective manner.
Surprisingly Dangerous Medicines:
I recently read an article about the dangers associated with some very common medications. The list included:
1) Mineral oil - which when taken in liquid form can run down the back of your throat into your lungs, resulting in "oil pneumonitis" - so if you take any liquid oil product orally, be sure to mix it well with solid food which will absorb it so it can be fully swallowed & not remain in the throat (like grease on a dirty glass) where it can run by gravity into the lungs.
2) Rolaids/Tums - which are used for heartburn, but which contain calcium which can cause you to develop kidney stones.
3) Diuretics - which cause the body to eliminate fluid, but in so doing can dehydrate you &/or cause high potassium (Aldactone does this) or low potassium (Lasix does this).
4) Metformin - which is used very often to treat diabetes, but which can cause liver problems, &
5) Selective serotonin reuptake inhibitor (SSRI) anti-depressants - which cause an increase in serotonin which generally helps with depression. However they should not be taken with other products that increase serotonin, as this excess serotonin can be toxic, causing "serotonin syndrome" which is manifested as muscle twitches, sweating, poor coordination, agitation, diarrhea, & occassionally death. So if you take an SSRI such as Prozac, Zoloft, Paxil, Celexa, or Lexapro, you should avoid St. John's wort (an herbal product) & Dextromethorphan (an OTC cough suppressant).
I feel that the biggest point this makes is that everything has potential side-effects. So the decision to use a medication must be based upon the risk vs. benefit ratio. In other words, do the benefits outweigh the risks? The answer will vary person to person & situation to situation, so be sure to discuss your situation with your physician. Also, realize that when your doctor asks for follow-up visits or bloodwork, he is likely monitoring for these potential side-effects.
Bone Marrow & Stem Cell Donation:
So I had to do some research for this as I have never given my bone marrow nor have any of my patients... to my knowledge. I do know the importance of donors however, as without an appropriate donor, a person in need will die. Unfortunately this was the case for the niece of my long-term employee many years ago. She was in desperate need of a bone marrow donor, but a good match could not be found. As her illness worsened, the physicians decided to try the transplant with the best match they could find... though they realized it would not likely have a good outcome. Sadly, this beautiful 12 year old little girl died shortly after her body rejected the transplant.
So many years later, I am still trying to learn more about bone marrow donation, & the question we had regarding the same has prodded me to do the research for both you & myself. First, I would recommend that you go to the website www.GiftOfLife.org as they have most everything you need in the way of education. They indicated that you need to give a swab of your cheek to begin the process, & this can be done by requesting a kit from them or by going to a community drive. I always thought that you could do it through the local Blood Bank, but I did not see that in the website, so perhaps you can call the blood bank to ask. There is a fee of $54 to process your sample & place you in the registry (which is a worldwide registry), but if you are chosen to donate, all further costs are picked up by them & you subsequently have no other fees to pay. You must be between the ages of 18-60, & should be in general good health. Once your sample is in the registry, they will constantly check for matches, so you might match in a few days, or a few years, or perhaps never. They will call you if you look like a good match, & at that point you will need to give a blood sample. If the tests on that blood are good, you will then have an exam, & if that goes well, they will set you up for the true donation. Apparently most people donate stem cells, though a few give bone marrow. The difference is that the bone marrow donor just has a needle stuck into a bone & the bone marrow is aspirated (=sucked out). Of course this is a simple procedure which is done with local anesthesia. To donate stem cells is a bit more complicated. It appears that you are given medicine which causes stem cells to leave the bone marrow & enter your blood circulation, where those stem cells are harvested in a process similar to donating plasma. Though it is more complicated, it does not require anesthesia.
Though you are not obligated to donate when you are contacted, of course it would be hard to say no... especially as you will only get the call when you have already been identified as a potential to save someone's life! Remember also that although you might offer to be the donor today, someday you or someone you love might be the recipient, so register today!
Pink Eye = Conjunctivitis:
Pink eye is the common term for conjunctivitis, which is an inflamation of the conjunctiva of the eye. It is generally manifested by redness of the eye associated with discomfort or itching, & crusting or discharge from the eye, & sensitivity to light. The common causes are: allergy, infection, & irritation.
Generally if it is an allergy, it should be bilateral (both eyes), & likely associated with runny or itchy eyes & nose. It also is likely going to occur at the same time each year, as likely pollen might be the cause. There are allergy eye drops available, such as Optivar & Alocril, though they do require a prescription.
Infection can be viral or bacterial. Viral infections are more common & often occur when you have an upper respiratory infection or "cold." These infections are very virulent & spread easily, thus we ask that you do not rub your affected eye as you can easily spread it to your other eye. Also, you often are not allowed to work or attend school until the redness resolves, as otherwise many people might get this infection from you. Fortunately viral conjunctivitis resolves spontaneously, but often the doctor cannot be certain that it is not a bacterial infection unless he does a culture of the eye, as viruses don't grow on a routine culture, but bacteria do. So in theory, a culture is helpful, but it is often not done with the first episode of conjunctivitis.
Many physicians will even treat with an antibiotic (for a bacterial infection) without a culture, as it seems harmless enough to do so... & cost-effective. But, remember that conjunctivitis can be caused by irritants. Occassionally eye medicines, including antibiotics, are irritating to the eyes... thus they worsen the inflamation & thus worsen the conjunctivitis! Also, smoke & chlorine act as irritants & can cause symptoms of conjunctivitis. Treatment for irritant pink eye is to eliminate the irritant, rather than using medicine, although sometimes steroid drops or anti-inflamatory drops are used to speed improvement.
So if you have pink eye, it is likely going to get better without treatment, but you can certainly see your doctor for an evaluation which can help determine the cause, which will then dictate the treatment. Also, if you are an adult with a painful red eye, you MUST see an Ophthalmologist to be certain you do not have glaucoma (which can lead to blindness if untreated). Also, any change in your vision MUST be evaluated by an Ophthalmologist as well!
Tick-borne Illness:
Tick-borne illnesses are those illnesses carried by ticks. They include many diseases such as: Lyme disease, Rocky-Mountain Spotted Fever, Tularemia, & Colorado Tick Fever. Specific ticks carry certain diseases, & they tend to live in certain regions. Therefore, Lyme disease which is carried by the deer tick, is more prevalent in the Northeastern United States as that is where the deer tick thrives. By the same token, Rocky-Mountain Spotted Fever & Colorado Tick Fever are carried by ticks that thrive in the Colorado mountains. It is important to know that though this is generally the truth, occassionally ticks get transported to new areas, & we do sometimes see outbreaks in abnormal areas. There have been rare cases of Lyme disease in Florida, but it is certainly not common. The deer tick is very tiny... about the size of the dot on an "i"... so the tick is usually not seen. Instead, the bite results in a classic rash which looks like a bull's eye, with circles of red, then white, then red, then white. If you have this classic rash, you should get a blood test to confirm the Lyme infection, & if this is positive, you will be treated with an antibiotic. Local physicians usually know the illnesses which are likely to occur in their hometowns, so a local physician should be consulted if you have a tick bite or odd rash.
But remember that the best thing you can do to prevent tick-borne illnesses is to prevent getting bitten by the ticks! This means that you should wear long sleeves & long pants, & you should tuck your shirt in your pants, & your pants in your socks. Then spray yourself well with a repellant containing DEET.
As one last helpful hint, if you find a tick embedded in your skin, don't pull if off, as often the head will stay embedded & can lead to infection. Instead, grasp the tick with a pair of tweezers & gently unscrew it by twisting the whole tick counter-clockwise. Since the tick has embedded his head by literally screwing it into your skin, this method will unscrew it, thus removing the head cleanly!
Amberen & Weight Loss:
There was a listener who reportedly heard a commercial for Amberen, an herbal supplement generally used for menopausal symptoms, in which they claimed that Amberen will balance your hormones & thus lead to impressive weight loss. First, I will say that menopause does cause a hormonal imbalance, but this does not necessarily cause weight gain, so correcting the imbalance does not necessarily lead to weight loss... so the premise is incorrect from the start. Also, just because they say this in a commercial does not mean it is true.
We addressed a similar issue in October of 2011, when we spoke about the DSHEA Act of 1994. This is the Dietary Supplement Health & Education Act which dictates oversight of dietary supplements. It was passed after much debate, but it basically classifies dietary supplements as FOOD products, thus though they are regulated by the Food & Drug Administration (FDA), they are treated as FOOD rather than as drugs. This allows them to be manufactured with lax regulation & thus contamination is frequent, & bio-availability is variable. I recommend that you only purchase supplements which have the USP (United States Pharmacopeia) seal on the label, as this shows that the supplement has been voluntarily tested for integrity, purity, dissolution, & safe manufacturing.
The DSHEA Act does dictate that the product cannot make false claims on the label, though apparently the companies get around this by putting their claims in audible commercials. So although you might hear wild claims about these products & how they might cure this or that, you will not likely find the false claims in writing, especially on the label. If indeed a supplement was to label itself as a "treatment" for a disease, the FDA would consider this a DRUG, & they would then have to do clinical trials to prove safety & efficacy.
So read THE LABEL of your supplements carefully, & if the label does not reflect what the commercial claimed, then don't believe the commercial! Also, be skeptical & read between the lines. I'm not certain, but a brief look at Amberen's website showed it's claims that it helps balance hormones & thus helps improve menopausal symptoms. There was information about how hormone imbalance (& thus menopause) can cause weight gain, then there was information about how Amberen fixes that imbalance, but they leave it to YOU to make the supposition that Amberen therefore causes weight loss. In other words, I never found a sentence that specifically says that Amberen CAUSES weight loss... it just says hormone imbalance causes weight gain, & that Amberen helps with the imbalance. They let you conclude that Amberen therefore causes weight loss. Very clever, but misleading advertisement, so be careful!!!
In closing, don't forget the radio show... Let's Talk Medical with Doctor Gigi, as that is the foundation for this blog. We are live on Fridays at 1:00-1:45 PM Eastern time, & can be heard on WTAN 1340-AM or on www.SkipShow.com. The podcasts are listed on the website, & go back as far as Sept. 2011... just look for a Friday podcast. If you or your friends have medical concerns, please feel free to call or e-mail me: (727)-441-3000 or (866)-TAN-1340 which is toll-free or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi