Medicine
New scorpion antivenom drug approved by the FDA
The FDA approved this month for the first time ever a new antivenom, Anascorp, used to treat Centruroides scorpion stings. These scorpion stings are especially dangerous to kids and can cause blurred speech, blurry vision, difficulty swallowing,even fluid in the lungs leading to breathing problems. This drug makes history by being the first drug developed in Latin America (Mexico) and approved by the FDA. It’s also the first drug approved by the FDA to treat this type of Scorpion sting. Anascorp is made from the plasma of horses immunized with scorpion venom. 98% of the children treated with this drug in clinical trials had their symptoms resolved in 4 hours or less. This is a huge difference from the prior treatment which often involved keeping kids in the ICU for days!
Avoiding NSAID’s? Here’s a list of what to avoid.
While NSAID’s (Non-steroidal anti-inflammatory drugs) are excellent anti-inflammatory pain medications, they can have severe adverse side effects. Some of these include kidney failure, GI tract/stomach bleeding, decreased platelets in your blood, liver damage, and high blood pressure. Many patients have been instructed to avoid anti-inflammatory drugs or NSAID’s but it’s important to recognize what medicines are actually NSAID’s. The common over the counter agents with NSAID’s are: Advil, Midol, Motrin, some types of Dayquil and Dimetapp and other cold and sinus medications,Aleve and Goody’s powder. But there are a lot more than that! So, it’s important to check the ingredients in each medication you buy over the counter or the generic name for a prescription you are written to see if any of the following drugs are in them. Here’s a list of what to look for:
Aspirin, Ibuprofen, Naproxen, Naprosyn, Ketoprofen, Flurbiprofen, Oxaprozin, Diclofenac, Etodolac, Tolmetin, Sulindac, Indomethacin, Toradol/Ketorolac, Meloxicam, Piroxicam, Meclofenamate, Nabumetone, Celecoxib/Celebrex
Antibiotics are not always what you need
Antibiotic resistant bacteria are becoming a bigger and bigger problem worldwide. Most of you have heard about MRSA (Methicillin Resistant Staphylococcus Aureus) but may not realize the many other bacteria that are accumulating resistance to our routinely used antibiotics. This is a serious problem! These resistant bacteria kill nearly 100,000 US hospital patients every year. While that is bad enough, the problem is likely to worsen unless we get a handle on the overuse of antibiotics in our country and start developing new antibiotics. 16 new antibiotics were approved for use between 1983 and 1987 meaning resistance wasn’t that big of a deal because we had newer meaner antibiotics to fight off the bacteria. But guess what, only 2 new antibiotics have been approved since 2008. We’re running low on options for treatment and need to maintain the efficacy of the antibiotics we have now. Imagine going to the doctor for a relatively common infection and being told it can’t be treated because none of the antibiotics we have work against it. It will be like going back to the pre-antibiotic era.
So, as a patient, what can you do to help? Don’t pressure your doctor to prescribe you antibiotics if he feels your illness does not warrant them. Viral illnesses are often the culprit for making our patients feel terrible but unfortunately antibiotics just won’t help. We can help you treat the symptoms but your body has to do the work to fight off the illness, not a pill. We all have bacteria that live on our bodies all the time. When you take antibiotics when you really don’t need them, it’s like giving your opponent all the plays in your book to prepare for the game. The bacteria use those antibiotics to figure out ways to fight against them the next time you’re sick.
Second, when you are prescribed antibiotics – take them all no matter how good you feel by the 3rd day of treatment! If you don’t, what you’ve done is killed off just enough bacteria to weaken the attack on your body but left behind all the super-bacteria that were strong enough to survive the first few days of treatment. They’ll be back to make you sick again.
The magic number: 10,000
Have you ever wondered if it is really necessary for doctors to go through a minimum of 11 years of training to be able to practice their field of medicine? I’m not going to lie- I have. After reading Malcolm Gladwell’s, Outliers, I realize again the value in the length of our training.
He states, “The idea that excellence at performing a complex task requires a critical minimum level of practice surfaces again and again in studies of expertise. In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours. ‘ The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world-class expert- in anything’ writes the neurologist Daniel Levitin.”
Becoming an expert in medicine appears to be the same. A doctor training in primary care has already spent 4 years in undergraduate school then 4 years in medical school learning the basic sciences required to practice clinical medicine. Except for the last 2 years of medical school, these 8 years are not spent actually practicing medicine though. That begins in residency. A family medicine or internal medicine physician will spend 3 years in residency working on average 60 hours a week (seldom <40 hours and by law not more than 80 hours). Working about 49 weeks out of the year at 60 hours a week adds up to 8, 820 hours practicing medicine. Add in 1000 hours from the clinical years in medical school and what do you know- about 10,000 hours. No matter how intelligent someone is upon graduating from medical school they still need the 10,000 hours “practicing” medicine to become an expert.
Interestingly, for specialists the numbers work out too- for example a cardiothoracic surgeon spends the same 8 years in school prior to residency then spends 5 years in a general surgery residency then 2-3 years in cardiothoracic surgery residency. The 8 years of school plus 5 years of general surgery are prerequisites in preparation for the more specialized skill. Then spending 70-80 hours a week (more typical in surgery residencies) over 3 years is just over 10,000 hours.
So, if you’re seeing a young physician or an older, more experienced one, at least you can be assured they have all met their 10,000 hours in their field required to be an expert.
Preventive Medicine
Preventive Medicine refers to preventing medical illness and disease instead of treating a disease after it exists. I continue to be amazed at how many patients I see a day who are physically suffering from diseases that can be prevented (referred to as primary prevention) or at least managed better to have fewer complications (referred to as tertiary prevention). For a doctor this is an important and sometimes overlooked area of practicing good medicine. It’s becoming a more and more recognized part of quality medical care as people are searching for ways to provide good care at a more economical cost. There is even a new field of medical training referred to as preventive medicine. As a patient, I invite you to become more proactive in taking part in your own preventive medicine. YOU are the one that lives your life everyday! You know what you eat and what bad habits you have. Being honest with yourself and your doctor about the effect those habits can have on your health is the first step in looking for ways to stay as healthy as you can.
If our country successfully adopted healthy lifestyles and reduced the incidence of obesity, heart disease and diabetes, our cost of medical care would plummet. Education about healthy diets does not seem to be working. I notice that taking a deeper look at what is driving people to turn to unhealthy food or physical inactivity despite their knowledge about what is good for them is more important. Studying the social determinants of health (for example, those that don’t believe they can afford healthier options or have transportation to get it) and the mental determinants of health (for example, poor coping skills causing a anxious person to turn to food for comfort) I believe is the answer. I invite you to take a look at your own life, what is holding you back from making the lifestyle changes you already believe you should make?
Addressing that is true preventive medicine.
Swine Flu in Birmingham, AL
I’m working at the health department this month and swine flu is certainly continuing to circulate in Jefferson County. See your doctor if you have fever > 100 with cough and/or sore throat. The only treatment are anti-virals (like Tamiflu) which do not cure swine flu but may lessen the severity of the illness or shorten the course of illness by 1-2 days. Some physicians are now even calling in these medicines for children with fever, cough and/or sore throat to avoid them having to wait in the waiting room at their office. Fortunately, thus far, most cases of swine flu have been fairly mild.
When you are swabbed for influenza at your doctor’s office, most can do a rapid test in their office to tell you if you have influenza but it must be sent to the state lab to determine if it is H1N1. Since 8/1/09, of specimens testing positive for influenza in AL, 99% have been confirmed novel H1N1. As of 8/27/09, Alabama has had 1,587 confirmed cases of novel H1N1 influenza (or swine flu).
There is no vaccine available for H1N1 yet. It is encouraged for all to get the seasonal flu vaccine when available. The H1N1 vaccine (separate from the seasonal flu vaccine) is scheduled to be available by mid-October but this will be given to high-risk patients first.
So what can you do? The most important preventive measure is personal hygiene. Wash your hands frequently with soap and water!! Cover your nose and mouth when you cough or sneeze. (If you don’t have a tissue to cover your mouth, cough into the crook of your elbow.) Stay home from school or work if you are sick. Get the seasonal flu vaccine when available. Remember, vaccines work best when everyone gets them.
The 10 leading causes of death and what you can do to help prevent them.
Here’s a list of the 10 leading causes of death as determined by the CDC for the year 2006:
1.Heart Disease
2.Cancer
3.Strokes
4.Chronic lung disease (like COPD)
5.Accidents (unintentional injuries)
6.Diabetes mellitus (diabetes)
7.Alzheimer’s disease
8.Influenza and pneumonia
9.Nephritis, nephrotic syndrome and nephrosis (kidney disease)
10.Septicemia (infection in the blood)
Now here’s a list of the top 10 things you can do to maintain your health. If you do the things on this list, you’ll be reducing your risk of all of the diseases on the list above. Do your part to take care of yourself! Don’t wait until you are sick to make changes in your lifestyle. Prevention is key!
1. Do not smoke. If you smoke, quitting is the single best thing you could do to improve your health. (Click here for more info.)
2. Limit your Alcohol intake to 2 drinks a day for men and 1 drink a day for women.
3. Maintain a healthy diet and lose weight if you are overweight.
4. Exercise 30-60 min 5 days a week.
5. Don’t sunbathe or use tanning booths.
6. Practice safe sex.
7. Control your cholesterol and blood pressure with diet, exercise and medication if needed.
8. Keep your shots up to date, including flu and pneumonia (if over age 65).
9. Have yearly health screenings with your primary care doctor even if you don’t feel sick. (You may need to be seen several times a year if you have chronic diseases like diabetes or heart disease).
10. Get help if you are suffering from psychological problems like depression, anxiety, or excess stress instead of turning to addictive habits like smoking, alcohol, drugs, overeating or other self destructive behaviors.
Vitamin B12- who needs it and are pills okay?
Vitamin B12 is an important vitamin mostly obtained from dairy products and meat. It is a critical ingredient your body needs to make red blood cells and also helps your nervous system work correctly. If you have low B12 levels, you might have anemia, depression, dementia or neuropathy (pain, burning or tingling sensation). Some people with low B12 also have high levels of homocysteine which may increase your risk of heart disease and stroke. Your doctor can run a simple blood test to see if your B12 level is low.
The most common reasons for low B12 are 1) not taking in enough in your diet or 2) a problem with your stomach or intestines that prevents you from being able to absorb the vitamin. This includes Pernicious Anemia (where you do not have the cells needed in your stomach to absorb B12) or long standing heartburn or ulcers or having had surgery on your stomach or intestines.
In the past, everyone who needed B12 supplementation was given shots- initially given several times a week for a couple weeks and then once a month. Now we know that unless you have a problem absorbing B12, it is just as effective to take a daily pill instead of getting a shot. Over the counter Vitamin B12 pills do not have enough B12 to increase your levels- you need to take at least 1000 mcg of B12 everyday. You can get a prescription for this high dose from your doctor if you levels are low.
Even if you’ve been getting Vitamin B12 shots for years, you can switch to the pill and it will be just as effective unless you have a problem absorbing B12 from your digestive tract.
The best way to get control of your stress
Since stress is an activation of our “fight or flight” or sympathetic activity, it is important to balance that with our “rest and digest” or parasympathetic activity. I’ve heard many people say they exercise for stress relief. While consistent exercise is a critical component to overall health and improving your body’s capability of coping with stress, it is yet another activiation of your sympathetic system. In fact, competitive athletes consider recovery a valuable part of their training. They understand the need for rest and relaxation to allow their body to recover from the stress it is put under during exercise and intense training.
So while we are unlikely to find a way to live in our world and eliminate all the sources of stress in our life, we can learn to increase our parasympathetic activity to balance that. Here is the key: take 30 minutes a day to engage in some activity that allows your mind to go into a state of relaxation. Choose activities that help you get quiet, restful and worry-free parasympathetic activiation. Every person’s activity might be different. One person could achieve that state by taking a bath each evening to relax but another might take a bath and allow their mind to spin with worries the whole time- that doesn’t count! The key is to do what allows your mind and body to relax for 30 minutes each and every day.
Here’s a list of activities that might work for you:
Yoga or Pilates
Meditation
Massage Therapy
Jacuzzi/sauna
Reading in a quiet spot
“Zoning out”
Listening to soothing music
Taking a bath
When you do this and have actually relaxed, you may notice tension in your neck, shoulder and back release. You might experience a decrease in your heart rate and blood pressure and a sense of calmness. If you do your activity before bed, you will probably be able to fall asleep faster and achieve a better night’s sleep.
Does it sound too simple? It’s obviously not that easy to do because how many of us get 30 minutes a day of a truly relaxed state of mind. But remember all those effects of stress on your body and health- it’s important to allow your body to recover! This is the best way to get control of stress- start today, make it a habit!
Are you stressed? What is it doing to your body?
A study done in 2003 showed that 80% of Americans reported feeling stressed out. Are you one of them? Take a look at what being stressed can do to your body. Chronic stress can alter our biochemical state and have major effects on our health.
Being stressed puts our bodies in the “fight or flight” state which leads to high levels of cortisol and adrenaline. When we are under chronic stress, the secretion of these hormones takes precedence over other functions like digestion, cellular repair, immune function, reproduction and liver function and detoxification. So we end up with poor blood sugar control, sleep disruption, carbohydrate cravings (which worsens the poor blood sugar control), reduced metabolism, reduced thyroid function, alterered sex hormone activity, infertility, depression, alcohol and drug abuse. Your immune system doesn’t work as well to fight off infections. Stress has even been linked to heart disease.
Basically our bodies are in a state of hormonal imbalance and we simply are not able to function like we want to. Not only that, but stress is also known to decrease the brains functionality causing difficulty thinking and solving problems or a loss of memory. And, after a long time of your body pumping out so much cortisol and adrenaline eventually it wears out and chronic fatigue sets in.
So as you can see, stress is not something to just blow off by saying “things will calm down when the kids are back in school” or “as soon as I get this project done at work my stress level will be a lot less.” You are just continuing the cycle and setting yourself up for problems that are becoming more and more common in America- obesity, heart disease, infertility, irritable bowel syndrome, depression, alcohol and drug abuse.
The best time to slow down and relax is when you don’t have time for it!
Stay tuned for some tips on decreasing your stress level.