The Medical News Report

September, 2021

#116

Samuel J. LaMonte, M.D., FACS

samlamonte@gmail.com

www.themedicalnewsreport.com

 

Subjects for September, 2021

 

1. COVID-19, delta variant continues—boosters

 

2. Updates in Cancer

 

3. Pregnancy issues affecting health-early and late

 

4. Colon Diverticular Disease

 

5. CPAP machine recall Alert!!

 

6. NSAIDs (Aleve, ibuprofen, etc.) not as bad for older people

 

      

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thank you, Dr. Sam

For those 59% of Democrats polled who favor socialism over capitalism, I suggest you read in depth where socialism will take the United States Of America!!

 

1. COVID-19 continues—the latest

The amount of new information coming out each month, has kept me revising my report on a daily basis, so that I can provide you with the most up to date information “hot off the press”. It has been challenging, but I am glad to do it. Please share this report.

Even though this COVID information is the latest, please check out my other subjects that are cutting edge information. Thanks!

The FDA has given full approval to the Pfizer vaccine for people 16 and older, while Moderna and Johnson and Johnson will follow in the next month. The children 12-15 year olds are still covered under the emergency authorization rule.

 

Booster now available in some places now

  As of August 26, 2021, the CDC now recommends the boosters to be started for people with immune system diseases and those in immunologically compromising health situations. That is somewhat ambigious, but the locations providing the boosters including pharmacies and grocery stores will determine your eligibility. Nursing home residents and staff were to be first in line, along with healthcare people and first responders, so we will see more clarifications over the next days.

  The CDC changed from 8 months to 6 months, although their website states 8 months from the last dose of vaccine of Pfizer and Moderna. But according to Dr. Anthony Fauci on Meet the Press on Sunday, August 29, the timing is “very fluid”. People in Clayton, Georgia are able to get a booster now, with certain requirements. Are they jumpoing the gun??? The website says it won’t be available til September. Since the vaccine is the same as the booster, maybe places are getting governmentl approval. Check with your local pharmacy, etc.  

  They are reacting to the numbers of cases of vaccinated breakthrough infections and hospitalizations rising, and governmental pressure to get more individuals vaccinated.

  Sadly, most of the data on vaccine effectiveness has been from other countries and in some experts say the research is not the best, as stated from Medpage, August 27, 2021 from the managing editor. This statement underlies the poor data used in determining decisions regardling boosters. I am all for vaccines, but sure want the science to be solid for me to stick my arm out.

  It is amazing when the pressure is put on the FDA (and the CDC) that suddenly these new recommendations and approvals quickly come out. This may encourage the hesitant to decide to get vaccinated, and USA Today, stated that could include about 30% of those hesitant.

  It will also give businesses, schools, hospitals, etc. the green light to plan vaccine mandates for the public, as stated by President Biden, which is highly controversial.  

  As of August 18, 2021, over 50% of adult Americans have been fully vaccinated per the CDC. Children under 12 are still not eligible. 30% of Americans are not vaccinated, and 10% have various medical reasons for not being vaccinated. The Antivaxxers make up about 20%, so we are not going to reach much beyond 70% vaccinated. Additionally, there have been 20-30% of the population infected and asymptomatic most without being tested. These percentages should bring the U.S. ery close to herd immunity (certainly in major portions of the country) , but no one wants to talk about it, for fear of discouraging some from getting vaccinated.

  And yet, the delta variant keeps infecting mostly unvaccinated young people creating unnecessary fear twice as fast as the previous alpha variant, as stated by Medpage, an internet medical journal. Herd immunity should not stop people from getting vaccinated when infections are continuing especially in low vaccinated states such as the South.

  151,000+ cases per day are being diagnosed, mostly in the South where vaccination rates are lower, according to Dr. Scott Gottleib, former FDA Commissioner. The majority of cases are younger and have mild disease, but because the numbers are so high, the inevitability is that there will be an increase in hospitalizations and even more deaths.

 

A. The Latest on the Delta Variant and its effect

  Good News, Bad News

  COVID symptoms can be confused with upper respiratory illnesses and allergies, according to the top Louisana State Health Officer in Medpage Today, August 11, 2021. The delta variant transmits easier (twice as fast, and twice the hospitalizations) but is no more lethal any other variant.

  If vaccinated, individuals have a 90% chance of not getting infected. The data is not in about children having more serious infections, although the media is hinting about it. So far children account for 15% of the cases, according to the American Academy of Pediatrics. Severe illness from COVID is rare unless underlying diseases magnify the issue in both children and adults. Medpage Today, August 10, 2021

  As always thought by many clinicians and scientists, those infected by COVID-19 have natural immunity and is better than the immunity from the vaccine. From data out of Israel, there is now proof that this true. Because the administration and their federal arms of the FDA, the NIH, and the CDC, pushed so hard for vaccinations for all, including those infected, and they strongly recommended that all of those patients be vaccinated, and now even take the booster. Why???

  I do not know, but I hope we get to the bottom of this as we are now finding out more about the origin of the COVID-19 being leaked from the Wuhan labs. And the administration continues to refuse to investigate, while the NIH was providing funds to them for “gain of function” research since the early 2000s (through a non-profit Eco-Health). Again, a very potent political issue.

 

Droplet vs aersol spread

  For the next few weeks we must accept that the cases will rise as the delta variant passes through our country, but it will fade. Hopefully there will not be a more aggressive mutation in our future, but we must be prepared.

  This is accentuated by the fact that it is now known that the virus transmits not only as droplets, which were prevented with good tight fitting high quality masks, but now it is also transmitted by aerosol particles, much smaller and easier to transmit, which most masks can’t  prevent near as well, but masks still help some, according to Don Milton, an aerosol expert at the University of Maryland School of Public Health. He has flatly told the medical community and organizations that the virus can be spread by microscopic particles which can be suspended in the air for extended periods and can travel much further than droplets allowing more infections not as well covered by most masks.

  Only masks such as N-95 and K-N95 (a knock-off) are really the most protective masks to protect against aerosol transmission (but not readily available) according to Milton. Masks help but excellent ventilation is very important including social distancing, and hand hygiene, as all must be practiced. Unfortunately, N-95 type masks are hard to breathe through. Medscape, August 6, 2021

 

Symptoms are usually mild even with the delta variant

  A mild headache, fever, sore throat, and runny nose would make many individuals assume they had a bad cold or seasonal allergy. That does not rule out other symptoms, but loss of smell is less likely as is cough and chest pain….very different than the original COVID-19. Regardless, stay away from people with any respiratory symptoms. There are plenty of other viruses that are communicable.

  It is still important to get tested, if symptomatic, to know  if the test is positive for COVID-19 and could potentially transmit the virus, especially to the vulnerable, who are filling our hospitals in certain areas of the country.

  The delta variant is peaking now and left its effect on the country and the world. Because of the high transmissibility of the delta variant, it has made all of us to be more careful. We need to protect those unvaccinated, but we need our hospitals available for all kinds of sick people to get in the doors of the hospital. It could be you with chest pain, an accident, an emergency! Emergency waits are extremely long.

 

Mandates are here

  With approval of the Pfizer vaccine by the FDA, we will see more vaccine mandates from businesses and state governments. And now the Oregon governor requires masks outdoors after an outdoor event caused several infections.

  Most masks as the only form of protection do little to protect people. It is the layers of protection that is effective.

  I do remind you that only medical grade masks work (N-95 and K-N95) are proven to be effective if tightly fit over the face and nose. How are we going to properly mask school children 2-12 year olds who are not eligible for vaccination. School kids above 12 must wear a mask regardless of vaccine status.

  Lockdowns are mandatory in Australia and New Zealand, and have paralyzed the countries. Lockdowns in the U.S. have already proven to be ineffective.

MedPage Today, July 31, 2021

 

Vaccine effectiveness against the delta variant—new data

  The vaccines show 88% effectivenenss against the delta variant if both doses of the vaccines are given vs 93% effectiveness with the alpha variant. There was a significantly lower antibody response with only one dose at 30% in a small study. NEJM, August 12, 2021

  With this new information on the effectiveness of the vaccines against the delta variant, it is clearly unwise to get just one dose of a two dose vaccine for the general public. When the boosters are available, they will bring even better longer lasting immunity against the delta variant. Of course, newer variants are likely, and more studies will be necessary should they dominate the cases.

  The immunosuppressed often do not develop a good immunologic response from the vaccine, and have enabled the virus to mutate in their bodies while some become chronically infected.

  This is why not only the immunosupressed need a booster, but also it is very important for their immediate friends and family to be vaccinated to provide a protective immunologic bubble around them. Will the booster do any better?  AMA Educational Hub, August 18, 2021

 

Big difference how hospitals are filling now as opposed to early in the pandemic

  As opposed to the last surge early in the pandemic filled by older sicker people, most people avoided the hospital for fear of getting infected on site. Now people are aggressively filling the emergency departments with even mild symptoms to be evaluated. Top that off with many non-COVID sick individuals who avoided the emergency room early in the pandemic, are also eagerly accessing medical care. We are paying the price because of unvaccinated people.

  Because the younger people 20-49 have not chosen to be vaccinated (30%), businesses are requiring vaccination of their employees. It is their own fault, but there are those suffering from their decisions…those medically unable to receive the vaccine, those too ill to receive it, some immunocompromised, and those convinced they are protected since they were infected. And most of all, those vaccinated are suffering from federal guidelines, stubborn school boards, children, because of the unvaccinated.

 

Viral load in noses of the vaccinated

  The CDC has produced some data that those vaccinated and may develop an asymptomatic  “breakthrough” infections” (last statistics were 0.004%), because their nose and nasopharynx (back of the nose and part the throat above the soft palate—see drawing) has significant viral presence that could transmit the virus to unvaccinated people (not likely the vaccinated). Again occurring because of the unvaccinated!

  Amount of viral load in the nose/nasopharynx apparently equates with magnitude of infections and presumably ease of transmissibility. I have read this not seen it in a high level research study. Below is a drawing of the areas. Note the Olfactory (smell) nerve at the top of the nose, which can be injured by viruses, Alzheiemr’s disease, and vascular events. In this case, COVID-19 sticks to the nose and nasopharynx, which is at the back of the nose, and uppermost throat above the palate.

An outbreak in Provincetown, Cape Cod recently that had a significant percentage of vaccinated people got mildly infected was all it took for the CDC to reverse their mask guidelines. Now the masks are back in the lives of the vaccinated, in our schools, and in our businesses.

  The CDC has no data of how often a vaccinated person can transmit (only that they have virus in their nose), but supportive data to back their tighter control of our country may come with more cases.

  The delta variant is as strong as it is because of the unvaccinated. Many of these people claim they have been infected with the COVID-19 virus and feel they are protected. Here is where it gets a little fuzzy. It has been stated that previously infected people don’t have as much protection as those fully vaccinated, but there is no scientific proof. One can easily compare vaccinated vs non-vaccinated, but what about the previously infected?

  Our freedoms are being encroached on quite frequently these days, but when we are in a pandemic, we must rally together and get as much protection as we can. We owe it to those who can’t get vaccinated, and are immunocompromised (those with autoimmune disease, cancer, taking medications that suppress the immune system, etc.). At last count that was over 10 million people in that group (3% of the population).

  This variant is about to peak, according to Dr. Marty Makary, Johns Hopkins School of Public Health, and we can’t let this variant mutate into another potentially more aggressive virus. We must limit the spread with vaccinated people, as it is the unvaccinated that are filling our hospitals.

  PLEASE GET VACCINATED!! Be safe, use proper hygiene, and avoid large indoor groups unless absolutely necessary. Those who want to avoid more rules in the future better do their part to prevent more cases. Otherwise, we all pay!!  

 

B. Breakthrough Infections of previously infected individuals

  So much is being made regarding the “breakthrough” infections of those previously vaccinated. 90% of those currently infected are the unvaccinated, but since no vaccine is 100% effective, there are those people who will have mostly an asymptomatic or very mild infection.

  If they require hospitalization, it is mostly because of the underlying medical disorders that may need monitoring for a few days, such as diabetes, kidney diseases, uncontrolled hypertension, heart disease, and those with immunosuppressive disorders or those who take a medication that might suppress their immunologic competence. But, keep in mind, it is a small percentage of those vaccinated (last reported-0.004%)/

   I wonder if people who have been previously infected are getting reinfected. No one is talking about that, but if they are not, that means they might be better protected than those who get vaccinated and get a breakthrough infection. Of course, that would go against what the federal medical people are saying, since they state they are not as well protected and need vaccination. Politics keeps getting in the way.   

  The statistics for the breakthrough cases are hard to find, but www.usafacts.com have it. Please look at this as it should help people feel better about these infections

unless a vaccinated person has underlying health conditions to increase the risk of a more serious infection.

 

Expanded treatment for COVID-19 with very early infection prevents progression with monoclonal antibodies

  Monoclonal antibodies (Regeneron) is now being offered to those who test positive as an outpatient and can receive this IV treatment very early and have a good chance of preventing the progression of symptoms. If a person has mild respiratory symptoms, they need to get tested, so they can qualify for this valuable treatment, which has more effectiveness against the virus before it can mount a strong offensive against the individual. Do not go without testing out of fear of knowing. Those with symptoms also could have a false negative test, so if symptoms progess, get retested.

  Regeneron is also being used for early cases in the hospital and is effective in some, but the earlier the better for Regeneron.

  Sadly, the latest information is that convalescent plasma is not very effective. This was a common treatment recently, but just didn’t hold up.

 

C. Boosters for All Americans

 

With talk that the current vaccines are only fully effective for less than a year, and the effectiveness of the vaccines are dropping as the months go by, boosters for all vaccinated people are being recommended by the CDC fter 28 days since the last dose of the vaccine. It was 8 months, then 6 months, and now 28 days. Where is the science?

  The FDA has approved the booster for vulnerable populations (3% of the population have immune issues), but it is clear that everyone will be offered the booster soon. This applies only for the Pfizer and Moderna vaccines, while J&J should follow soon as the reviews are completed.

   The World Health Organizations is requesting a delay of 2 months for our boosters to get more countries the available vaccines rather than Americans getting the third vaccine when so many countries have few vaccinated at all because of the cost, availability, etc.

  The booster needs to be the same vaccine as received before, as stated in journal articles. The booster consists of the exact exact vaccine as the first two, according to the report.

   This includes any age (12 and older)! Those more vulnerable for all the reasons stated many times will be prioritized first.

  It remains to be seen how many Americans will choose the booster, but those older and those with health issues will certainly jump at the chance.

 

  It is known that immunosuppressed individuals get COVID-19, the virus is often only partially killed, leaving the virus in their systems for a prolonged time, which is a great environment for a virus to further mutate. This population could further the spread of the delta variants.

  In one kidney transplant study of 151 patients, 51% did not develop much antibody response from the vaccine doses.

  Unfortunately, as many as 50% of immunocompromised individuals do not respond at all well to vaccines, according to Johns Hopkins School of Public Health, Dr. Dorry Segev. Why does the administration think they will respond any better with another dose? Physicians must step up and decide who should get these boosters.

  An Israel report was very positive about the increase antibody response from the booster. The U.S., Hungary, some European countries, Asia, and the Middle East are planning on offering boosters.

  The CDC preferred the term “third dose” rather than boosters, to differentiate from “boosters” for others who might have not had a robust response from the first two doses such as nursing home residents who have been fully vaccinated.

  Will a third dose increase side effects? That is not known, and will be a challenge for many hesitant about getting vaccinated. There are enough doses available for all eligible Americans. There will be 80,000 sites including pharmacies where the booster can be received. Experts have stated that the booster will increase titers of antibodies tenfold. Dr. Walensky, CDC director, is optimistic that a yearly booster will not be necessary, but no science to back up her statement.

 

3 studies are cited by the administration as backup for their decisions on the booster (not peer reviewed yet!):

1- A New York study showed a drop in vaccine effectivenss from a very modest drop from 92% to 80%, and 20% of new infections in that state occurred in vaccinated people and 15% of those hospitalized had been previously vaccinated.

2- A nursing home study showed a drop of effectiveness of the vaccine from 75% to 53% over the last 5 months.

3- 21 hospitals in 18 states found continued effectiveness at 86% in general and 90% in those with good immune competence. Why is a reason for booster??

  These studies have yet to be peer reviewed and are posted only on the CDC’s website. Vaccine effectiveness is waning, according to these experts, but I hope to see these studies rather than take the word of the CDC, considering where we have been with the CDC since the beginning of this pandemic. I see these studies as indirect evidence about this and controversial, since no study has proven that a certain level of antibodies is more protective, however, more evidence may be coming. The epidemic in the South is seeing the beginning of the delta variant starting to wane. However, that is no reason to slow the effort against the virus.

Medicinenet.com, August 19,2021  

  I must remind the reader that the CDC and the FDA have recently stated that antibody testing should not be used by the public to determine their immune level of protection or the level of antibodies necessary to be protected. It is to be used as a research tool. Now they are making decisions for the public based on this antibody test which has several limitations.

  Their thought process comes along the lines of higher antibody levels are better. It seems rational, but we need scientific proof.

  Antibody titers don’t even measure all the antibodies against the spike protein of the virus, the standard of how the virus gets into cells, according to a special report in MedPage Today Internet Journal on August 3, 2021.

  Additionally, the antibody tests do not measure responses of the T and B cell lymphocytes, which kill infected cells.

  Pressure from the administration including the CDC and FDA is immense to get out in front of this pandemic, not for the political gain, but for the health of our country. Of course, that is at the time, we are letting over 200,000 illegals through our Souther border monthy, and now are bringing thousands of Afghanistan refugees to the U.S.

Medpage, August 3, 2021

 

D. Children have underlying medical issues too!

  As the schools have opened (at least some), the case load of children getting infected is rising as 4.2 million kids are infected as of August 22, 2021 with mostly mild symptoms, but not because they went to school. They are getting infected after school, and at home with careless behavior. Where is the data to prove they are getting infected in school.  The schools can control the spread much better than outside of them. The CDC supports open schools, previously stating that home is the number one place kids get infected.

  Regardless, mask mandates for kids in school are already here in most states, and kids will deal with this better than their parents. One or two tests per child are being initiated in schools to stay ahead of a surge in specific schools.

  Children are being admitted to the hospital (15% of those admitted) as well as adults, because they suffer from the same underlying ailments making them more prone to infection similar to adults (cancer, congenital diseases, asthma and other respiratory diseases, obesity, diabetes, and immune illnesses.  

  Most hospitals are reporting 23 hour admissions to evaluate the patient’s status, and most are discharged, but the media and the feds don’t say that….they just announce the hospitals are being overrun with admissions. Granted, the sicker children and adults with more symptoms will have to stay longer, and in truth, this will be a problem for some hot spots in Southern U.S. States for the coming weeks. But as the variant slows down as it passes through the unvaccinated, we must meet the challenge, like it or not.

  The FDA is supposed to have full approval of the Pfizer vaccine before September 1. Hopefully this will encourage hesitant people to get vaccinated, so that MORE VACCINATED parents of these children can act as a shield around these younger children who can’t get vaccinated (under 12)

 

E. Trends in the Delta variant and meaning for the future

  Please keep in mind that the delta variant is much more easily transmissible and the reason for so many more cases.

  The immigration factor

  While the case numbers rise, hospitalizations are rising with much more younger people than older (even children), with children transmitting the virus to other children as schools open, while thousands per week of illegals (over 2 million this year) just are walking over our southern border with active COVID-19 infecting Americans in the southern part of our country wherever they are sent by bus or air. 20% of them with symptoms are positive while the usual 30-40% of the asymptomatic are not tested, and have infected our citizens. And yet, we have all these rules for American children, the vaccinated, and the unvaccinated, I ask the reader, how is it that the hypocrisy is tolerated? I wish we had that much concern for the people in Afghanistan that need to be rescued and are even being charged to be airlifted. While those who come over our border are bused or flown free of chage anywhere in the U.S.

  Is there a connection between the southern border and the rising cases in Florida and Texas??

  We all want the virus to go away, so why would the government allow any group to go without some kind of control?

  The age group of 30-39 are four times more often to be hospitalized unless over 85 years of age. Only 1 out 4 cases is estimated to be reported to the CDC. Note the statistics below.

 

Note that only 10% of infections are in those 65 and older, while 50% of cases come from 18-49 years of age. Of course, as one can see, if an older person is infected their chances are much higher of being hospitalized and dying. Keep in mind a significant number of children are immunocompromised and have underlying diseases leading to hospitalizations as well.

  The data is saying, older people are not getting infected because they have been vaccinated. GET VACCINATED FOR GOD’S SAKE. But still be careful, because there is no guarantee anyone of us could not get infected and be in trouble, not to mention the number of transmissions that might occur before one is symptomatic (and if asymptomatic, could spread the infection to many more).

  The CDC had Feb-May, 2021 Florida state stats on the above chart from the CDC. It is well known these stats on age will change when the delta virus is analyzed.

  The average number of hospitalizations in Manatee County, Florida is 269 per day while Hillsborough County, Florida has 2555 per day. The average daily number of cases in the State of Florida is over 23,000 per day, currently with more than 13,000 hospitalized. 90% were not vaccinated!!! The admissions to the hospital do not differentiate children and adults being admitted FOR COVID or just positive with underlying health issues as the real reason for the admissions.

  Most cases are still in the younger to middle age group with hypertension, diabetes, heart disease, and other underlying medical illnesses that have decreased their immune response to disease. Here is the latest graph for Florida cases.

 

The Florida state partial map shows where the highest

 

Below are the number of cases PER COUNTY in Florida from Mayo Clinic. The darker the color, the higher the number of cases. The left map was the beginning of August and the one on the right shows more cases by the end of the month. Cases per day are over 100 cases/100,000. You can see how many more counties are darker.

  www.usafacts.com provides these numbers=18,114 cases per day. Manatee has 477 cases per day. Keep in mind that these are mostly mild or moderate cases not needing hospitalization. There are 10,207 current hospitalizations in the State of Florida, leading the nation per capita according to the Florida Hospitalization Association. GET VACCINATED!

 

     

 

Georgia had 4195 cases FOR THE STATE/100,000 population reported in the first week of August and 181 hospitalizations with 33 deaths. At the end of August, there have been 7,380 cases and 91 deaths. Compare the charts. Darker means higher number of cases.

 

     

 

The death rate is lower too (compared to a year ago) because those infected are much younger (20-40 years of age). The reason is that people over 40 have been vaccinated at a higher rate especially over 60 (80%) and these younger but yet sicker people are far less likely to die.

  Even though cases are rising, I remind the reader there still is no science backing masks to prevent the virus, and only with layers of protection can we see some degree of protection (masks, ventilation, hand washing, social distancing, isolation for those with symptoms, etc.), and yet the mask mandates continue. And there is no research being currently being carried out on the value of types of masks that are of any value, while the experts say the only mask that has value are the professional N-95 masks, as cloth and paper masks have not proven of much value in any clinical study. So sad we can’t have science driving our decisions, as children are being used in this issue.  

  The bottomline, if you are healthy, your risk is minimal if you are infected and the risk of hospitalization and death is minimal. If vaccinated there is only a 10% chance of getting hospitalized, since 90% of those infected are unvaccinated.

  The immunologic status of those previously infected vs those actually fully vaccinated is still not clear. The CDC still recommends all people over 11 years of age should be vaccinated (and all previously infected), but the data for those who have been infected probably only need one dose of a two dose vaccine has not been studied.

Mayo Clinic data, CDC data 

  If you feel you need a mask feel free to choose one, but use it correctly, and don’t congregate or get in a poorly ventilated areas, otherwise you are fooling yourself that it will prevent transmission. Outside, you should be fine, but again, if you feel more protected without any scientific evidence, do it and respect those who don’t.

F. The epidemic within the pandemic—alcohol abuse and obesity

  If there was ever a time for substance abuse to rise, it was this pandemic, since the lockdown occurred.

  The dietary recommendation from national organization for alcohol consumption from 2015-2020 was 2 drinks for men and one for women. There was not much information on the volume.

  1 drink equals 12 oz of 5% beer, 5 oz. of 12% wine, or 1.5 oz. of 40% liquor (80 proof). Unless a jigger is used, everyone can overdo the number of ounces if the glass used is larger, if ice is used, etc.

  It is estimated by a 2020 survey published by Pub Med (The National Library of Medicine) the consumption of alcohol increased by 75% in men and 39% in women, with more days of consumption per month. When home became work….work became home, and the time per day to drink increased considerably. Happy Hour became hours!

  28% of adults in the U.S. now report they weigh over 200 lbs. according to a recent Gallup Poll. By 2030, it is estimated that most Americans will be obese including 33% of children ages 6-11 will be overweight, and 50% ages 12-19 will be overweight or obese.

  Alcohol injures the liver, heart, and the pancreas and is linked to several cancers. It weakens the immune system, and worsens anxiety and depression, especially during times of stress such as the pandemic.

  Obesity decreases our lifespan by up to 8 years. Mortality from alcohol related disease increased 40% from 1999 to 2017 and over 150% in adults ages 24-35.

  Obesity is linked to at least 238 other medical conditions including 13 types of cancer, type 2 diabetes, sleep apnea, hypertension, hyperlipidemia, and depression. Obesity has increased death rates even in midlife ages 25-34.

  Heavy alcohol consumption increases fatty liver, which leads to cirrhosis, liver cancer, and potential death.

  Add 93,000 deaths in 2020 from drug overdose deaths (60% were fentanyl) and substance abuse and deaths continue to rise with this pandemic.

  Getting individuals into appropriate interventions has never been harder. The unintended consequences of this pandemic have been monumental.

Medscape, May 25, 2021

   

G. Flu season is around the corner

  While we all contend with COVID-19, the flu season is around the corner, and children are the most likely to transmit it and become symptomatic. One of the few side effects of our hygienic and mask behaviors was a minimal flu season last year. However, it should not keep individuals from getting a flu vaccine this fall. Also RSV (respiratory synchial virus) can be a severe childhood respiratory disease including other coronaviruses that cause the common cold, rhinoviruses, and others, as the symptoms overlap greatly. A bad case of flu will put a person down for 2 weeks and does kill the vulnerable populations including a significant number of children.  This is the Flu season in 2017-18:

 

Although the predictions of flu morbidity by public health was incorrect for 2020, our protective techniques for COVID-19 applied to influenza, but there is no guarantee this fall and winter, we will be as fortunate. Get the flu shot and get the COVID-19 vaccination too. Ask your physician the timing of these vaccinations. The earlier you prevent the flu this season the better, since obviously COVID-19 did not wait for cold weather.

 

 

2. Updates in cancer

The pandemic created delays in diagnosing and treating cancer, progress is still being made. Screening is critical to prevent cancer deaths, more advanced cancer treatments, and more suffering.

 

  A) Deaths averted with early breast cancer screening

This drawing is exactly why breast cancer screening is critical to diagnose cancers in a very early stage to prevent a case like this showing the spread to lymph nodes.

  Most breast cancer screening for populations is recommended to begin at age 45, according to the American Cancer Society, while others leave it up to personal doctors with a recommended screening age range of 40-49, depending on several factors.

  A study from the Lancet Journal, Nov. 24, 2020, revealed the death reduction benefit by beginning at age 40 in the UK.

  Researchers followed 54,000 women from ages 39-49 with annual mammograms for an average of 22.8 years.

  They also followed the same number of women without routine mammography (107,000).

  During the first 10 years, those who had mammograms annually had 83 deaths whereas the control groups had 219 deaths. That is a 25% fewer deaths from breast cancer. That is saving one life for every 1000 mammograms, which continues to be the findings in most studies. Breast cancer screeing saves lives!!

  In 2020, an estimated 276,000+ women will be diagnosed with breast cancer, and 64% will have an early stage of cancer. Approximately 42,000 will die. 1 in 8 women will be diagnosed with breast cancer during their lifetime. Early breast cancer can be cured in 99% of the cases.

  It is pretty clear, annual mammograms are important for young women to begin considering at age 40+, although, most recommend beginning at age 45 unless there is a family history, genetic markers, or other circumstances that might encourage earlier screening.

 

  B) Incidence of cancer in adolescents and young adults

  An analysis of cancer trends in the young from 1973-2017 finds a 30% increase incidence in cancers with kidney cancers rising the fastest and breast and testicular cancer the most common.

  Young people age 15-39 were included in this analysis.

Females--Of those diagnosed with cancer, breast cancer was diagnosed in 25% in females, 17% thyroid cancer, and 11% cervix and uterine cancer.

Males—of those diagnosed with cancer 18% had testicular cancer, 10% melanoma, 10% non-Hodgkins lymphoma.

  According to studies, there has been a decrease in leukemia, lymphomas, and brain cancers.

  Environmental, dietary, and obesity factors seem to play the biggest role. Factors include changes in age of white women having children later, exposure to chemotherapy as a child with cancer, increasing intensity of UV light (melanoma) and ionizing radiation, lack of exercise, and the HPV virus (human papilloma virus).

  It is very common for older children and certainly young adults up to 40 years of age not to seek routine care, and do not have primary care doctors, using urgent care as the primary source of acute medical needs.

  Screening for cancer does not occur until the age of 40-45. However, young people who have a history cancer in their family, must understand the need for closer surveillance and conversations with their doctors about their risks and screening choices.

  The weight issue, with lack of exercise, and poor dietary habits seem to be the glaring factors that could be addressed more aggressively, however, emphasis in most medical practices does not actively deal with these factors. Doctors are so busy in caring for diseases rather preventive measures, these factors will likely worsen, especially as the Hispanic population increases (they have 50% obesity rate).

JAMA Network, Dec. 2, 2020

 

 C) Survivors of cancers in those who are at risk for a second cancer

  It is well known that individuals who have one cancer are more likely to have a second one later in life, especially in smokers and those overweight according to NCI-SEER* studies by the National Cancer Institute.

*NCI-SEER studies—National Cancer Institute program on Surveillance, Epidemiology, and End Results

  In 2019, there were 16.9 million cancer survivors in the U.S. being projected to 22 million by 2030.

  Second cancers occurred in 11% of younger adults (20-64)and 25% in those 65 and older. Recent reports state about 15% of patients, if all cancers are included, are at risk for a second independent cancer.

  The highest incidence occurred in patients with laryngeal, Hodgkins lymphoma, esophageal, and gall bladder cancer, however, 18 of the most common cancers were included in this list. Lung cancer topped the list at 33% of deaths for a second cancer.

  Those who continued to smoke and or stayed overweight (obese) had the highest incidence of second cancers. Smoking is connected to oral, throat, larynx, lung, esophageal, pancreas, bladder, breast, colon, uterus, kideney, liver, cervix, and acute myeloid leukemia. Smoking causes 1-5 cancers.

  In 2014, 70% of people of age 20 or older were  overweight and 36% of the those were obese.

 

D) Drop in PSA screenings have increased the number of metastatic cancers at diagnosis

  The incidence of metastatic prostate cancer at diagnosis has increased from 6.4% to 9.0% per 100,000 men since it was not strongly recommend for asymptomatic men to be screened. Of course, family history, and other factors would increase the need for screening in any cancer.

  During that period, the overall number of men being screened dropped from 61.8% to 50.5%. The period from 2008-2016 was studied by these authors.

  The USPTF*came out with their recommendation to not perform routine screenings with PSA in 2008. The American Urological Association was against the recommendation. The American Cancer Society recommended it be a decision between the doctor and patient (I was honored to be a member of the task force when ACS began revising all of its cancer screening recommendations).

*USPTF—U.S. Preventative Task Force

  PSA (prostate specific antigen) screening has been proven to reduce the incidence of metastases and deaths.

  In early 2000, there was a movement by the federal government to reduce screenings because of overdiagnosis and false positives requiring unnecessary procedures. Part of the process was trying to rein in healthcare costs.

  There is always a price to pay for routine screenings, but not only is it helpful in earlier diagnosis but saves lives. However, the morbidity and false positives, in some academician’s minds outweighed the good.

  Screening for cancer has been solidly recommended for breast, cervix, and colorectal cancers, but prostate screening lost favor enough to convince many people they refused the blood test, but it is always wise to rely on personal physicians to make those kinds of healthcare decisions (not bureaucrats).

Presentation from Genitourinary Cancers Symposium, 2021 presented in Medscape.

 

  E) New guidelines for lung cancer screening for high risk people

  There has been a disappointing percent (14%) of people who smoke or used to smoke that are taking advantage of lung cancer screening using a low dose spiral CT scan to find early cancers or suspicious spots in the lung that deserve evaluation.

  The USPSTF* has revised these guidelines to include people 50-80 (used to be 55-80), have smoked 20 pack years (one pack of cigarettes for 20 years; 2 packs a day for 10 years, etc.)(used to be 30 pack year). It is important to discuss this issue with the personal physician to understand the risks and benefits.

*USPSTF=U.S. Preventative Services Task Force, the major federal advisory group to the administration.

  Additionally, those who have quit for 15 years or still smoke should be screened annually.

  This screening method is already reducing the chance of death by 20%, and with this revision of guidelines will increase the number of early cancers still curable.

  These new guidelines double the number of people who are eligible for screening, covered by insurance. All who participate should enroll in a smoking cessation program.

  Please, if you know a smoker, one who smoked at least 1 pack of cigarettes for 10 years, has quit 15 years ago or more recently, please inform them of these facts, because it is dropping the mortality rate a lot.

  Lung cancer is the second most common cancer and the leading cause of death from cancer. 229,000 people were diagnosed with lung cancer in 2020. Smoking accounts for 90% of lung cancer. 5 year survival is 20%. 79% of patents present with the lung cancer already spread to regional lymph nodes or distant sites.

  There are many resources for smoking cessation programs, medications, and other methods.

JAMA network March 9, 2021

 

F. Detrimental effect of aspirin on colon cancer spread in older individuals

  The medical literature has supported using aspirin as a preventative of colon cancer and cardiovascular disease if taken for at least 5 years and if not diagnosed with cardiovascular disease. There is even evidence that in those with colon cancer that is curative with adjuvant chemotherapy, aspirin may reduce the incidence of recurrence.

  However, a new study, in older (70+) individuals, shows an increase of metastases of colon cancer compared to those who do not take daily aspirin. There was no increase in localized colon cancers but the number of metastases was significantly increased, according to the authors of the clinical research project that included 19,000 individuals. This study continued to show benefit in younger individuals if taken for 5 years, but not those 70 and over.

  The bottomline, if a person chooses to take low dose aspirin as a preventative for colon cancer or cardiovascular disease (and cardiovascular disease free, he or she must take the daily aspirin for at least 5 years for the benefit to appear, but must be younger than 70. Moreover, older people taking aspirin for these diseases not only show no benefit in cardiovascular disease mortality or colon cancer prevention, but are associated with more spread of colon cancers.

J. National Cancer Institute, March 1, 2021

JAMA, Oncology, March 1, 2021

 

G. Obesity and cancer risk

  It is well known that being overweight increases the risk of many cancers. The mechanism comes through the immunological route, in that obesity is an inflammatory condition stimulating certain proinflammatory cytokines, which suppresses T-cell immune competence. These changes are seen most dramatically in fat cells, where these immune cells accumulate and are stored.

  When an individual is challenged with cancer cells, the normal protective mechanism is a diminished increasing the chances of cancer cells not being inhibited and forming a tumor.

NEJM, March 25, 2021

 

3. Pregnancy issues—Part 2

Part 1 of pregnancy risk factors and issues can be found in the February, 2021 report. Part 2 continues on recent medical journal articles regarding various issues for pregnant women.

  15% of pregnant women experience adverse pregnancy outcomes.

A) Low dose aspirin on pregnancy hormones (HCG), pregnancy loss, and live birth

  A study on low dose aspirin in 1227 pregnant women, 18-40 years of age included in 4 major medical centers. Relative to placebo, the aspirin group had 8 more HCG detected pregnancies, 15 more live births, and 6 fewer pregnancy losses. 

  Taking the 81mg aspirin 4 days a week had a positive effect on these aspects of pregnancy. Talk to your doctor about this study and the possible benefit pre-pregnancy.

  Human chorionic gonadotropin (hCG), a glycoprotein, is the hormone produced by the very earliest cells of a pregnancy (trophoblasts) that are cells that surround the embryo, which eventually forms the placenta. A similar hormone produced by the pituitary gland is called luteinizing hormone (LH), secreted in both men and women.

  (hCG) interacts with receptors in the ovary for the  maintenance of the corpus luteum for the maternal recognition of the earliest pregnancy. It actually allows the corpus luteum to produce progesterone during the first trimester of the pregnancy, which enriches the uterus to form a rich supply of blood vessels to assist in the viability of a growing fetus.

  This hormone (hCG) can induce ovulation and is often used in in vitro fertilization procedures.

  In men it is used as a performance enhancing drug and is illegal to use in athletes for sporting events. hCG can stimulate the production of testosterone.

  It is used by homeopathic medicine to induce weight loss, but these over the counter products are not FDA approved and they have announced they are fraudulent and ineffective for weight loss.

Annals of Internal Medicine, January 21, 2021

 

  B) Pregnancy and protection of COVID-19 of the infant and newborn; breast feeding

  The JAMA-Internal Medicine, January 15, 2021 reported on a national study with 6380 women hospitalized for childbirth with infection with COVID-19 (out of 406,444 admissions)-- 1.6% of the total women were hospitalized for childbirth).

  The bad news

  Those pregnant with COVID required more intensive care, mechanical ventilation, had a higher incidence of heart attack, thromboembolism, pre-eclampsia, more pre-term births, higher rate of stillbirths, and although low, had higher death rate. 98% of these women eventually were discharged.

  These women are younger, more obese, black, more likely diabetic, and had kidney disease. It is clear that pregnancy management and underlying health issues must be a priority. Safety measures are a must, and getting vaccinated is very necessary, which will protect the baby as well, at least for a time.

  Another study found that there are IgG levels in infants from women who have been infected while pregnant. The longer time from infection to delivery created higher IgG in these infants. These levels diminish over weeks, as does other forms of antibodies that travel across placenta from the mother. It is felt that vaccines in the mothers would impart protection.

  Not only should pregnant women be vaccinated for COVID, but should breast feed to transfer further viral protection to their infants if vaccinated.

JAMA-Pediatrics, January 29, 2021

  

  C) Postpartum high blood pressure and other adverse outcomes are red flags for later cardiovascular disease

  The American Heart Association has provided new guidance for women to prevent heart disease. It is well known that hypertension during pregnancy will continue in significant numbers if not addressed. Hypertension is one of the prominent flags for future cardiovascular disease.

  Black, Asian, and Hispanic women are known to carry higher risks during pregnancy in a number of ways that lead to later cardiovacualr disease.

  Pregnancy loss, gestational diabetes, gestational diabetes, preterm delivery, smaller birth weight, and abruption are all red flags for later cardiovascular disease, and must be followed up after pregnancy to monitor for these cardiovascular issues. Add to the list women who could not or did not breast feed, or even disprupted lactation.

  11% of pregnant women smoke during pregnancy. Smoking cessation is critical in preventing cardiovascular disease. 1-800-Quit, which doubles the cessation rate.

Circulation Journal, March 29, 2021

 

  D) Effect of coffee on pregnancy outcomes

  In pregnancy, high consumption of coffee has certain detrimental effects: higher pregnancy loss, lower birth weight, and pre-term births. There is also a higher risk of fractures in females (not males).

 

  E) Six pregnancy complications increases heart disease risk later

  The American Heart Association has reported that there are six pregnancy complications that increase the risk of cardiovascular disease (CVD) later in a woman’s life.

1- Hypertensive disorders of pregnancy

   Those women who suffer from high blood pressure during pregnancy have studied during their lives and found to have a 67% chance of developing cardiovascular disease (CVD) during their lifetime and an 83% increase risk of stroke.

  Pre-eclampsia of pregnancy has a two fold increase of CVD.

2- Gestational diabetes increases the risk of CVD by 68% and the risk of type 2 diabetes ten fold.

3- Preterm delivery (earlier than 37 weeks) doubles the risk of CVD.

4- Placental abruption increases the risk by 82%.

5- Stillbirth doubles the risk.

  The American Heart Association has called these complications out so that women who suffer from them will be put on alert for the risks.

  The association notes that breast feeding will decrease these risks, along with diet, exercise, and good nutrition. Good follow up with the knowledge of these risk factors will enhance health. Communications between OB docors and primary care is also extremely important. That includes close blood pressure monitoring, blood sugar, and lipid testing is helpful. Early statin therapy is encouraged if necessary.

  It is critical to educate patients about these risk factors and be proactive in managing them. The authors of this article note that the year of pregnancy and the postpartum period should be considered a “golden year” for women to realize how important it is to the future of their health.

Circulation, March 29, 2021

 

   F) Pregnancy, COVID-19, and the vaccine

  There have been hesitancy in getting the COVID vaccine in women of child bearing age. Concerns during the pregnancy for the child along with untruths in the media, have been a real negative, even in the face of peer reviewed medical journals reporting no complications from the vaccine including other reports about pregnant women who tested positive for COVID.

  The clinical trials testing the value of the vaccine excluded pregnant women (as would be expected).

  A group of women (84 pregnant and 1 lactating, and 16 non-pregnant were studied throughout the course of receiving either the Pfizer or Moderna vaccine.

  Antibody levels from the vaccine were similar in all groups. There were no side effects other than the usual vaccine side effects (fever, ache, headache).

  Hopefully as physicians continue to see these encouraging reports, they can more aggressively suggest the vaccine. American Journal OB/Gyn, March 24, 2021

 

4. Diverticular diseases of the Colon

Diverticulosis/Diverticulitis

Diverticuli are small bulges (outward) of the intestinal lining. About half of all people have some diverticuli after 60 years of age. Although most do not have symptoms, cramps, bloating, and constipation do occur. The cause is not known, but it is thought that increased pressure in the colon is an underlying cause.

  Fiber in the diet is the secret to normal bowel function. Diverticuli are more common in patients with IBS (irritable bowel disease).

  A colonoscopy or barium enema test can demonstrate these diverticuli.

  The best treatment for mild symptoms of diverticulosis is a) high fiber diet (fruits, vegetables, beans, and whole grains), b) high water intake, c) exercise, d) bulk fiber products such as Metamucil, and taking time for a bowel movement without straining. A daily bowel movement is not necessary.

      

Colonoscopy view of diverticulosis

 

When a diverticulum becomes inflamed it is called diverticulitis. It can cause severe abdominal pain, nausea, and marked changes in bowel habits. If fever occurs with abdominal tenderness, you must see your doctor, which may require hospitalization. Recurrent disease may lead rarely to removal of a section of the colon.

Complications include abscess, intestinal obstruction, and a fistula (the diverticulum can rupture and cause abnormal connections to the outside of the bowel or bladder). All of these complications can lead to peritonitis, which is an emergency.

Risk factors include a low fiber diet, smokers, aging, high fat diet, obesity, and medications that can cause constipation, including steroids, NSAIDs, and opiates. 

  The American Gastroenterological Association (NEJM, November, 2019) has published recommendations for managing acute diverticulitis, and has largely been unchanged over the past few years. There is more emphasis on individualized care with a patient-centered decision making process. There continues to be an increase in the number of severe cases that are being  offered (perhaps due to more aggressive surgeons and the increasing incidence of obesity).  resection of that particular portion of the colon.

  Here are the new guidelines:

1. CT scans should be considered when diverticulitis is suspected.

2. Antibiotics should be used “selectively rather than routinely” for mild cases of diverticulitis. If some of the following abnormalities are present, antibiotics can be considered: patients with other serious diseases or immunosuppression, elevated C-reactive protein blood level (>140mg/L), elevated white blood cell count above 15,000, presence of fluid collection, or a long segment of obvious inflammation of a long segment of colon on CT scan.

3. if symptoms persist after an episode of inflammation, repeat CT and colonoscopy is indicated.

4. Partial colon resection should not be based solely on the number of episodes. Disease severity, operative risks and benefits, chance for success, and patient preference.

5. Measures to prevent recurrence must be maintained including a high fiber or vegetarian diet, regular physical exercise, achieving a normal body weight, smoking cessation, avoidance of NSAIDs except low dose aspirin for cardiovascular disease prevention.

6. there are no known medications to lower the risk of recurrence.  

  Antibiotics usually recommended are either metronidazole (Flagyl) plus a quinolone (Cipro, etc.) or amoxicillin/clavulanic acid combo (Augmentin). Concern for C.diff.* infection is always a concern in patients needing multiple rounds of antibiotics especially in older patients.

*C.diff.=Clostridium Difficule is a serious infection usually caused by ovr use of antibiotics which reduce bowel bacteria causng these opportunistic infections. This infection is very resistant.

  Either combination of antibiotics gives the same risk for repeat episodes. However, the incidence of urgent surgery for diverticulitis was lower in the Metronidazole-quinolone group.

  The quinolones are known for several side effects including hypoglycemia, mental issues, peripheral neuropathy, aortic aneurysm, and tendinitis. In spite of these relatively rare side effect, this combo is prescribed 7-8 times more often than the amoxicillin/clavulanic group.

  There is a warning issued by the American Gasteroenterological Association to be very selective in prescribing quinolones to immunosuppressed patients. There are 10 million Americans that come under that label. They also encourage physicians to use amoxicillin combo group more.

Annals of Internal Medicine, Feb 22, 2021

 

5. CPAP recall alert

Recall of 2 million of CPAP (continous positive airway pressure)  and BIPAP (bi-level positive airway pressure) machines is under way as reported by the New York Times. The machines are made by Phillips including certain Respironics BIPAP machines and ventilator machines.

  The U.S. Food and Drug Administration announced that polyester-based polyurethane foam as a liner was used in the apparatus to reduce sound and vibration of the machines. This allows breathing in or swallowing certain chemicals and black debris that could cause asthma, skin and airway irritation, with toxic and carcinogenic effects for the patient’s organs including the liver and kidneys.

  The FDA ordered Phillips to repair or replace these faulty components. They also ordered extensive testing before these machines are returned to the patients.

  About 2 million of these machines are being used in the U.S.

  Consult the treating doctor for further information.

Medicine.net, August 19,2021

 

 6. NSAIDS (Aleve, ibuprofen) not as bad for kidneys as thought in older patients

 

Non-steroidal anti-inflammatory drugs have been touted as dangerous for the kidneys especially in older people. In fact, they are, if taken regularly without monitoring the kidney function. Those with kidney disease should avoid these medications.

  I can vouch for that, as I found myself in partial kidney failure from taking prescribed naprosin, a strong but very effective NSAID. Within 9 months, my kidney function studies went from normal to abnormal range of the serum creatinine and GFR (glomerular filtration rate). Thankfully, my internist was monitoring my kidney functions, and caught it fairly early. It took over a year for those studies to return to normal values and have remained normal for years without damage.

  However, a recent study found no difference in the kidney function, even in older people who took NSAIDs regularly and did not have higher rates of kidney malfunction. This is not to understate the potential for damage in certain people with normal kidney function. That is why these blood studies must be followed especially when these stronger NSAIDs are taken daily.

  NSAIDs have been routinely used for osteo-muscular disorders, even COVID-19, for years, but when physicians were forced to reduce the number of prescribed opioids, the use of NSAIDs increased and even acetaminophen (Tylenol). 

  NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), naprosin, Voltaren, indomethacin, Celebrex, etc.  Acetaminophen is not an NSAID.

  NSAIDs are anti-inflammatory in nature by influencing the prostaglandin system, which are a type of lipids which are manufactured at the sites of tissue damage that help in the repair of that damage. They are involved even more in inflammatory diseases especially orthopedic and muscular disorders, arthritis, etc. They also influence the clotting system (platelets), and influence the stomach acidity.

  Because of these effects on the body, caution for people who have stomach trouble, are on other meds to reduce blood clotting, or have impaired kidney function, should be very careful about taking these NSAIDs

  It has been stated without any scientific information to back it up that these NSAIDs should NOT be taken when the COVID vaccine is given, as it might diminish the antibody response from the vaccine. Talk to your doctor about the issue. A significant number of people have muscle aches and fever with vaccines and often individuals reach for these mostly over the counter medications to combat these side effects.

  I bring this up because I saw a small article in the Sarasota-Bradenton newspaper in late March, warning people not to take them around the time of their receiving the COVID vaccine. Tylenol was recommended.

  Tylenol is preferred for many reasons, but in searching for scientific data to support such a statement about avoiding one or two days of NSAIDs regarding depression of the immune system, I was unable to find it.

  I suggest as always to talk to your doctor about taking these over the counter medications when getting the COVID-vaccine to prevent fever and muscular ache. Also, just because a medication is OTC (over the counter), does not mean it is without side effects and must be respected. 

J. American Geriatric Society, March, 2021

I could not resist……………..

That completes the September, 2021 Medical News Report, #116.

 

Next month, the October, 2021 report will include:

1-COVID-19 updates

2-29 million women are living in Sex Slavery

3-TIAs and strokes

4-Diabetes updates

5-Circadian Rhythm information

6-New screening guidelines for those with a history of colon polyps

 

As always, stay safe, stay healthy and well, and get vaccinated. Dr. Sam