The Medical News Report

November, 2022

#130

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Happy Thanksgiving

Subjects for November, 2022:

1. Breast Cancer screening, newest guidelines

2. COVID and Influenza updates

3. Anti-radiation exposure medications

4. Erectile Dysfunction—7 options for treatment

5. Date Rape Drugs

6. Pre-eclampsia; Maternal death rates in U.S. rising; Rh factor disease in pregnant women OB/Gyn Series--Part 5

7. Gastro-esophageal reflux and Barrett’s esophagus—a review

8. Blood and Blood Products; Blood types, Transfusions, Donations, Pregnancy Rh factor Disorder

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. Healthcare is making it harder to get everything we want in our care.

  You should never act on anything you read in these reports. I have always encouraged you to seek the advice of your physicians regarding all health issues.

  Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive with 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. Never stop a prescribed medication without telling your physician.

  The more you know, the better your care will be, because your doctor will sense you are informed and they will provide better care.

  Always write down your questions before going for a visit.

Thank you, and Happy Thanksgiving. Dr. Sam

November, 2022 Subjects:

**A quick note about an NFL change in protocol for concussions**

  Last month, I reported on head injuries and concussions with protocols for them. After what happened to the quarterback of the Miami Dolphins, Tua Tagovailoa, returned to the game, having cleared the current concussion protocol, he still had some unsteadiness (ataxia) which was supposedly from a previous back injury, however, after sustaining 2 concussions in two consecutive games, and wrongly sent back into the game since he had a little unsteadiness, ataxia will now be considered a reason for not returning to the game based on concussion protocols in the NFL.

  Unsteadiness on anyone is a cerebellar brain abnormalitiy until proven otherwise, and certainly should be part of the concussion protocol. I applaud the NFL.

  If the reader did not see my report last month, I strongly encourage anyone to read it on the latest information on concussion and head injury for any age.

1. Breast Cancer Screening Guidelines-ACS

October was Breast Cancer Awareness Month

Get your mammogram!

  Casey De Santis, wife of Florida Governor, Ron DeSantis, is cancer free because she caught her breast cancer early with screening mammography. God bless her and thanks to breast cancer screening, the death rate has been reduced by over 20%.

  A woman can’t wait to find a lump. It must be diagnosed when it is smaller than a pea. Mammography is the current answer. 1 in 8 women develop breast cancer in their lifetime. The pandemic dropped the screenings terribly, and mammograms are still down 20%, which equates to fewer early breast cancers being diagnosed.

  The current American Cancer Society screening guidelines* for women with average risk without a personal history of breast cancer, or a strong family history, or genetic mutations, and has not had chest radiation therapy before the age of 30 should follow these guidelines:

1. Women between the age of 40-44 have the option to start mammograms annually.

2. Women 45-54 should get annual mammograms.

3. Women 55-older can do annual or every other year mammograms based on the discussion with their physician. It should continue as long as a person is in reasonably good health and has an estimated 10 year life span ahead of them, all to be discussed with the primary physician.

4. Proper education regarding risks and benefits for breast screening is always necessary.

5. Clinical breast exams are not recommended prior to breast cancer screening. Exams at other times would be at the discretion of the woman and doctor. Research has not proven a clear benefit of regular physical breast cancer or self exams, another topic to discuss.

6. Digital mammograms (3-D) ae commonly used today, and have fewer call-backs than standard mammography, but are not available in some communities. If something is found on the mammogram, other tests may be necessary, such as ultrasound.

www.cancer.org

*I was proud to be a member of the ACS National Cancer Screening Task Force that revised these issues while an active volunteer for ACS (40 years).

  Support your American Cancer Society!!

The Famous Norman Rockwell Thanksgiving Dinner Scene

2. COVID and Influenza update

  A. We finally know the truth!

  After over 2 ½ years, a video of a Pfizer scientist has admitted, under questioning in Europe, that the COVID-19 vaccine was never studied regarding the prevention and transmission of the emergency authorized vaccine. This is not surprising considering the short period of time before it was promoted as the answer to end this virus. But to not admit this and have 2 administrations not tell us, is reprehensible, since lies were perpetuated from experts in infectious disease and pharmaceutical companies including Dr. Anthony Fauci, when he was a member of President Trump’s White House COVID Task Force. He continued to not tell the truth throughout the Biden administration mandating children and adults to get vaccinated or be sent home or fired. This was also accepted by many businesses, who required the vaccine.

  I understand the emergency we faced, after the Chinese Communist Party and the WHO delayed letting the world know of the severity and danger of what has become the worst pandemic any human alive has faced.

  We also were not told about the possible side effects until they started happening in recipients, and even though they were small in number, myocarditis and other serious side effects occurred, especially in young healthy males.

  Parents were concerned about their children and its benefit, and did not accept the vaccine in great numbers due to the confusing facts being promoted. Healthy younger people were not convinced, and when they got infected felt they were immune as is the case for most infections, but the administration did not acknowledge natural immunity….a sad thing to do.

  Those with underlying medical conditions heeded the CDC’s advice and a high % got vaccinated. Those were the most likely to get the sickest and over 600,000 died. But with newer variants of the virus began hitting those fully vaccinated. This created more doubt, since the administration did not have adequate information to be making many of their statements, and the public distrusted their information, leaving many to not get vaccinated. If they had told them that the vaccine, Like the flu vaccine, may not prevent the disease, but lower its severity, I think more people would have been vaccinated.

  When the Omicron variants took over, the vaccine clearly was preventative, but did reduce the severity. Now we are facing the 4^th dose this fall, and most healthy people are not receiving it. Sadly, the CDC has lost a lot of credibility, and must become an independent organization in the future if they want to be effective. Politics have contaminated the FDA and CDC terribly.  

  The success of boosters so far has not been great, with less than a third of people getting the first booster available over 6 months ago and now the new fall vaccine success lags.

  I wish everyone would get the basic vaccine and at least one booster, but now that we know the immunity only lasts for 4-6 months, we would have to keep getting vaccinated. The CDC has already recommended annual boosters for children 11 and older. The child must previously had the full vaccinations to qualify, which means about ¼ of children qualify. This continues to be in the face of not recognizing natural immunity. We also have over 95% of the country with some type of immunity, however, as the experts have told us, that immunity only lasts 6 months.

  The sad news is the administration did not fund research for a good inexpensive antibody test for those who had natural immunity or previous vaccination, to find out their current status. That would have required them to acknowledge natural immunity, and just wanted to promote the vaccine. Would it not be helpful, to know about the kickbacks Big Pharma has given Congresssmen and the White House.

  We also continue to get more information about the NIH’s financing of the Wuhan virus long before the pandemic was discovered. In the middle of this October, it was discovered that Boston University has performed more gain of function research on the bat coronavirus, and made it deadly in 80% of cases. OMG!! What if it gets leaked, as it did in Wuhan? We have no business creating such dangerous diseases anywhere outside of the CDC.

  Doctors in California could be prosecuted (with legislation soon to be voted on) for “COVID disinformation”, when the feds have provided many non-scientific decisions and guidance. And they still mandate the vaccine to many groups, without sound scientific confirmation.

  However, since the severity of the infection has become so mild in most, the success of this pandemic came not only from the vaccinated, but the millions of people who got infected and had better immunity than those who were vaccinated, and created herd immunity.

  Think about the political manipulation this administration has used to control and overpower the public as an instrument for the leftist to promote socialism/Marxism and the climate change promotions with $trillions of dollars being misappropriated that has created the current inflation disaster.

  I am sad to realize how little our politicians think of us, and that goes for both parties, as there are now more independents than ever before. Will we ever drain the swamp?? NEVER!! At least not as long as we have the Dems running the show and Rhino Repubs not doing their job. Get rid of these politicians with your vote!!

  Our children are behind 2-3 grades in math, as reported by the California School Boards, thanks to the dumbing down of our  children’s education, spending more time on gender discussions, CRT, and keeping kids out of school.

   Language delay has been a problem, with little children having to wear masks, and not being able to see the lips move with speech and missing facial expression. So many schools now have classes filled with Spanish speaking children creating its own problem, with a lack of Spanish speaking teachers.

  Thankfully, a large number of parents are getting involved with their children’s school education, and need to voice their disapproval at the voting booth this month.

  Add the legislation to take away the authority of parents over their children’s decisions, including abortion, gender identity, trans surgery and medication to alter hormone levels. If passed, this essentially is doing away with parental guidance, authority, and influence. My goodness, why would any parent want this?

  And would the CDC remind people and children, unless you are wearing a N-95 mask, it doesn’t work. Masks for children are destructive, and yet they still require them in many schools. Quit using masks as a political statement!!

  And to add to the insanity of this country, as the liberals want to promote equity in transsexual issues, there are performances in front of children and idiotic parents that show off drag queens dancing in extremely sensitive ways trying to normalize this aberrant behavior.

  It was discovered that taxpaying dollars are funding drag queen shows in Ecuador.  Fine with drag queen shows, but not federally funded. The American people need to know about how far the efforts to push diversity and equity are going by the radical left Dems. America…. vote your conscience.  

  With historic inflation, the poor economy, accelerating crime, cashless bail, the open disastrous southern border, fentanyl deaths, reckless spending, and a runaway administration who has weakened America in the eyes of our adversaries, is there any reason not to want change?  

   B. The Omicron variant fall vaccine; Flu vaccine

  The government will end its free COVID new booster (bivalent) by the end of this year or until the government purchased supply has been depleted. The emergency use authorization act will end, since the pandemic has essentially ended.

   The cost for the private sector is being quadrupled (from $34 to $130 per dose), but insurance should cover it. However, those without insurance will have to cover the cost. I would hope Pfizer and Moderna (and now Novavax) doses might provide a discount for the poor who won’t get it. Too bad Biden couldn’t have saved some his $trillion spending for the cost to the uninsured, since he was so pro-vaccine.

  As expected, the drug companies are seeing little side effects and good immune response from the bivalent vaccine.

  The fall COVID vaccine has been received by a 22 million people, but less than a 1/3 of the population plan on getting it unless something changes. Most of the people getting the new bivalent vaccine are over 60. That is no surprise, considering age is a risk factor by itself. A new study reported those 80 and over are particularly vulnerable.  And certainly anyone with risk factors at any age should take advantage of all boosters.

  Getting the Flu vaccine is important as well. The flu is “supposed” to be worse this year. If we had a “twindemic” issue this winter, we could lose a lot of positive momentum, so get vaccinated if older and are more at risk. We still have to have a great deal of faith that these boosters are really necessary, especially if healthy and younger than 60.

   Flu vaccine is only effective for 40-60% of people, but does reduce the severity of the illness, which is no small thing. A full case of flu can put you down for weeks, and it still kills thousands yearly. Flu can still put you in the hospital with pneumonia and worse. Don’t let the pandemic mentality get in the way of getting a flu shot. Seniors can get a double strength dose, since they are the most vulnerable. But remember children can suffer from flu a lot worse than COVID. Get them a flu shot.

  Australia in the Southern Hemisphere usually mirrors our flu experience 6 months earlier, since their winter is in our summer, and they report the worst season of flu in the past 5 years, which hit children the hardest, and the U.S. usually chooses the same vaccine strains to cover as Australia.

  Talk to your doctor about this and the bivalent Omicron fall vaccine. They can be received at the same time.

  We still have no COVID vaccine that has lasting immunity, however, and still don’t have adequate information on just how much immunity is necessary to prevent a serious infection long term. I am afraid, COVID will follow influenza, and annual boosters will be recommended, but no science to prove that YET! Expect 20+% of the population to get an annual COVID shot, just about the numbers for flu shots.

  C. LONG COVID SYNDROME—new info!

  There is a significant amount of research ongoing in patients with long COVID.

  The patients vary in symptoms, severity, length of the long syndrome, and different blood findings. A good percentage are showing exhaustion of their T-cell lymphocytes that are the main fighter against viruses, and many have low cortisol levels, reactivation of the Ebstein-Barr virus (infectious mono), and other cellular reactions.

  Therapies are being tested as well, including cortisone supplementation, targeted therapy against Ebstein Barr virus, using Paxlovid for longer periods of time (currently given in acute infections only), and therapies to deplete B cell lymphocytes, which are commonly elevated in long COVID, and those with chronic fatigue syndrome/myalgic encephalomyelitis, according to Dr. Eric Topol, an expert at Scripps Research Translational Institute, San Diego.

  Those with persistent pulmonary symptoms often respond to asthma medication (inhalers), and need to be monitored for cardiac involvement (heart failure, myocarditis, etc.).

  Patients are not considered infectious even with positive tests over time, but extra precautions make sense, and in their condition could be more susceptible to other infections especially flu, so get vaccinated, if ok with the treating physician.

  Nearly 1 in 20 who get COVID have prolonged symptoms for months after they “recover”. The symptoms are thought to be autoimmune in origin, as I have mentioned before.

  COVID stimulates our immune system like any infection, only more severe, especially in those vulnerable groups, and these patients persist with certain symptoms, especially weakness, fatigue, and brain fog.

  The millions with Long COVID are missing work, having to quit their jobs, or are being laid off. Insurance has become a real issue, and getting disability is very difficult, even Social Security (they are raising SS by 8% next year). This is having an impact on our work force, and these patients are very frustrated that there are not more answers for treatment. It certainly is a good reason to get vaccinated, because most with this syndrome are unvaccinated.

  A recent University of Glasgow study reported by Medicinenet.com that 42% felt only partially recovered with prolonged shortness of breath, fatigue, palpitations, and “brain fog”. Those who were asymptomatic (or only very mild) or were previously vaccinated rarely reported persistant symptoms and recovered quickly. Long COVID also correlates with the severity of the illness, not surprisingly.

  As in all autoimmune diseases, treatment can be inadequate, and symptomatic treatment is the mainstay. Each person must have continued evaluation and individualized treatments, which may include corticosteroids and biologic therapies. I will keep my readers updated regarding this syndrome and any treatments that get approved.

Medicinenet.com October 13, 2022

  D. Be aware of side effects of Paxlovid

  A very recent study found that Paxlovid, the standard of therapy for outpatient COVID patients who test positive, have drug interactions with many medications (the ritonavir, an HIV drug, is one of 2 drugs in Paxlovid). It interacts with cholesterol lowering medications by preventing the breakdown of these drugs, and may increase bleeding in patients on blood thinners. However, Plavix, a platelet lowering blood thinner, may interact in the opposite way, by increasing the risk of clotting. Drugs that treat irregular heartbeats (antiarrhythmics), may increase in the blood stream causng problems as well from Paxlovid.

MedicineNet October 14, 2022

  The good news is Paxlovid is taken for only 5 days, but if on these meds, please discuss these potential side effects with your doctor, to consider adjustments in dosage, etc.

  The value of reducing the symptoms and severity of COVID is worth taking these meds if a person is in higher risk groups. Healthy people need not take it, according to the CDC. Of course, the administration wants everyone to take it.

  Telehealth has been very successful

  Just a note to the readers. Telehealth visits especially with the primary care doctors were very successful during the pandemic, and still are. This has been more successful for people in rural areas, blacks, the poor, are a long distance to their doctor’s offices, or need mental health discussions and substance abuse counseling.

  However, some doctors have abused this when prescribing certain medications, especially for Adderall, opioids, etc. Recently, because doctors were pressed so hard to stop prescribing opioids for deserving patients, that there is now a federal law protecting doctors from imprisonment for overprescribing drugs. So many patients were abandoned and sought street drugs. Although, not law, no one should seek telehealth without first having established themselves with that doctor face to face. (my opinion!).

  Telehealth requires a computer or iphone (facetime) for a visual visit. Doctors should see you on the visit, not just a phone call, unless there are circumstances with very poor patients or those who don’t have internet.

  It also can be a great way to discuss lab follow-ups.  

3. Anti-radiation exposure medications

  The administration apparently is concerned enough, that Biden authorized $290 million expenditure for a medication  (Nplate) to address radiation effects on the platelet count, which if very low will cause bleeding. The Department of Health and Human Services confirmed this purchase in October. Biden has said that the threat has not been this high since the Cuban Missile Crisis (refuted by several experts).

  Unfortunately, one must respect any talk of nuclear threats, and with the perceived weakness of the U.S. and Europe, it may be warranted. People are buying antiradiation drugs off the internet with no guarantee they are getting the proper drugs, and having no knowledge of harms vs benefit. On that basis, I felt it important to educate my readers. Nplate, which requires a prescription is not available, so far, on the internet, but there are substances that can be purchased.

  Acute exposure to radiation causes many health issues if exposed by the skin, inhaled, or ingested. On the CDC website there is a site regarding radiation emergencies.

  They state that removing internal contamination from the body will help reduce the risk of health effects. These emergencies can occur anywhere radiation exposure occurs.

  It is obvious carefully controlled radiation therapy for cancer has its effects as well, but is well tolerated with small daily doses, however, the accumulation effect is well known—mucosal ulceration, damage to surrounding organs and tissues, fatigue, scarring, dysfunction, and late effects especially to blood vessels, lung tissue, and the mouth and throat.

  For acute exposure there are medications that limit or remove internal contamination depending on the type of radioactive material. Treatments include potassium iodide, Prussian Blue, and DTPA (diethyllenetriamine pentaacetate). There are also medications that can raise the platelet count which can occur with radiation causing bleeding. Nplate is one of those drugs.

Acute Radiation Syndrome

  The symptoms include nausea, vomiting, headache, and diarrhea, with obvious psychological distress. Skin irritation, itching, tingling, and swelling may occur. The risk of  developing cancer is increased later in life.

  Bone marrow suppression, with a drop in production of blood cells, and there are drugs that can speed up blood cell production, Neupogen, and is given in many cases of cancer patients receiving chemotherapy.

Nplate (romiplostim)

  Nplate is used to elevate the platelet count, most frequently when chemotherapy lowers the count below 30,000. It is also used for patients with idiopathic thrombocytopenic purpura (ITP), a bleeding disorder, when corticosteroids are not working, the front line medication.

  My brother-in-law was on it for 2 years because of an unknown platelet disorder. It worked too!!

  I can find no data on its use in radiation exposure. And it is not the ideal drug to use, so who wanted to push the stock of Amgen?? They say it must be injected within 24 hours of exposure, so who is going to get it??

  The FDA approved Nplate in 2021 to treat the low platelet count and prevent bleeding from radiation exposure. Amgen, the drug company began studies in 2019 regarding its potential use for radiation sickness. The $290,000 provides 50,000 courses of the drug, according to Amgen, and is a very small buy, probably just the administration.

  Clearly, there are many abnormalities that occur when exposed to war levels of radiation. This drug only addresses one aspect (platelet caused bleeding) of the exposure, so I am wondering what is happening that we don’t know about.

NBC Health

Here are the substances found on the internet:

Potassium Iodide (KI)

  Do not take KI (potassium iodide) unless instructed by public health or emergency response officers. KI only protects the thyroid from I-131, and does not protect the rest of the body. If recommended, it is for only those under 40 and pregnant or breast feeding. Radioactive iodine may be released in a nuclear power plant emergency. KI can help prevent thyroid cancer in infants. KI helps prevent the thyroid from absorbing the radioactive iodine. It must be ingested shortly after exposure.

  Do not take table salt or foods as a substitute for KI. Only use FDA approved products.

  Whether KI, in a nuclear explosion in wartime, will help may or may not help. Seeking shelter is the best defense.

  There are 2 FDA approved forms of KI—tablets either 65 or 130mg depending on weight. Oral liquid is available as 65mg. Follow recommended dose from a physician or emergency response officer. One dose of KI offers protection for 24 hours, and additional doses will have to be recommended by these professionals.

  In a nuclear detonation, I-131 can occur, and only about 10% will make its way to the earth’s surface before developing decay, according to the U.S. Department of Human and Health Services on their website. Of course, all plants, animals, etc., are contaminated, and ingestion is the greatest concern. Ingesting foods outside the zone of contamination is the best form of prevention.

Prussian Blue

  PB is a pill that is an antidote against radioactive cesium and thallium, by blocking absorption in the gut by these radioactive isotopes. It reduces the biological half-life of thallium from 8 to 3 days, and for cesium, 110 days to 30 days. It is available in 500mg capsules only available by prescription and should not be taken unless authorized by the officials dealing with the emergency. It can be taken by almost eanyone, including pregnant women, and children 2 and older.

DPTA

  This chemical can bind radioactive plutonium, americium, and curium while it passes through the body, and cannot prevent these isotopes from entering the body. It is excreted in the urine. It can help for days and even weeks. It comes in a calcium and zinc form, and the calcium form should be ingested in the first 24 hrs. if available. After 24 hours, if additional medication is recommended, the zinc form is recommended, and if not available take supplements of zinc. Pregnant women should ingest the zinc form.

    We can only pray that diplomatic efforts are successful to prevent the end of the world. It is clearly time to have a strong respected country who has a strong military and is known to back up their abilities to deter these evil forces. Our weakened perception worldwide is a serious flaw created by our current administration.

CDC website

4. Erectile Dysfunction—7 options for treatment

  It is well known that erectile dysfunction is a blood flow issue to the penile tissues (corpus cavernosum) to fill the organ with blood and keep it erect. It is responsive to physical, psychologic and neurologic stimulation, a very complex mechanism.

  Being evaluated by a specialist is appropriate especially if the usual Viagra-type pills don’t help or cause side effects. Any physician can prescribe these ED pills.

  About half of men 40-70 have ED to some degree, although only 1 in 10 report complete lack of erection.  

  A. Common causes of ED

   There are many causes of ED, and those who take medication and drugs that can interfere with the flow are a common cause, as are diseases that create vascular disease, such as atherosclerosis, diabetes, autoimmune diseases, liver or kidney disease, prostate cancer treatment, and neurological diseases. Psychological overlap is also a common factor, relationship problems, anxiety, depression, stress, obesity, high cholesterol, high blood pressure, and hypogonadism causing low testosterone.

  Patients with low or high blood pressure, heart disease including those with coronary artery disease and or arrhythmias, history of heart attack, and strokes should discuss medications that treat ED, as they may cause serious side effect.

  Do not take with cardiac drugs. Taking Flomax (prostate type drugs) can lower the blood pressure and should not be taken for at least 4 hours prior to taking these ED drugs.

  A good physical exam, prostate exam, and medical history are critical to perform before taking medications. Checking the testosterone levels may be necessary, based on exam and history.

  B. Options to treat ED:

Medications (including testosterone), vacuum erectile device, ultrasound shock wave therapy, penile injections, penile implant, and laser

   1—Medications

    Testosterone

  If a person has low testosterone (hypogonadism), taking replacement medication (if low) may be valuable, improving libido, energy, and muscle strength, improve depression and mood fluctuations. Taking testosterone when the blood levels are normal is not recommended and potentially dangerous.

  Complications from too much testosterone over time may include sleep apnea, acne, balding, testicular shrinkage, high blood counts and possible blood clotting, increased levels of estrogen (female hormone). Enlarging a normal  prostate may occur causing urinary difficulty, and it may increase the speed of growth of a prostate cancer, especially in hormone sensitive prostate cancers. Excessive testosterone can reduce cognition, aggressive, and risky behavior, with mood swings and irritability.

     ED drugs

  These erectile medications reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical the body produces to relax muscles in the penis. This allows the vascular areas to engorge creating an erection with proper stimulation.

  Viagra, Cialis, Stendra, and Levitra are the 4 medications prescribed. All improve blood flow including sexual stimulation and arousal (psychological). There is a fast dissolving form of Levitra (Staxyn). All the rest need to taken 30 minutes before sexual intercourse. Viagra should not be taken after a meal, because food blocks absorption or prolong the time it can begin to work. Cialis and Stendra are not affected by food and are the closest to “on demand” erections.

  None of these drugs are guaranteed for a “second round”.

  Cialis has a daily dose that improves prostate caused urinary symptoms and erections (2.5mg-5mg.).

  Cost is a big factor, and if insurance pays for the medication, it limits the number. Good Rx and discount companies should be contacted.

  About 70% of men have success with these meds.

  Side effects

    Flushing, nasal stuffiness and runny nose, headache, blurred vision, muscle ache, indigestion, nausea, and if on heart medication can cause heart attack. Rarely, sudden loss of hearing or vision can occur. Rarely, these meds can cause a continuous and painful erection (priapism). More than 4 hours requires immediate medical attention.

   Priapism (erection longer than 4 hours)

  Nasal decongestants (Sudafed) or phenylephrine may prevent nasal stuffiness and in priapism, can be used in the ED under direct supervision by injecting those medications directly into the penis. Ice packs between the anus and scrotum may reduce the erection. Removing the blood in the penis may also work, and in rare cases, surgery may be necessary.  

  There are great benefits from the use of ED medications, but they are not for everyone.  

  20 million prescriptions a month may create a small percent of side effects, but with that number of prescriptions, that still calculates to hundreds if not thousands of side effects. Some of these pills that can be purchased online may not have the stated amount of medication, and may contain other unwanted substances. Herbal Viagra is worthless, all of the above according to Mayo Clinic and Harvard Medical School.

   Ocular events can be dangerous

  Out of the 1,146 side effect cases, there were 3 different adverse ocular events—retinal detachment, ischemic optic neuropathy, and retinal vascular occlusion. These patients all used Viagra and other similar meds . The average age was 65. A proportunately higher number of these cases were diabetic, had hypertension, or coronary artery disease.

  When blood fails to reach the eye, sudden loss of vision can occur. If this occurs when taking these meds, please consult a doctor immediately.

Medscape General Surgery, April 18, 2022

There are other side effects that can occur, therefore, if sudden symptoms occur, seek help immediately.

WebMD

   2-- Vacuum device (Pump)

  The penis pump is a hollow tube with a hand powered or battery powered pump, and is used to suck out the air in the tube creating a vacuum. Once an erection occurs, a tension ring is placed at the base of the penis to keep the blood in the penis, after removing the tube. If this is successful, usually the erection will last through orgasm.

   3-- Ultrasound Doppler treatments for ED

  This new therapy is not well studied in the medical literature, although the infomercials on TV sound fantastic. Unfortunately, I have to use the statements from the companies that sell the ultrasound shack wave treatments, as In can’t find satisfactory research in the medical literature.

  If you have tried other methods unsuccessfully, you might want to consult one of these doctors, but be very cautious about putting a lot of money down without a money back guarantee in writing.

  The ultrasound microwave uses acoustic waves that are generated by an electromagnetic source to stimulate the blood vessels in the penis. The article I reference states that these waves can reverse the lining of the blood vessels (endothelium) and restore the normal blood flow to the penis. I need more information!

  In an article from the NIH (National Institutes of Health), they describe the use of ultrasound for diagnosis of the blood flow of the penis using papaverine, which is injected to dilate the vessels and see if they repond.

  The NIH is not reporting on this ultrasound shock wave therapy, and until there is a published medical journal article supporting the use of this machine, The placebo effect can work with any treatment, and so buyer beware. Also it is not FDA approved.

  One reference stated it required 2 treatments a week for 3 weeks. It also needs to be repeated in many cases. One pilot study of 20 men had improved results of ED after 6 months. Costs may add up to $2700 according to healthline.com with $450 per session.

  4-- Penile injections

  Penile injections have been used successfully to those who can’t take medications for medical reasons or lack of success. This therapy is not a cure anymore than taking a pill to provide temporary increases in blood flow to the penis.

  The medicine is injected directly into the shaft of the penis, as taught by the doctor and or staff who prescribes the medication, a vasodilator, papaverine. This procedure has been FDA approved since 1995, with a 70% satisfaction in some surveys.

  It takes 5-20 minutes for an erection to occur. Some men will require foreplay and stimulation of the penis.

  The erection will last 30-90 minutes, after intercourse and orgasm. This would allow longer periods of time for having sex if desired.

  It should only be injected once in 24 hours and no more than 3X per week.

  Complications are rarer than using oral medications. However, there is anxiety with injecting medicine into a man’s own penis to attain an erection, and motivation must be high, but anxiety will diminish with confidence in its use.

  There are 2 other medications that may be used. Phentolamine, blocks the nerves that normally tells the muscles in the arterial wall to constrict. It can be used in combination with papaverine, if decided by doctor and patient, which allows a longer time for dilation of the vessels and more time for the erection.

  Aprostadil, a prostaglandin E1 medication can also be prescribed, which can cause vasodilation of blood vessel walls, and has only been used for the past few years.

  More recently the medication Trimix, a combination of all 3 medications mentioned above, has been used more frequently.

  Before any injection, do not use any form of oral ED medication. If taking daily Cialis, stop that pill for 3 days prior to any injectible.

  Precise instructions on the use and storage of these refrigerated medications must be followed and precise injections into the corpus cavernosum are necessary to achieve the satisfactory result.

Inject into the corpus cavernosum, the vascular portion  of the penis.

Priapism (an erection lasting longer than 4 hours) may occur with this method or in ED pills, and the ingestion of a nasal decongestant, Sudafed or phenylephrine, may reverse the prolonged erection, and reverse the nasal congestion. A photo ID is required to buy this medication (Sudafed only), as it is kept by the pharmacy.

  People on blood thinners probably should not be using these injections.

  For people that have had prostate surgery and have ED, special discussion is necessary.

  Clearly, this is not the first line of treatment, but may become a real option that, if a man can tolerate the simple injection, this is a good consideration.

Mayo Clinic, rxmd.com

  5-- Penile implants

  Another option when others fail, is a penile implant. It also can be used in patients with Peyronie’s disease, which  creates a congenital or traumatic bend in the penis, which can be very painful. Implants are not a good idea for those prone to infection, are immunocompromised, or have diabetes.

  Penile implants don’t enlarge the penis or increase sensation, but will allow a man achieve an erection.

  2 types of penile implants—inflatable implants and solid

  The inflatable implants has a fluid filled reservoir placed under the abdominal skin, and can be pumped to send  fluid to fill the inflatable cylinders inserted along the corpus cavernosa, the vascular areas of the penis that would normally fill with blood to create an erection. The drawing shows the reservoir, and one can also see that the valve in inserted in the scrotum, and when it is time to release the fluid, the man pushes on the valve, and the salt water returns to reservoir. There is a 2 piece implant too. The choice would be explained at the time the urologist discusses the procedure.

3 piece implant

semi-rigid implant

The semirigid implant remains in the erect position at all times and must be pulled up to the pelvic rim and secured with an elastic strap.

  There is a 2 piece implant, but is not as desirable as the 3 piece, because the 3 piece totally deflates and provides a normal erection. Having a reservoir in the abdominal wall is not much of an inconvenience. Of course, the semirigid implant has to be dwelt with 24/7 as an erection, and is difficult to conceal.

  6-- Laser therapy; pulsed acoustic waves

  High Intensity Laser therapy implies there is something wrong with the lining of the vessels in the penis, which is false. The problem comes from lack of neurological stimulation, which allows the blood vessels to accept blood flow.

  The minimal amount of advertisement (and no scientific backup) implies the laser treatment allows regeneration of the lining of the vessels, which then better allows them to fill with blood to create an erection.

  They state that the laser creates acoustic waves that stimulate nerve endings allowing them to function.

  Having enormous experience using various medical lasers, I would state that I would not waste my time with unapproved and likely worthless treatments, other than giving the person the placebo effect as any sham procedure can do.

  I would recommend seeking an experienced urologist who has had years of treating ED in many ways, and can give the best advice, with approval of a man’s personal physician regarding pre-existing medical conditions that might complicate these treatments, and start with the most simple therapy and if not successful, proceed to other more invasive methods.

Mayo Clinic

5. Date Rape Drugs

  Date rape drugs are not just used on dates. Guarding one’s drink in a bar is always smart and not accepting a drink from someone a person doesn’t know is even smarter.

  These drugs can be used anywhere, and it is important to be aware of the environment in which this could happen.

  People who take these drugs can become very confused, sleepy, and have difficulty defending themselves, and not remember what happens.

TYPES OF DATE RAPE DRUGS:

A. GHB—gamma hydroxybutyric acid

  There are many street names including easy lay, Georgia Home Boy, X, ecstasy, etc. It is a depressant and occasionally prescribed for narcolepsy. It is a liquid.

B. Rohypnol (flunitrazepam)—“rufie”

  This is a strong benzodiazepine (anti-anxiety), and often called rufies, etc. and is not legal in the United States. It is a white pill.

  Drug companies have now manuifactured as a light green pill with a blue center, and if dissolved in clear liquid will turn the fluid blue, giving the person a warning something is in their drink.

C. Ketamine

  This is often used in veternarian surgery as an anesthetic, because it does not cause respiratory depression and prevents the animal from being intubated.

  When I was a surgical resident we performed local surgeries with this drug, which worked great, but created hallucinations in the recovery room, and was stopped. I also used it in animal research during my residency.

  It is currently being used experimentally and in certain carefully supervised cases for severe resistant depression cases, as are other hallucinogenic drugs. Ketamine is a clear liquid or a white powder than can injected when liquefied.  

D. Alcohol

  One has to include alcohol in the discussion regarding rape, as this substance is abused frequently and is often used as a vehicle for the drugs above or to reduce a person’s defensive capabilities and judgment.

  GHB and Rohypnol can cause serious side effects in higher doses including cardiovascular and neurological consequences. These drugs take effect in as little as 30 minutes and can last hours.

  When younger people get in a nightclub setting and alcohol starts to reduce inhibitions and judgment, it is a classic time for people to put these substances in a drink.

  Mix your own drinks, and if in a club and the drink is made at the bar, a person is at risk. If a drink doesn’t taste right, don’t drink it, and if a person starts to develop drowsiness and feels strange notify the establishment, your friends, and call 911, and never get into a compromising position with someone you don’t know or leave with them. Stay with your friends and don’t be a loner.

  If a person wakes up in a strange place or if you are going to the emergency department, try not to urinate, and do not douche, wash your hands, or change clothes, as the urine and blood will demonstrate the drug, and the fingernails, clothes, and a rape kit will be checked for DNA and evidence of rape on exam.  WebMD

THE NATIONAL SEXUAL ASSAULT NUMBER IS 1-800-656-HOPE

6. OB/GYN Series—Part 6—pre-eclampsia; maternal death rates; Rh factor disease in pregnancy

A. Pre-eclampsia

  This condition in pregnancy is characterized by high blood pressure, sometimes associated with fluid retention, and protein spill in the urine. Eclampsia is a more severe hypertensive condition, sometimes can include seizures and coma.

  Pre-eclampsia complicates 2-4% of pregnancies globally and can be progressive, unpredictable, and serious. It is associated with 46,000 maternal deaths and 500,000 fetal and newborn deaths annually. It usally occurs after 20 weeks of gestation.

  Hypertension can occur for other reasons than pre-eclampsia. Those with hypertension before 20 weeks of gestation probably have essential hypertension and will continue their blood pressure elevation more than 3 months after delivery.

  Most cases occur at term, are mild, and resolve after delivery. But if blood pressure and constant prenatal care are not performed, the risk rises.

  It is more common in the socioeconomically disadvantaged, certain races (Black), and in diabetics, hypertensives, those with chronic kidney disease, those overweight, with severe anemia, autoimmune diseases, and a history of pre-eclampsia in a prior pregnancy or a family history.

 In vitro fertilization increases the risk.

 First pregnancies are the most likely, because with future pregnancies, there is adaptation in the placenta with benefits to prevent pre-eclampsia.

  Age plays a role (over 35), first pregnancy, or more than 10 years since last pregnancy.

  The pathogenesis of pre-eclampsia is now known. Reduced placental blood flow can occur inciting release of  proinflammatory cytokines, which affects certain blood vessel placental growth factors. These factors can reduce oxygen to the fetus and create these cellular inflammatory chemicals which create manifestations of pre-eclampsia.

  Complications include:

1- Preterm babies (before 37 weeks), fetal growth restrictions and low birth weight,

2- Abruption (placenta prematurely separates from the wall of the uterus causing potentially fatal hemorrhage to mother and fetus).

3- A drop in platelet count and liver enzyme abnormalities, with destruction of red blood cells (hemolysis), and  hemorrhage can occur causing death of mother and fetus. It is called HELLP Syndrome! This can occur shortly after delivery as well, usually in those with pre-eclampsia.

  Another name for pre-eclampsia is gestational hypertension. The blood pressure is greater 140/90.

  These patients may have:

1- spill protein in their urine, can have certain neurologic symptoms (altered mental status, blindness, stroke, visual problems, and headaches),

2- pulmonary edema (fluid in the lungs from heart failure), causing shortness of breath.

3- reduction in platelet counts that can lead to excessive bleeding and disseminated intravascular coagulation*(DIC).

4- damage to the kidneys with failure (increase creatinine).

5- damage to the liver--abnormal liver function studies (alanine aminotransferase (ALT) and aspartate aminotransferase(AST). Pain in the upper abdomen can occur from inflammation in the liver.

6- swelling of the legs can occur

7- the placenta becomes distressed and abruption** may occur, fetal growth can be affected, with possible abnormalities of the umbilical artery and fetal death. 

   Prevention

 Weight management, exercise, initiation of aspirin (baby-81mg) therapy after the 12^th week of gestation. An assessment of dietary calcium intake (if less than 900mg/day, increase calcium in the diet (at least 500mg per day) and calcium supplements may be recommended.

  Blood pressure medication is critical if the BP is over 140/90.

  If the symptoms are more severe, anticonvulsant medication may be recommended (magnesium sulfate), and corticosteroids may be recommended to assure good development of the baby’s lungs before delivery.

  Baby monitoring will likely be recommended with serial fetal ultrasounds to check for fetal growth and amniotic fluid levels.

  Biophysical profile can be performed checking for heart rate with baby movement in the uterus, babies; breathing rate and muscle tone can be assessed as well.

  Labor induction at 39 weeks is recommended. These measures can reduce the risk of pre-eclampsia progressing to eclampsia. Technique of delivery (vaginal or C-section) will depend on pelvic measurements, gestational age of the baby, and severity of the disease.

  Eclampsia is defined as the woman developing seizures, and stroke, may occur with blindness.

  Death within 42 days after delivery can be attributable to eclampsia.

  Postpartum monitoring is critical for blood pressure levels and blood work levels. Follow up is also absolutely necessary making the mother aware of the above symptoms that still may occur (headache, seizure, vision changes, blood pressure, belly pain, or nausea and vomiting.

NEJM, Mayo Clinic

B. USA FACTS 2021—deaths in pregnancy

  C. Pregnancy Rh factor trouble

  Women who are Rh- and their baby is Rh+ will have potentially blood reactions should their blood accidentally mix.

  Normally their blood does not mix, but in the delivery process, it can happen, and the mother can develop antibodies from the newborn.

  The next time she has a baby, and if that baby is Rh+, the antibody can cross the placenta and destroy the baby’s blood rendering them anemic and threaten the life of the baby.

  All pregnant women must have their blood type known, for this reason.

Treating Rh factor disease

  If the mother is Rh negative and the child is Rh positive, and the mother’s placenta blood accidentally gets into the child at birth, during an amniocentesis, with a fall, essentially a transfusion reaction occurs, causing anemia, liver injury, jaundice, and even heart failure in the child (hydrops fetalis), which can cause a stillborn or potential death of the baby. It also could sensitize the mother for problems with future babies.

  Diagnostic procedures to detect a possible Rh issue are

1- amniocentesis (the fluid may be yellow from increased bilirubin),

2- ultrasound  may show enlargement of the liver,

3- umbilical cord blood sample, and testing of the mother’s blood.

  Treatment requires intrauterine blood transfusion of the fetus, by injecting blood into the vein of the umbilical cord. Early delivery may be necessary to protect the baby.

  Prevention is the name of the game. All pregnant women should be tested to see if they are Rh negative, and if so, will be tested for Rh antibodies. If the woman has not been sensitized, she will probably be given immunoglobulins called RhoGam. This product can prevent Rh factor disease, by preventing the mother’s blood which is Rh negative to be able to react to Rh positive cells.

  If high risk, at the 28^th week, the mother can receive RhIg immunoglobulin with a second dose 72 hours after delivery to further prevent reaction if the baby is Rh positive and mother is Rh negative.

  RhIg destroys Rh factors and can prevent future Rh issues in future pregnancies if the baby is Rh positive.

Children’s Hospital of Philadelphia

  With the increasing weight of the average American and rising numbers of people with gastro-esophageal reflux, the concern for Barrett’s esophagus continues. Those with hiatal hernia, Schatzki rings, and large abdomen can  reflux stomach acid into to the esophagus.

  The stomach lining can resist the acid secreted by certain cells in the lining to help digest food.

  However, the lining of the esophagus is not so lucky, and that acid can cause ulcers, chronic irritation (esophagitis), and scar stricture (narrowing).

  Not only are those concerns real, the chronic irritation from acid reflux can cause changes in the cells of the lower esophagus creating a transformation of those lining cells to precancerous cells, and eventually cancer.

   Unfortunately many of these causes are somewhat silent or create minimal symptoms (indigestion, burning, mild pain, etc.).

  Below is an endoscopic photo of what Barrett’ s esophagus looks like at the gastroesophageal junction. This must be differentiated from ulcerative and erosive esophagitis, all caused by acid reflux.

  Below is an example of a normal and Barrett’s esophageal drawing. Note the reflux usually present that creates the inflammation and chronic changes in the lining of the part of the esophagus.

  Those who have chronic reflux needing medication to reduce acid from burning the lining should have a gastroenterologist look down their esophagus and stomach (flexible endoscopy).

  Schatzki’s ring is a congenital ring that narrows the opening of the lower esophagus creating difficulty swallowing (getting food stuck) and needing dilation, which can be discovered with endoscopy.

  It is found in 6-15% of patients undergoing a barium test of the stomach. It may be associated with a hiatal hernia, seen on the right. I have both!

5% of the U.S. has Barrett’s, and 3-5% of those will develop adenocarcinoma of the esophagus, a very deadly cancer, because it is usually not diagnosed early. The 5 year survival rate is only 20%, but can be cured if found early.

  As many as 8% of those with reflux have Barrett’s esophagus, therefore, once again, monitoring and even biopsies if necessary are important to initially diagnose this disease and decide when it must treated surgically.

  It is more common in males and smokers. About 0.2-0.5% of patients followed annually for Barrett’s esophagus will develop cancer. Usually the endoscopy is only performed every 3-5 years, so that would put the rate to as many as 1.5% every time they are scoped.

  Treatment is critical to prevent acid reflux with proton pump inhibitors (Priolsec, Prevacid, and Nexium, etc.).  It inhibits acid secretion for longer periods of time, being released in 2 phases.

  Contrast this class of drugs with the H2 inhibitors, such as Pepcid, Zantac, Tagamet, and Axid. The proton pump inhibitors are stronger and preferred.

Surgical treatment (endoscopic resection with ablation)

  If dysplastic cells are present, it is recommended that that area of involvement be resected endoscopically. Dysplasia is considered precancerous.

  These lesions at this stage are very superficial and can be removed and can leave the muscular layers of the esophagus intact. However, the mucosa and submucosa must be removed to give the best chance of complete removal, however is technically more difficult and can create scarring and narrowing of the opening. The decision to remove just the mucosa or both the mucosa and submucosa must be determined by the depth of the abnormal cells. Seek an experienced surgical gastroenterologist.

  Comparing the recurrence rates of these 2 techniques is about the same, so a more conservative approach makes sense.

  Following the resection of the areas of concern (with the dysplastic cells) is followed by an ablation procedure to rid the area of the metaplastic* cells that would extend further away from the area with the cancerous cells. This is performed by radiofrequency ablation.

Metaplastic cells=*cancer progresses from cells that histologically demonstrate normoplasia to metaplasia to dysplasia and finally anaplasia. If anaplasia is present, this would be considered cancer, and treated accordingly. However, very early cancer can be treated endoscopally rather resection.

  There are different forms of ablation, nitrous oxide in a balloon, radiofrequency, and argon laser with the laser showing slightly better cure rates.

Discussion is critical

  Obviously, decisions must be made exactly how the treatment will be recommended and should be a team effort with second opinions considered.

In conclusion

   Those who have persistent gastroesophageal reflux (GERD), should be treated intensively with proton pump inhibitors, stop smoking, and have close surveillance with endoscopy every 3-5 years to monitor these abnormalities, regardless of the type.

  If Barrett’s esophagus is diagnosed, the biopsies are critical to determine the extent of the treatment, which should be a patient centered decision. The gastroenterologist should be well versed and efficient in treatment options should removal of the area be necessary.

JAMANetwork, A review, August 16, 2022

  8. Blood and blood products; Blood types, Transfusions, Donations, Pregnancy Rh factor disease

Donate Blood

A. Blood Types  

Percent in population     

O+ 43%       B- 1%

A+ 31%      AB- 0.5%

B+ 15%

AB+ 5%

A-    2.5%

  If you have a rare blood type, blood banks will beg you to donate, and with that blood, if you need a transfusion, you will be lucky to get your type, settling for O-.

  Blood type is a classification of blood, based on the presence or absence of antibodies and inherited blood substances on the surface of red cells. These antigens can be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system.

  Blood types are inherited from both parents. There are actually 43 different human blood groups, but the main 2 are the ABO and Rh groups and determine what type of blood a person can receive. They last for life except in certain circumstances such cell transplantation, certain infections, cancer, and autoimmune diseases.

B. Blood is typed in 2 main ways—

  The ABO system--A,B, AB, and O with antigen A or B

  The Rh system--Rh (Rhesus) factors are antigens, which are proteins that are on the surface of the red cells, which mean they can react immunologically to other types of antigens—ABO compatibility.

  The antibodies are formed from the immunoglobulin IgM in a white blood cell lymphocyte.

  The types of blood imply what antigens the blood cells carry. A, B, AB, and O. these types either have antigens (positive) or not (negative). Positive blood types can’t receive negative type blood.

  The Rh system is most important in pregnancy with the infant. If the Rh factors don’t match up, there is a reaction, which can be life threatening. This is highlighted in this report.

  O- blood is the universal donor, because those people do not have any antigens, and anyone can receive their blood.

  AB+ blood are called universal recipients, which means it has no antibodies and can receive anyone’s blood.

  Typing blood must determine the ABO and Rh +,- status. Although there are many other minor incompatibilities in the blood, if the ABO and Rh types are safe, there is likely blood can be received. 

  O blood means it does not carry antigens.

  If there is a transfusion reaction, it means the body’s immune cells recognize the wrong antigens and form antibodies to reject these red blood cells.

C. Red Blood Cells

  Red blood cells can be given without the plasma, especially in surgeries where replacement is necessary, and saline can be given as the fluid replacement, leaving the plasma to be used in more necessary conditions.

  When I donate blood, they take one unit (500cc) of whole blood but can take a second unit of just the red cells, by removing the whole blood separating the red cells from the plasma, and then returning the plasma back to me all in the same process. This helps 2 people.  

  Red blood cells carry oxygen in the hemoglobin, which is the iron containing protein necessary for blood to carry oxygen.

D. Plasma

  The red cells are carried through the blood vessels by a fluid called plasma, rich in chemicals that can be helpful in patients.

  Transfusions may consist of whole blood (red cells and plasma), packed cells (red blood cells only), or plasma to replace the proteins in the blood that help the blood volume expand (with rapid blood loss) or help the patient form normal clotting.

E. Plasmapheresis

  This is the process of taking blood out of the individual separating the plasma (nonblood portion) from the red cells and returning either the red cells or plasma to the patient. With this process, antibodies can be removed from the plasma in patients with autoimmune disease. The plasma is discarded and the red cells re-transfused. The plasma can be frozen and used for many medical issues.

  Plasma can also be used to treat certain autoimmune diseases such as myasthenia gravis, certain types of polyneuropathy, Guillain Barre’ syndrome, thrombotic thrombocytopenic purpura, multiplr sclerosis, lupus, and others.

  Saline or other liquids replace the plasma removed. This is called plasma exchange.

  The process of removing and replacing the plasma is similar to the process of kidney dialysis. The process may be necessary as much as 5 days a week taking 1-3 hours for the procedure. Treatment frequency varies depending on the disease process.

  During the pandemic, it became apparent that the plasma (called convalescent serum) of the blood in those who had a COVID-19 infection could treat very ill patients and later even less ill patients. However, later, if became obvious that those with milder infections did not always have high levels of antibodies, and the treatment lost some favor. However, patients who were hospitalized had high antibody levels and their plasma could be used once they fully recovered.

F. Platelets

  Platelets necessary to provide normal blood clotting can also be retrieved from the plasma. Platelet packs can be given as a transfusion in certain medical emergencies where bleeding is hard to control, someone has been on blood thinner, or need additional platelets because the count is low from disease.

G. Donating blood

  One of the greatest gifts one can give is blood. I have been a donor many times. The need for blood for surgery, injuries, and other medical needs is always at a near critical point. The pandemic certainly strained the supply in blood banks, because people feared donating.

  As mentioned above, when I donate blood they take 2 units of blood but return my plasma after separating the red cells from the plasma, just as they do in dialysis.

PLEASE DONATE BLOOD OFTEN. THE U.S. IS ALWAYS IN GREAT NEED. SUNCOAST AND ONE BLOOD CENTERS ARE THROUGHOUT FLORIDA, AND THERE ARE OFTEN NEIGHBORHOOD DRIVES TO ENCOURAGE RESIDENTS TO DONATE BLOOD. I DO!!

H. Receiving Blood transfusions

 In the past, fear regarding receiving transfusions were somewhat real, especially when HIV-AIDS entered the country, but now with modern techniques the analysis of blood for HIV,hepatitis, etc. is excellent.

  Here are the risks according to the Clevelend Clinic

HIV-1 in 1.5 million donations

Hepatitis C-1 in 1.2 million donations

Hepatitis B-1 in 100,000 donations

I. Transfusion Reactions

  When blood has certain minor incompatibilities, or incompatible blood is accidentally given, there may be symptoms of the reaction. Itching and hives may occur easily treated with antihistamines.

  Even though there is a well-defined technique to properly match blood to be transfused, to provide blood in surgery, in cancer patients, cases of severe anemia, burns, injuries, the emergency departments, or in the field, reactions may still rarely occur.

  In more severe reactions, back pain, dark urine, chills, fainting or dizziness, fever, flank pain, skin flushing, and shortness of breath can occur immediately or in some cases can be delayed even days.

  Immune cells can damage certain cells in the lungs and kidneys. Pulmonary edema, shock, renal failure, and anemia are the result of a severe reaction.

  Treating more severe reactions include IV fluids, epinephrine, corticosteroids, anti-fever meds, and even dialysis if renal failure is occurring.

Healthline, American Red Cross

J. Pregnancy Rh factor disorder (repeated from OB/Gyn Series above)

  Women who are Rh- and their baby is Rh+ will have potentially blood reactions should their blood accidentally mix.

  Normally their blood does not mix, but in the delivery process, it can happen, and the mother can develop antibodies from the newborn.

  The next time she has a baby, and if that baby is Rh+, the antibody can cross the placenta and destroy the baby’s blood rendering them anemic and threaten the life of the baby.

  All pregnant women must have their blood type known, for this reason.

Treating Rh factor disease

  If the mother is Rh negative and the child is Rh positive, and the mother’s placenta blood accidentally gets into the child at birth, during an amniocentesis, with a fall, essentially a transfusion reaction occurs, causing anemia, liver injury, jaundice, and even heart failure in the child (hydrops fetalis), which can cause a stillborn or potential death of the baby. It also could sensitize the mother for problems with future babies.

  Diagnostic procedures to detect a possible Rh issue are

1- amniocentesis (the fluid may be yellow from increased bilirubin),

2- ultrasound  may show enlargement of the liver,

3- umbilical cord blood sample, and testing of the mother’s blood.

  Treatment requires intrauterine blood transfusion of the fetus, by injecting blood into the vein of the umbilical cord. Early delivery may be necessary to protect the baby.

  Prevention is the name of the game. All pregnant women should be tested to see if they are Rh negative, and if so, will be tested for Rh antibodies. If the woman has not been sensitized, she will probably be given immunoglobulins called RhoGam. This product can prevent Rh factor disease, by preventing the mother’s blood which is Rh negative to be able to react to Rh positive cells.

  If high risk, at the 28^th week, the mother can receive RhIg immunoglobulin with a second dose 72 hours after delivery to further prevent reaction if the baby is Rh positive and mother is Rh negative.

  RhIg destroys Rh factors and can prevent future Rh issues in future pregnancies if the baby is Rh positive.

Children’s Hospital of Philadelphia

Final note on the election

  I spent a great deal of time in the 2 previous months describing the harmful and extreme misinformation out in the media about socialism and how it is totally being promoted by the radical leftist Democratic Party, as the party we once knew, is gone.

  Biden and the Inflation Reduction Act(what a misnomer) should be called the Climate Change Act, but will push us closer to the dreaded socialized type of medicine that most educated people know will destroy the quality of Medicare, as we face doctor and nurse shorages sufficient to drop how well we are cared for in the future.

  The academic medicine institutions are fully supporting socialized medicine, CRT, etc., and the latest New England of Journal is pushing the “Inflation Reduction” Act, because it is going to reduce the out of pocket costs of prescription drugs, BUT, doesn’t even start until 2025. By then, there will hopefully be a new president and a new political party running it, who can deal with the pharmaceutical mafia. But until we put the pharmaceutical company in their place (because they own the Congress), the statements made by this journal are nothing but rhetoric, and it just shows how socialistic the medical journals and their supporters have become.

  Look around you and let your pocket book guide your vote America!! Taxes and spending by this administration have caused so much outcry in our country, residents are moving away from blue states. Look below! Biden has spent $5 trillion since he took office. We have 2.4 million illegals that crossed our border this year, and 98 terrorists have been apprehended crossing our borders.

  America deserves more!! America needs closed borders to illegals and Cartels! America needs less crime and a supported police force! America needs a stronger military with the weakness clearly displayed by this White House with the current obvious results through out the world.

  America needs to quit blaming racism for our faults. America needs to unite!!! America needs new leadership!

“Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy—the inherent virtue is the equal sharing of misery”. Sir Winston Churchill

PLEASE VOTE THIS MONTH! 

If you don’t know who you are voting for by now, I think it is your American right and responsibility to SPEND SOME TIME GETTING EDUCATED, and know who you are voting for. I have made my opinions quite clear, and feel there is nothing else to say but VOTE IN PERSON!! Dr. Sam

This ends the November, 2022 Medical News Report

Next month, the December, 2022 subjects will include:

1. Triglycerides, the other fat—cardiovascular disease risks

2. Nurse shortages rise! Getting serious!!

3. OB/Gyn Series—part 7—BRCA mutations—new information on higher risks in other cancers

4. Another look at the polypill

5. Spirituality and serious medical illness and health

6. Infectious disease update including COVID, Flu, etc.

  I hope you have a wonderful Thanksgiving and enjoy your families as we continue to pray for all those affected in any way by Hurricane Ian. Most who are reading my reports know how fortunate we were!!! Stay healthy and well, my friends, Dr. Sam