The Medical News Report
Samuel J. LaMonte, M.D., FACS
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Subjects for October, 2023:
Kim Kardashian and Phil Mickelson-Psoriasis, Psoriatic arthritis
Jimmy Buffet-Merkel cell (skin) cancer
October is Breast Cancer Awareness Month
Get your mammogram!
Please note I published a 3 part series on breast cancer the last 3 months, so be sure and click on my website to read them.
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
a) Americans throw away $millions of personal prescriptions a year…and never tell their doctor
b) Medicare payments to hospitals for COVID related services—Wow!; Paxlovid and Lagevrio just about the same!
c) Baby Aspirin not valuable for older healthy people
d) A Climate emergency??
e) Have the newer diabetic weight loss drugs dethroned Metformin as the standard therapy for Type 2 Diabetes
f) Administration touting negotiations for lowering drug prices on 10 drugs (for Medicare)..maybe in 3 years??
g) President Biden’s accomplishments??
h) Over the counter progestin only oral contraceptives
i) Beware of Medicare Advantage
Patients ditching their prescriptions has become such a serious issue, and patients are suffering for their denial, stubbornness, and inability to understand the hazards of stopping prescription medications and not telling their doctors.
Many medications create serious side effects when stopped abruptly.
Of course, the younger generations don’t even have a primary care doctor, plus the millions who don’t have insurance. Urgent care is not the place to manage a person’s healthcare.
Paxlovid and Lagevrio just about the same benefit!
Medicare payments to hospitals for COVID related services to hospitals—Wow!
The latest COVID booster is now available. The booster is a monovalent shot that specifically targets the BA4/5 variant of the Omicron subvariant, which is approved for those 12 years and older and under an emergency authorization for those 6 months to 11 years of age.
According to the CDC, it will cover all circulating strains of the virus. A single dose is all that is needed for those 5 years and older. Those who have not been vaccinated are eligible for 3 doses of Pfizer and 2 doses of Moderna. They are interchangeable. The FDA assures the public the booster has met a rigorous evaluation for safety, quality, and effectiveness. Those that should strongly consider getting the shot are older people and vulnerable groups. Otherwise, healthy younger people should make up their own minds.
Only 17% of the adult population received last summer’s booster, so most of us have lower antibody levels since it has been quite a while since we have had the original shots. Only 43% over 65 got the shot last year. Unfortunately, the CDC and FDA did a good job of confusing and mismanaging the pandemic, and this is the result.
BTW, some experts don’t recommend getting multiple vaccines at the same time. Ask your doctor!
Paxlovid and Lagevrio
When symptomatic with COVID infection, it is important to quickly get a prescription for 5 days of Paxlovid, but Lagevrio, is now also available as an alternative. However, some doctors prefer Paxlovid, because they have more experience with it. Both are just about as effective.
It greatly reduces the need for hospitalization and death from this virus, which is still very much around, although in fewer numbers.
Get tested with a drug store COVID test and get the medication, as it is only valuable if taken within a few days of when symptoms occur. It still is proving very valuable, so get it.
Medpage Today, September 21, 2023
We have all been suspicious of the numbers of cases of COVID cases early on, even up until the time the CDC decided to quit keeping track of the numbers, because they were incorrect.
We also know that for every diagnosis of COVID seen or admitted to the hospital during the pandemic, that the hospital was reimbursed 15% higher than their usual and customary payments. This created some internal issues with every person coming into the emergency department and or admitted to the hospital reimbursed at the higher rate. Every positive test was considered a case!!
I just got my Medicare monthly statement and noticed the reimbursement for COVID testing (charge was $120) and the reimbursement to the hospital was $96. I also noticed that the doctors were reimbursed far below 50% of their charges.
Medicare in 2024 will reduce payments to doctors another 3.5%, a huge loss to doctors who have had just as much inflationary issues as everyone else, and yet the government thinks they deserve even lower fees.
This type of reimbursement to the hospital for COVID related services was brought to the attention of many in the healthcare field and realized the use of COVID diagnosis only needed a positive test, even if the patient came in for a car accident, a baby, etc. The feds increased the desire for the hospitals to make more money and thus comply.
This hypocracy should not have been taken out on the overworked physicians, while the hospitals were getting such high reimbursements.
The burnout, the understaffed and overworked doctors and nurses are leaving medicine in great numbers as we liberalize our rules on who can care for you, let foreign trained doctors skip taking training in the U.S., and allowing less trained nurses, PAs, and technicians to take care of us in offices, and in the hospital.
I have discussed these problems before, but must make everyone realize the negative impact on our healthcare system, as the academic medical centers have become as liberal as the radical left politicians, and are strongly pushing racial inequity, Woke idealism, and creating schism in the medical profession. Money talks!
Our medical students are being totally indoctrinated with these socialistic, Marxist ideologies and made to depend on AI (artificial intelligence) to teach them how to become doctors. We are in for some rough times ahead, and as I have stated always, we as patients must become a leading member of the healthcare team, knowing about our medical conditions, and their management. Without it, we going to continue to receive more inferior medical care.
It has been routine for older people to take a baby aspirin, because earlier studies (1989) found that it lowered cardiovascular and strokes. However, more recent studies have found that the risks outweigh the small benefits of routinely taking a baby aspirin each day. There is no evidence that people over 70 decrease their risks at all if the person does not have current cardiovascular disease or suffer from other diseases as type 2 diabetes, which is a neurovascular disease.
The USPSTF, the federal advisory task force, also does not recommend baby (81mg) aspirin for older people without cardiovascular disease.
The bleeding issue has become more obvious as many of those taking aspirin routinely (for any reason) have minor bleeding from the stomach and can create iron deficiency anemia over an extended period of time.
Those taking routine aspirin, who have low normal or low hemoglobin levels need to have an iron (ferritin) level checked. Also, it is not well known that people taking daily reflux medicine won’t absorb the food’s iron either, so another reason to keep an eye on the hemoglobin.
Talk to your doctor about the value of taking a baby aspirin daily. There is no question there is value for people who are dealing with vascular diseases, but monitoring the hemoglobin level is advisable.
NEJM Journal Watch, August 2,2023
No one with a brain should deny that we have had a hot summer, and that over the past few years we have had some increases in weather related events, but most of us have lived through the “7 year” phenomenon all our lives. The question is how much can we do about it? How much money is Biden willing to throw at it?? $1.7 trillion!!
If you listen to those having “climate anxiety”, you have been led down the radical left lane, with the media loving every minute of it. We all know the media is nothing but a wing of the radical left, using their influence to omit most of the crises we are facing.
And now Biden has declared we are in a climate emergency??? What about our southern border crisis? Our fentanyl crisis? The Cartels taking over our border with 3.8 million of illegals having come over the border since Biden became president. Also there is an estimated 1.2 million got-a-ways to be added to that list, and although we have arrested 167 known terrorists, it is estimated that there are close to at least 3000 who have slipped through the border. Are we begging for another 9/11?
The human trafficking crisis is at an all time high as the Cartels are bringing thousands of unaccompanied minors over our border and selling them as slaves for sex, minimal paying jobs, physical abuse, etc??
What about the crisis in our cities who are sanctuary cities declaring emergencies because they can’t handle the illegals, who are coming to their cities displacing kid’s sports fields for illegals taking them over? Massachusetts is putting them in college dorms!
What about our cities that are being inundated with homeless people and their nasty living habits and drug use. The feds are now sending more money toward the homeless, because it goes to the illegals too. Crime is everywhere, and the justice system doesn’t even keep the worst in jail…no bail, etc. What about overt crime in malls and department stores?
What about the fentanyl and other drug deaths?? What about the mental health crises in our younger people? The loss of education and maturation in school children?
And this administration who has turned their back on all of these crises and emergencies and expect us to worry about the climate???
Of course, weather issues will always be of great concern, but it must be prioritized in relation to the multiple crises and chaos orchestrated by this administration pushing us closer to a Marxist country. Get rid of these people who are trying to destroy our country!! VOTE!!! We have a lot of work to do!!
2/3 of U.S. adults have been impacted by the substance abuse crisis and what is being done about it??
Type 2 Diabetes does not usually need insulin as the beginning drug, as Metformin has been the standard therapy. It has been effective, causes less hypoglycemia, does not affect weight, safe, and affordable. However, the benefits of improving cardiovascular and renal damage from diabetes, has been called into question.
In 2008, the FDA called for medication to reduce the diabetes effects on the cardiovascular and kidney effects brought on by the disease. It became apparent from more research that metformin was not doing much to reduce these terrible consequences of diabetes.
A new class of drugs (GLP-1 inhibitors) not only reduced these consequences, but helped reduce the serious nature of being overweight in such a high percentage of patients, in fact, could reduce 10-15% of body weight and with this benefit and other effects were addressing the usual way diabetics died—heart attack, stroke, heat failure, and kidney failure.
The drug classes to treat diabetes are GLP-1 inhibitors (Wegovy, Mounjaro, Ozempic, Rybelsus), DPP-4 inhibitors (Januvia, etc.), and the older medication Metformin is a SGLT-2 inhibitors. They were found to have a significant impact on weight as well, and the rest is history.
Trials found a reduction of major cardiovascular and renal events by 14% over Metformin with the GLP-1 inhibitors.
Recent studies on these drugs do show a plateau on losing weight in diabetics particularly. The dose may need to be increased, and a reevaluation of the patient’s behavioral modification techniques necessary to get the most out of these drugs and assist in weight loss.
These drugs required a monthly injection and were enormously expensive (over $1000 per month).
With the development of the oral drug, semiglutide (Ozempic), it was found to be just as effective and less expensive, although much more costly than Metformin. There are internet sites that provide monthly prescriptions for $297/month.
In 2023, the American Association of Clinical Endocrinology recommended these new medications to reduce the major cardiovascular and renal events of diabetes.
More recent studies are showing improved peripheral arterial disease in these diabetics with use of these drugs.
So has Metformin been dethroned? No, not in those without organ diseases, and with weight management, and life style improvements, these less expensive drugs are still worth using. For those not able to afford these new meds, hopefully there are financial assistance options for help.
This will be a challenge for treating physicians and patients.
There is no question, there is a tremendous demand for these new drugs for weight loss alone and in non-diabetics. Don’t expect these medications to be covered by insurance if the patient is not diabetic. Celebrities are jumping on these drugs, and those that can afford them.
Side effect of the GLP-1 inhibitors need to known: nausea, vomiting, diarrhea, decreased appetite, stomach pain, constipation, fatigue, and hypoglycemia. Vivid dreams are not unusual.
Jardiance and Ozempic are the oral drugs, and are less expensive, as mentioned, so talk to your doctor about these meds.
Some pediatricians are starting to look at these medications in slightly older children with significant weight issues.
Weight management in the doctor’s office has been a big disappointment not only for the patient but for doctors who do not have the time per patient to manage this issue. These new weight loss drugs may have been intended for diabetics, but they are just as effective for non-diabetics who need to lose significant weight.
Medscape, August 17, 2023
The feds are trying to negotiate with Big Pharma for 10 drugs that cost Medicare/Medicaid $16 billion, according to the AMA news. Unfortunately, it will be 3 years before any change could take into effect. That shows you how little clout the “Inflation Reduction Act” has had on our pocket books (call it for what it is—climate change act).
These drugs are primarily diabetic and blood thinner drugs. What they didn’t mention was that Big Pharma can make up the lowered cost (if it ever happens), by raising the price for private insurance companies.
This is what our president has done for us, as shown below in the diagram. If you think these items are making our country better, I am sorry you don’t want the same things I do in this country, and if we keep our constitution, you have that right. This country deserves better.
The many crises we are facing in 2023 have grown rapidly since Biden took over, and it is time that the truth be allowed to surface in this administration, with Biden trying to fool the country that Bidenomics is a good thing. Most of his pseudo-accomplishments came as the pandemic devastation began to slow, and therefore, he and the Obama people running his administration must compare his results with those that were present when Tump was our president. I wish he was able to turn around our country, but the economical challenges still facing all of us is just too obvious when you put gas in your car or buy groceries, not to mention the added cost of buying a house (i.e. a $300,000 house today will cost us $9350 per year more, over what it would have cost 2 years ago).
We must stop the hemorrhaging, and in the area of medical debt, it is really creating a healthcare issue for most Americans, with more and more bankruptcies due to medical bills, now 65.5% of bankruptcies as of April 2022. 14% of Americans with medical debt plan to declare bankruptcy this year.
I recently reported that the “night after” pills are now available over the counter. It is still very important to
discuss with a doctor about buying over the counter oral contraceptives to prevent pregnancy after unprotected sex, rape, incest, etc Below is a handout from NEJM.
The Medicare Advantage ads on TV are deceptive, and Joe Namath knows it. The ad says call The Medicare Helpline, but it is a hotline to sign you up for Medicare Advantage only. They imply little expense and total coverage. But, they do not explain how tough it is to get pre-approval for special testing, procedures, and surgeries with the Advantage plans. It delays needed medical care often and has created chaos for many patients, frustrated doctors, and now CMS (Centers for Medicare Services) has demanded that any ad for Medicare Advantage has to be approved by them before being aired, starting in October. What you have been seeing until now is deceptive marketing.
Eligible recipients get Medicare A (hospital insurance), but Medicare B (medical insurance, a supplement to Part A is not available). Medicare B costs extra for it is a supplement to cover the 20%, but only for those in traditional Part B and is not included in the Advantage Plan, nor is Part D, the Medicare prescription plan.
The Advantage plan touts total coverage for meds, and that is far from the truth. Generics may be free, but most of the expensive drugs that are the most popular ones may not be covered at all and will require out of pocket expense.
The ads call Medicare Advantage, Medicare C, implying it has more coverage than Medicare, and yes, it includes vision, hearing, dental services, gym memberships, etc., which are not usually covered with traditional Medicare, but the main differences in traditional and advantage plans is the flexibility of the plans in more serious circumstances, needing special testing, imaging, etc. and procedures that must be preapproved. Advantage plans are much tougher when it comes to this area. There can be a great delay with some plans trying to convince advantage plans to cover it, because this is a less expensive plan ,and they must lower their costs by preventing recipients from getting expensive items covered, often including referral to a specialty center, such as a cancer center. The networks are often limited in many areas, regarding what doctors they can see and the hospitals available to them.
There are many plans under the Advantage Plan, and it must be understood that their plans are quite different based on the cost of the plan. Most of their plans are nothing but HMO plans, although there are some PPO plans that are more costly.
Any HMO requires the gatekeeper (usually the primary care doctor) to approve specialty referrals, special testing, etc., but there is great pressure on these doctors to limit referrals to keep the costs under control.
Because of the limitation of revenue paid to these doctors and facilities, many are refusing to accept them, limiting choice even more today than ever before.
The bottom line, the people you call about Medicare Advantage are being paid to get you to sign up. Also there are many different plans, and I advise you be sure you sre talking to Medicare official representative that can provide all forms of Medicare to sign up to, not someone from Medicare Advantage agent being paid to sign you up. Click on www.medicare.gov for the official website of Medicare.
Do your research on traditional and advantage plans before letting anyone sign you up. If you choose the Advantage Plan, sign up with the real Medicare office. Ask, “Are you an official representative of traditional Medicare or Medicare Advantage?. “
Is the Advantage Plan cheaper?? Yes, but you get what you pay for!! Something for nothing is the problem, and if you listen to these deceptive ads from Joe Namath, and other celebrities, etc., you get the impression it is better than traditional Medicare. It is less expensive, but the limits are where they can trip you up.
I reported about this issue last year, and I emphasize it again this year, because the ads are even more deceptive.
If a new recipient (64) is quite healthy, it may be a good option, but otherwise, “buyer beware” if you are older and have significant medical conditions. It is difficult to convert back to traditional Medicare, but can be done during the normal October 15-Dec 31 time period.
The (first time) initial enrollment period is 7 months, starting 3 months before you turn 65 and ends 3 months after the month you turn 65. You must sign up for Medicare Part A when first eligible, and if you wait, your monthly premium may go up 10%. You will have to pay the penalty for twice the number of years you wait. You may delay Part B, if you have other supplemental insurance. Otherwise you must sign up for Part B initially without penalty, and it is an additional charge, which is not in Medicare Advantage.
If you were born after 1960, you will have to wait til age 67.
The annual enrollment period is October 15 though December 7, with Medicare changed beginning January 1.
Medicare Advantage open enrollment happens every year Jan. 1 to Mar. 31. During this period, anyone who is enrolled in the advantage plan can change coverage, but there will be fewer options.
The cost of Part B is $164.90, a decrease of $5.20 in 2022.
Call 1-800-Medicare for any questions. If you choose traditional Medicare, you will also want to enroll in Part D, traditional Medicare’s prescription plan, not available to people in the Advantage plan. If you wait, there will be a penalty.
Data on Medicare Advantage and the complaints
Among 650,000 airings, 27% potentially misled beneficiaries into thinking they were being recruited for traditional Medicare, and they were signed up for the Advantage Plan. Avoid the Medicare Helpline “Hotline”, as it is for Medicare Advantage agents, rather than the official number 1-800-MEDICARE.
If you are in poor health, and require high priced medications, procedures, infusions in doctor’s offices, etc., please don’t get sucked into the advantage plan. Part B is very important to have, since that is the supplement to Part A which pays the 20% Part A doesn’t pay in traditional Medicare.
Alarmingly, about 20% of calls to Medicare complained they were automatically enrolled in Medicare Advantage without their knowledge.
Medpage, September 21, 2023
Trade Center 9/11
The World Trade Center health program is covering all the health consequences on the firemen, policemen, EMS, etc. for the smoke and aerosol debris that has injured or killed more people than the over 3000 people killed with the 9/11 terriorist attack on the Twin Towers. Who is talking about this??
We are ripe for another 9/11, especially with the weakness of our current administration and allowing hundreds if not thousands of terrorists to cross our borders (the northern border is surging too). We are asking for devastation from without and from within!!
Leukemia, prostate, and thyroid cancer rates increased the most in first responders with a 41% increase as reported by Mt. Sinai Hospital, NYC.
Massive dust clouds with ash, debris, and harmful particles inhaled caused the issues.
Here are the health issues that are covered from that day of doom: NEXT PAGE
Note there is a handbook on these health problems for trying to save those in the Twin Towers on 9/11, found on the CDC website www.cdc.org
We must wake up before it is too late!!! Prayers for all those affected by 9/11 including those lost and their families and friends, and all the first responders, the deaths, and the suffering from disease and emotional consequences.
From 1953-1987, there were toxins in the water supply to the Marine Base at Camp LeJuene, North Carolina. Today, the base is still used worldwide for readiness in military exercises for NATO sponsored exercises-Marines and Sailors. It includes Special Forces and the Expeditionary Forces in Readiness.
The toxic water came from the Tarawa Terrace water treatment plant , which was primarily contaminated by PCE (perchloroethylene or tetrachlorethylene). The source of the contamination was the waste disposal practices at the ABC One-Hour Cleaners, an off base dry cleaning firm.
Millions of military personnel, family, and civilians have been affected over that 34 years by drinking the water on base and perhaps surrounding the base.
The massive lawsuit settlement could range from $25,000 to $1 million per individual depending largely on the severity of the condition caused by the water contamination. The lawsuit alleges it could cause every kind cancer from leukemia to skin cancer. It also alleges it can cause every disorder from autism, learning disabilities, suicidal ideation, PTSD, dementia, and autoimmune diseases including scleroderma, Graves disease of the thyroid and eyes, rheumatoid arthritis, Celiac, Sjogrens, and Hashimoto disease of the thyroid. Kidney problems of all kinds, birth defects, blood disorders, etc. Essentially the lawyers are blaming every disease on the toxins. Parkinson’s disease is a leading disease allegedly affected by TCE.
In 2022, President Biden signed the Promise to Address Comprehensive Toxics Act, which expanded the health care and disabilities benefits to veterans with service connected diseases harmed by the 2 trichlorethylenes and benzene. It actually includes any toxic exposures to veterans anywhere.
Trichlorethylene, TCE, dissolves in fat, soluble in water, and readily evaporates. TCE has been used in dry cleaners, decaffinating coffee, a degreaser in industrial, commercial, and military facilities.
Initially, TCE was tied to leukemia, affecting a Marine’s young daughter, who died in just 3 years in 1997, and the local media jumped on the story. With the assistance of that father, lawyers sprinted to create mega-lawsuits alleging every disease known to man was caused by TCE and benzene exposure at Camp LeJeune. And all from one dry cleaners store.
Miscarriages, neural tube defects, congenital heart disease, autoimmune diseases, countless cancers, and Parkinson’s disease are linked to the widely used chemical.
In 2012, a report was published that found a group of twins from World War II found that TCE exposure increased the risk of Parkinson’s disease was 500X more likely. 11 years later, the J. of Neurology reported that Marines who served at Camp LeJeune between 1975-1983 compared to those who served at Camp Pendleton, Calif., had a 70% higher risk of developing Parkinson’s disease.
Findings included exposure was highest in 25 year olds, the exposure could have been somewhat brief (17.4 months average), and the marines were unaware of the exposure, that Parkinson’s occurred decades later after earlier exposure. How many cases of this disease will occur eventually, since most of the soldiers and family member, staff, and employees still may have an increased risk to develop Parkinson’s??
Reports go back to 1969 for the link of TCE and Parkinson’s in those exposed who were work related, however, the data that links environmental exposure is less compelling. The environmental exposure implies drinking water, bathing, and cooking.
Animal studies show that exposure to TCE leads to concentration of brain metabolite 1-trichloromethyl-1,2,3,4 tetrahydro-beta-carboline with resultant degeneration of dopamine neurons in the substantia nigra, a critical area of degeneration in Parkinson’s disease.
Because TCE evaporates, the suit contends that inhalation of the chemical could cause problems.
Many question those who live close to dry cleaners in all cities.
Despite the risks, TCE (and PCE) continue to be used to vapor degease in the U.S. and dry cleaners continue to use the product to clean clothes. If it is that serious why does the government not fobid its use?
In 2022, the EPA stated that that TCE is still an unreasonable risk to humans. There is no question of the link between disease and TCE. But, consider all the other environmental and hereditary factors that affect not only Parkinson’s disease and all the diseases cited as being caused by TCE/PCE. And where did benzene get in the equation?
In this lawsuit-happy country we have (2/3 of the lawyers in the world live in the U.S.), we will continue to see class action suits for every potential hazard that people are exposed to. The U.S. has reduced the use of these chemicals but many countries have not.
Expect more regulations for the use of TCE, but then Monsanto still produces and markets Roundup and pays the penalties while making enough money to counter the lawsuits.
JAMA Network, May 25,2023
A. Kim Kardashian, Phil Mickelson—Psoriasis and psoriatic arthritis
B. Jimmy Buffet—Merkel cell skin cancer
Kim Kardashian has psoriasis well under control, obviously, and Phil Mickelson, as a golf champion, still suffers from psoriasis and psoriatic arthritis that occurred earlier in his career. Both are on biological medication.
This disease is an autoimmune disease as are so many. They all affect the same immune system that is not reacting to certain specific organs in our body. The musculoskeletal system and skin are probably the most affected parts of our body, but the eye can be involved (uveitis) and nerves, blood vessels, and just about every system can suffer this abnormal reaction to our usually normal immune system. And these diseases are usually hereditary to some degree.
Psoriasis affects 2% of Americans, and about 15% of those patients will suffer psoriatic arthritis.
The skin disease precedes the arthritis in 60-80% of patients usually in less than 10 years. It also is very similar to rheumatoid arthritis at the cellular level and another common autoimmune disorder. Most commonly the disease begins 18-35 years of age. There is no cure and it will be lifelong, but with treatment, can be controlled.
Uveitis, eye inflammation, can cause eye pain, redness, and blurry vision. If not treated, loss of vision can occur.
Charateristics of psoriasis
The skin may be dry and crack (and bleed). The spots flake off easily, making a challenge to keep their homes clean, especially the bedroom. Itching and burning is not uncommon. Patches of thickened red, scaly rashes are typical of the plaque type of the disease. These rashes may be cyclic and can last weeks, months, or be permanent, but the disease may resolve for significant periods of time. Just like many of the autoimmune diseases, remissions and exacerbations are common.
Triggers include injury to the skin, cold weather, infections (Strep), bad sunburn (although tanning helps the rash), HIV, emotional stress, smoking, alcohol, and hormones.
There are 7 manifestations or types of this skin disease. There are 5 types of arthritic psoriasis, which I will report on later in this report.
The 7 types of skin manifestations are:
1) guttate 2) plaque 3) inverse 4) scalp 5) nail 6) pustular 7) erthrodermic
1) Guttate psoriasis may appear as a regular rash of many types, including drug rashes, and if there is any question about it, a skin biopsy should be performed. and be confused with drug rashes, Grover’s disease in older patients. It can form small or large areas with redness, areas of roughness, even mild scabbing, etc.
This type usually occurs in younger people and children, but can occur at any age.
2) Plaque psoriasis is probably the most easy to diagnose as these area usually affect areas near joints (elbows, knees, scalp, etc.), but can appear anywhere, and cause major flaking. All of these lesions can itch, be very sensitive, and even with healing can leave slight changes in skin color.
3) Inverse psoriasis can occur under the breasts and in the armpits as seen below.
4) Scalp psoriasis can occur with any type of psoriasis, and actually the treatment differs only in that solutions of medication need to be used to prevent disturbing the character of the hair cosmetically.
These lesions could be confused with seborrheic dermatitis (dandruff), and dandruff shampoos may actually help it, so the confusion could continue.
5) Nail psoriasis may be confused with fungal disease, and doe thicken the nail, causing yellowish discoloration
6) Pustular psoriasis blisters up and can get infected. This photo shows it on the hands and foot and sole.
7) Erythrodermic psoriasis, a much more violacious red form is above right on the back and side of the trunk.
Heredity plays a role in 40% of psoriasis cases. In fact, if a parent has the disease, the risk is three times more likely for a child to develop some type of this disease. 85% of those who develop psoriatic arthritis already have dermatologic psoriasis.
This is a serious inflammatory skin and joint disease and deserves a proper workup by a dermatologist and/or rheumatologist, because some of the more serious treatments include immunosuppressive drugs, which are quite effective but very expensive.
As in all autoimmune diseases, there is an increased risk of other autoimmune diseases in the system as in most of these diseases including the eye (uveitis, keratitis, and conjunctivitis), obesity, hypertension, diabetes, Celiac and Crohn’s disease, cardiovascular disease, and psychological disorders due stemming from embarassment, lack of self esteem, and frustration with the disease. Children can be bullied.
The standard treatment can start with NSAIDs (non-steroidal anti-inflammatory drugs), but biologic drugs (discussed under psoriatic arthritis below) have become the standard of care for more resistant types. These drugs may be used as topical and systemic in nature.
Prescription steroid creams, shampoos, Vitamin A creams and lotions, solutions (calcipotriene), tar products, light therapy (UV) all will be tried on the skin lesions before the biologic type of drugs are used.
About 1/3 of patients with severe psoriasis have echocardiographic evidence of asymptomatic coronary artery microvascular dysfunction. It is felt this disease, an autoimmune disease, can affect any organ, and vasculitis is one of them. Hypertension and diabetes are also more likely. It was suggested that people with more severe disease will benefit their cardiovascular system with injectible biologicals used in psoriatic arthritis and severe skin disease (Stelara, Cosentyx, etc.)
Medpage Today, September 20, 2023
B. Psoriatic Arthritis (PA)
Joint pain, swelling, and stiffness are the hallmarks of PA, but then they are also the same for mos forms of arthritis. If by chance the arthriris starts before the rash, it probably will be misdiagnosed as osteoarthritis, the most common type of arthritis.
PA can be mild or severe, and can affect most joints, but the fingers and spine tend to be more involved, and it can be disabling. There is no cure and treatment needs to be initiated to prevent permanent joint damage.
Swollen fingers and toes should alert the physician, PA needs to be ruled in or out. However, there are no tests to prove psoriasis without a skin lesion biopsy.
Psoriatic Spondylitis causes inflammation between the joints damaging the disc. Sacroilitis can occur as well.
The 5 types of psoriatic arthritis are:
1) Symmetric-include multiple matching pairs of joints, which are disabling, progressive, and destructive
2) Asymmetric-usually 1-3 joints that are not matching
3) Distal finger-closest to the nail
4) Spondylosis-spine may be involved partially or completely causing stiffness, with difficult motion; involves the ligaments as well; can also involve all joints.
5) Arthritis mutilans-severe deforming, primarily of the fin
These are examples of deformity, X-ray evidence of calcification, and joint abnormality. Note the sacroiliac joint (above) is very cloudy from inflammation and damage.
Unfortunately there are no diagnostic blood tests for this disease. It is made clinically based on the character of the rash and biopsy of he skin, The arthritis can be confused with any other type of arthritis, but with these rashes present, a clinical diagnosis of psoriatic arthritis may be made.
Biologicals are the main stay of treating more severe PA, although NSAIDs will help the inflammation and pain, with exercise and streatching.
TOPICAL TREATMENTS for skin psoriasis and joint disease
a. Corticosteroids—may be topical or systemic
b. Vitamin A-analogues—calcipotriene(Dovinex, Sorilux), and calcitrio. These are often combined with corticosteroids for topical use.
c. Retinoids—Tazarotene (Tazorac, Avage, etc.)
d. Calcineurin inhibitors modified formulations—tacrolimus (Protopic) and pimecrolimus (Elidel). These immunosuppressants are used to treat a variety of conditions and are indicated for cases that do not respond to other categories. (These are also used to prevent organ transplant rejection.) Topical solutions are used in thinner skin areas around the eye and other areas. Not recommended during pregnancy.
e. Salicylic Acid shampoos and scalp solutions--are non-prescription and can be used alone or with other medications. Dandruff shampoos help some.
f. Coal tar preparations—although smelly and can stain clothes, these topical preparations are effective in milder cases and help itchy scaly scalps.
g. Anthralin—a coal tar cream that slows skin cell growth to remove scales and make the skin smoother. Not recommended for the face and genitals.
h. Light therapy—probably one of the few conditions that approves of the use of a tanning bed. That and regular sun exposure is effective in mild to moderate psoriasis. UV-B light is the proper spectrum of ultraviolet light.
Psoralen compounds can be used on the skin before UV exposure, called PUVA treatment, increasing sensitivity of ultraviolet light. Some dermatologist may have tanning beds in their office for this therapy.
i. Excimer laser—this machine can target just the involved areas and requires fewer sessions.
ORAL OR INJECTIBLE MEDICATIONS
a. Corticosteroids—triamcinolone injections into the skin of resistant plaques may be helpful.
b. Retinoids—Acetretin and others are pills to reduce the production of skin
c. Biologic drugs—these are necessary for resistant skin disease and arthritis. These immunosuppressives are injectible usually weekly. They block the action of the T-cell or can block proteins in the immune system, such as interleukin 17-A, 12, or 13
The T-cell lymphocytes form the inflammation in the skin cells and joints, even the eye. TNF (tumor necrosis factor alpha) is another proinflammatory marker.
This is big business as these medications cost thousands of dollars per month. The number of TV commenrcials tells you they are making big bucks. Otezla, Remicade, Humira, Cosentyx, Talz to mention a few. They target the cytokines, proteins, or other factors initiating inflammation. If the injections can be performed in the doctor’s office, Part B of traditional Medicare will cover them to some extent.
National Psoriasis Foundation 1-800-723-9166
Testing for tuberculosis is necessary, and blood work to follow the effects on the blood count and other organs is also necessary. These products can cause lymphomas, so surveillance for enlarged lymph nodes is very important.
d. Methotrexate—a chemo preparation but less effective than the newer biologics.
e. Cyclosporine—an immunosuppressant but not as commonly used as the biologics.
Aloe extract creams, fish oil treatments with UV light therapy, and barberry are some of the topical therapies that may reduce the severity of psoriasis.
www.psoriasis.org is the website for The National Psoriasis Foundation and worth checking out.
C. Jimmy Buffet—Merkel Cell Skin Carcinoma
1 case in 130,000! Wow!! And I just reported on the same potentially deadly skin cancer on Terry Bradshaw, the famous Pittsburgh Steelers quarterback and sports celebrity in the May, 2023 report, so I will ask you to click on my website for the report on Merkel cell carcinoma. www.themedicalnewsreport.com/136
I do not know the exact circumstances of Jimmy’ case, but know it metastasizes and he reportedly struggled with it for many years. This is the disease he died from.
The 5 year survival rate is 52% if it spreads, so he was one of the unfortunate ones.
It is 40 times rarer than melanoma skin cancer, but only points out the need to have any new skin growth be checked, that pops up on the skin regardless of appearance. Merkel cell carcinoma appears rapidly as a painless nodule and can be skin colored , purple, or red. The rest of the information is in my website above. Skin cancers all are sun induced, so wear sunscreen.
Although carotid artery screening is not recommended for the general population, finding significant blockage and having it removed has prevented many a stroke, including me.
There are screening tests often marketed in cities throughout the country. Those who have noise (bruits) in their carotid arteries heard with a stethoscope have a blockage from atherosclerotic plaques, usually from high cholesterol plaques, but there are those who have had radiation treatments to the neck (in my case), injuries, etc. that can cause narrowing (stenosis) of the artery and eventually cause a stroke.
Stroke occurs 795,000 times a year. About 610,000 of are first strokes. 15 million occur worldwide. Strokes occur more often with age, doubling for each decade after age 55.
Symptoms of early stroke or a TIA (transient ischemic attacks) include
Rates of strokes have modestly decreased in developed countries.
Stroke is the leading cause of chronic disability, and the second leading cause of dementia, and the fourth leading cause of death.
TIA (transient ischemic attack) is viewed as a temporary abrupt onset neurological deficit due to brain or retinal artery ischemia lasting less than 24 hours in duration. The deficit disappears and is a sign that stroke may occur within the following week following a TIA. These patients must be worked up (imaging studies) to see if there is evidence of an infarct in the brain, as there is a 10-20% stroke risk within 90 days.
The best dressed Senator Fetterman, had a stroke and it interfered with his comprehension of words, and he developed severe depression, which can follow strokes as well. He requires great assistance with a computer to help him understand what it said to him. How can he be effective?
Senator McConnell either had 2 TIAs and or a head injury with a petit mal seizure. No information about his workup. There does not have to be any evidence on imaging studies that it has happened. Whether it was a post-injury cause or atherosclerosis does not matter. It happened, and the White House doctors are not telling the truth, in my opinion.
Asymptomatic strokes noted on routine brain imaging among persons age 55-64 will be present in 11%, and 25% for those age 70-75, 32% for those 75-79 and 40% for those 80-85. The brain also shrinks with age, because the blood supply slowly decreases. It is part of aging.
Risk Factors include elevated fats in the blood, hypertension, diabetes, obesity, cardiac causes, smokers, physical inactivity, moderate alcohol daily intake, diet, psychosocial stress, and depression. Drug abuse (amphetamines, cocaine, etc.), anticoagulants, and revascularization procedures.
Atrial fibrillation is a strong stroke risk estimated to cause 2.6 million persons in the U.S. (2010).
These strokes cause ischemia (blockage) in the brain as opposed to hemorrhagic (which bleed) strokes.
Asymptomatic carotid stenosis rises with age and can be found in 50% of individuals 65 and older. Considering a procedure in these patients begin to appear as the obstruction becomes 65-70%. 75% has been the standard when stenting or endarterectomy is entertained.
This completes the October report.
Next month, the November, 2023 report will include:
1. Late breaking Medical News
2. Vitamin D and the immune system
3. Celebrities with unusual diseases—Sam Neill-non-Hodgkins Lymphoma, Billie Elish-Tourette Syndrome, Christina Applegate-Multiple Sclerosis
5. OB/Gyn Series—part 11—new oral med for severe postpartum depression
Enjoy the best time of the year, and stay healthy and well, my friends, Dr. Sam