The Medical News Report

September, 2015, #44

www.themedicalnewsreport.com

1. Hydration-Heat Exhaustion, Heat Stroke

2. Female Sexual Dysfunctionnew information on a

    Female “Viagra”—Abbyi-the pink pill!—it’s a start!

3. Cataracts--diagnosis and treatment

4. The Gastrointestinal Series-Part 6-Peptic Ulcer Disease

5. The Obesity Series—Part 2—the influence of the environment onChildhood and Adolescent Obesity

6. The Best Hospitals in America (U.S. News and World Report)

7. Follow up from last month on the high cost of Breakthrough Drugs

 

1. Hydration—how much does it take?Heat Exhaustion and Heat Stroke

We have all heard that 8 glasses of water a day is necessary for adequate hydration. It is not true. There are many factors that change the amount of water we need to consume each day including, ambient temperature, whether we are sweating, in dry vs humid conditions, mouth breathing, certain diseases, kidney function, etc.

On the average, men need 121 oz. and women 91 oz. of water per day.  We usually get about20% of our required water in foods per day. For example, an apple is 84% water, banana 74%, broccoli 91%, ground beef 56%, cheese 39%, and even a bagel 33%.

Working out in a hot and humid environment can dehydrate a human in as fast as 30 minutes. Keep that in mind the next time you cut the yard, take a hike, or play 18 holes of golf. Rehydration with 5-10 ounces of water every 20 minutes is recommended. Also, you are losing valuable sodium and potassium, which is necessary for muscle metabolism. Cramps and weakness will occur with- out replacement. Stay away from sugary sports drinks (choose G2 instead of Gatorade or sugar free Powerade) and always pre-hydrate with 2 cups of water 2 hours before a workout or strenuous activity.

There are certain beverages that are dehydrating especially alcohol, because it affects a pituitary hormone called ADH (anti-diuretic hormone) that regulates the release of urine depending on the status of the body’s hydration. ADH directly affects the release or retention of water by the kidneys.  Sugars, caffeinated tea, coffee, sugar concentrated drinks all will dehydrate, however, depending on the volume of fluid taken in will counter the effect to some extent.

Age, general health, and the weather all affect our hydration. The thirst center gets lazy as we age, and the elderly are frequently chronically dehydrated.

Heat cramps, exhaustion, and heat stroke are the result of getting overheated and not staying hydrated.

Heat cramps include sweating, leg and stomach cramps, thirst, and can be reversed with cooling and hydration of the body. If not treated, heat exhaustion will occur.

Heat exhaustion includes fatigue, nausea, headache, muscle aches, cramps, lightheadedness, anxiety, excessive thirst, cool, clammy skin with excessive sweating.

Heat stroke will occur if heat exposure continues. Symptoms include high body temperature (104 degrees), no sweating, flushed skin, high heart rate, rapid breathing,  agitation, and confusion with unconsciousness . If not treated immediately, damage to the major organs can occur. It can lead to brain damage, seizures, delirium, coma, and death.

If you recognize this, get the person in the shade, get to a cool place, remove clothing, and call 911. Rehydration with intravenous fluids are immediately necessary including heart rate and blood pressure monitoring. Pre-existing conditions can affect outcome.

The best treatment is prevention!! Stay hydrated, including potassium and sodium replacement, avoid alcohol, and get out of the heat. If a person notes any early signs or symptoms, act immediately.

3400 Americans died of heat-related illness between 1999-2003.

Reference: http://www.mayoclinic.org/diseases-conditions/heat-stroke/basics/definition/con-20032814

Also WebMD

 

2.Female Sexual Dysfunction-New information about a“Female Viagra”, now FDA approved!

10% of pre-menopausal women report sexual dysfunction and some studies go as high as 43%. Therefore, it is high-time that this issue be given” it’s due”. There is a FDA approved medication that apparently can improve the libido in pre-menopausal women. Just like the treatment for erectile dysfunction, no treatment helps all men and this one will be the same. After all, sildenafil(Viagra) is not an aphrodisiac and finding one is still being researched. Love Potion #9 is still out there, but research is getting closer. Animals are attracted with the scent of pheromones. If that exists between humans, creating it has certainly been difficult.

The placebo effect of confidence in using Viagra, Cialis, etc. may fill in the gap for men, and I suspect any the new female pink pill will have that same benefit. 

Flibanserin (Addyi) is now available. It affects the serotonin levels in the brain. This is a critical neurotransmitter in the brain. Antidepressants (SSRIs) also affect the serotonin levels in the brain.This drug is supposed to increase the libido. There was no mention of increased capability of having an orgasm. Compared to a placebo, it increased enjoyment in sex by 0.5-1.0 more events per month. That is a start! The study referenced tested 2400 women with the average age of 36.I have not read the effects on older women, especially post-menopausal women. The FDA has only approved it for pre-menopausal women for now.

Another recent drug being tested is bremelanotide (BMT). It appears to increase enjoyment of a sexual event with better sensation, better frequency, better intensity of desire, and a reduction of distress over the level of sexual desire according to a phase 2B clinical study presented at the American Society of Clinical Pharmacology at the 2015 annual meeting. Phase 3 trials will still need to be performed to test the safety of this drug before the FDA will look at it.

There is no test to define levels of sexual dysfunction, as it is a subjective issue. Patients present to their doctor with a complaint of dysfunction, whether that is lack of desire, difficulty having an orgasm, or some type of mechanical problem (i.e. dryness of the vagina and/or pain on intercourse). Defining depression is equally difficult and may be an additional problem in sexually dysfunctional women. Proving these types of medication’s benefit is also subjective. Satisfying sex can occur without orgasm.21% of women reported difficulty with orgasm in one study of 30,000.

Addyi has potential side effects since it has vasoactive effects especially in the presence of alcohol. Low blood pressure, dizziness, and possible fainting can occur.

There is increased risk if a patient is taking a CYP3A4 inhibitor medication (there are many drugs including grapefruit juice that inhibit this liver enzyme). This enzyme is critical in detoxifying drugs in the liver, and if a person is taking a medication that inhibits the ability of the liver to breakdown a drug such as Addyi, the concentration of the drug will elevate thus causing an increased risk of side effects.

Patients with liver disease should not take Addyi. Be sure your doctor knows what medications you are taking including all supplements, as some of these are also inhibitors of this enzyme. 

 This study on the experimental drug BMT was a double blind study with self- administration of the drug or a placebo for 12 weeks. The women did not know if they were taking the actual drug or the placebo. Two sexual function index tests were used to report arousal and sexual desire in premenopausal women. The results showed improved number of sexually satisfying events, arousal, and less distress.

There are no guidelines for evaluating patients with sexual dysfunction.  However, I have read recommended tests and pelvic exams that will rule out physical (diseases, weight issues, and congenital deformities), and mental issues that can be specifically treated, which might be contributing to dysfunction. Even physical conditioning must be discussed.

Seek out specialists that are interested in sexual dysfunction. Blood tests include a panel of female and male hormone levels, thyroid, and B12 levels. Any pelvic disease (i.e. endometriosis, polycystic ovaries) must be discovered using extensive pelvic and physical exams. Family and social (drug or alcohol abuse) history will be valuable as well. Couple relationship issues play a big role and must be addressed with counseling. Even cultural and religious issues should be considered.

There are several types of behavioral therapy that can be initiated if indicate, but the goal is to have comfortable, satisfying sex with orgasm.

Although not specifically stated, it is a no-brainer that the partner must be supportive, cooperative, and desirous of assisting in achieving success as a couple. There is not much evidence- based informationin the literature regarding the value of sex therapists, couples therapy, Kegel exercises, Eros clitoral therapy, directed masturbation, and other forms of help. However, I suspect they are worth exploring.

The advent of gynecological cosmetic surgery has become quite popular and consultation with an expert could be considered if a woman’s anatomy makes her feel self-conscious. I will be exploring that subject in the future.

Antidepressants, postmenopausal estrogen vaginal cremes, Buprion (Wellbutrin), Viagra, and apomorphine have been tried with mixed results.

Testosterone will increase libido in post-menopausal women, but the hair growth that will occur has been a negative. The Endocrine Society does not recommend its use in healthy women, but this is a discussion you must have with your personal physician.

Social issues including proper foreplay, “get rid of the kids”, proper environment, experimentation, “date night”, adequate rest, etc. must be part of any attempts at improvement. And I suppose “ gradual improvement and patience” is the key to achieving a satisfying sexual experience.

I think there will be a plethora of bogus treatments marketed soon since there certainly are for men.

This is a complex area of medicine that is long overdue for answers to women’s sexual issues.

By the way, there is an insurance code for sexual dysfunction that includes non-orgasmic disorders (FOD-Female Orgasmic Disorder). That would imply that insurance would pay for a consultation.

Remember, this is not approved for post-menopausal women, which is probably the group that requests help regarding this issue much more thanyounger individuals. That includes those cancer patients who are put into a post-menopausal status (breast and ovarian). Survivorship issues in these patients frequently include sexual dysfunction in a high percentage of these patients.

Stay tuned!  Reference-Medscape

Consult the Mayo Clinic website ; About.com

 

3. Cataracts—diagnosis and treatment

I have had a very positive response about discussing eye disorders, so I will continue with the most common eye disorder causing visual loss for aging Americans. By the time a person is 75 years of age, 91% will have cataracts (50% by 65). Non-Hispanic whites have the highest rate. I found no good reason for this racial disparity. Could it be the pigment around the eye absorbs light better in blacks just as football players put black under their eyes to reduce glare?  Cataracts are slow in developing, therefore, the timing of intervention will be up to the person and their ophthalmologist when or if surgery is indicated.

  

The risks for developing cataracts earlier and more likely are:

1) excess ultraviolet light {sunlight without eye protection} 2) smoking 3) genetics 4) diabetes 5) alcohol use 6) radiation therapy for cancer around the eye 7) congenital-born with cataracts 8) injury to the eye 9) chronic use of cortisone

  

 

Cataracts create cloudiness of the lens of the eye seen through the pupil as cloudy, and the vision is not clear. The lens should not be visible. It is seen much easier in older dogs, as their pupil is much larger.

Because of physical changes with clumping of protein in the lens, it begins to appear cloudy (even brownish in cloudy, and begins to interfere with good vision.

The lens also becomes less flexible, less transparent, and thicker as we age. All these factors cause light to be scattered rather than focused on the retina causing a less clear image.

 Note that the lens has a capsule or sack it lies in, as demonstrated by this drawing .

Other visual symptoms can include lights appearing brighter (photophobia), double vision (diplopia) with only one eye and changes in color. Some may even go through a period of improved vision as the cataract may act as an improved lens, however over time vision will falter. Also the patient may require a change of prescription for their glasses more frequently.

  

Timing for surgical correction will be a decision between the patient and ophthalmologist. Many wait til correction with glasses is no longer effective. Cataract formation is a slow process.

Treatment options: Only one eye can be operated in the same session. Once first eye surgery has healed, etc., the second one can be addressed (4-8 weeks) depending on the surgeon’s experience, preference,  and how well the first surgery went.

The 3 types of cataract surgery:

1. Phacoemulsification

The most common method of removing cataracts is called phacoemulsification. Through a tiny incision, the lens is reduced to small pieces using an ultrasound probe with a small suction which can remove those fragments. This ultrasound probe sends waves through the lens and emulsifies the lens. The term “phaco” comes from the Greek meaning lens. No stitches are necessary and no eye patch is needed. Only eye drops are used for numbing the cornea. It takes about 15 minutes. Eye drops of various types are used post-op.

If you would like to see a live cataract operation with the placement of an Alcon lens implant, click on https://www.youtube.com/watch?v=rUCoQzui704

2. Extracapsular cataract surgery

If the cataract is advanced (very hard),the phacoemulsification technique can’t break up the cataract to remove it. This alternative technique requires a large enough incision to remove the entire cataract intact, much like older techniques. This will frequently require an actual lidocaine injection, and this type of surgery will take longer to heal (stitches are necessary and will take time to dissolve).

3. Intracapsular surgery

This is rarely performed today, but this requires an even bigger incision because unlike the other 2 techniques, the cataract lens and capsule is removed. This requires the lens implant to be placed in front of the iris.

Without a lens in the eye to focus the image on the retina, very thick eye glasses used to be required (we all remember those ugly glasses many years ago). Today, a new lens of varying type is inserted into the capsule to replace the lens removed.

There are 3 type of lens:

1. Monocular lens—this is the most common lens implanted, but only restores the vision at one distance, and you will likely need reading glasses or glasses to give you good vision at multiple distances. Astigmatism surgery can be performed at the same time, since the new lens will not. A few incisions to remove the warping of the cornea will usually take care of it.

2. Toric lens—these are stronger lens and will correct all but the near vision. It can correct astigmatism too.

3.Multi-focal—these are similar to multi-focal contact lenses, and usually prevent the needfor any reading glasses.

  

Lenses can be one-piece or multi-piece, acrylic, or silicone. The lenses can essentially replace distant vision or vision at all distances.  If the patient has astigmatism, it can be treated at the same time with a radial keratotomy (corneal incisions to smooth the warped surface of the cornea that cause astigmatism).

Exciting new lenses can be implanted (one for distant vision and one in the other eye for near vision—just like contact lenses). There is a new blue light filtering lens that blocks UV rays and blue light, which is thought to cause macular degeneration. Light adjustable lens are being evaluated by the FDA currently, which act just like glasses that change shading depending on how bright ambient light is. The research is impressive to supply a lens for every vision need.

Only the traditional monocular lens are covered by Medicare, and to have the multifocal lenses implanted can cost $1500-$2500 per eye out of pocket.

Preparations for ocular surgery:

1. As for any surgery, knowing what medications you are allowed to take and not are critical, especially aspirin, oral anticoagulants –Plavix, Xarelto, etc., medications that interfere with blood coagulation (St. John’s wart, vitamin E, fish oil; Coumadin is usually stopped 3-5 days before surgery. Flomax can affect the eye and either needs to be stopped or the eye surgeon will give you a medication to counteract the effects.

2. You are not allowed to have a contact lens in the operated eye.

3. Be sure you follow the surgeon’s written instructions perfectly regarding eye drops after surgery, resuming medications, activities, etc.

Postop complications are very rare but can occur. Haloes are not uncommon for several days, a feeling of a scratchy eye, and slight irritation. Rare complications include infection, retinal detachment, bleeding, inflammation, glaucoma, secondary cataract, and even loss of vision.

15 minutes of surgery for great vision is well worth the minimal risks, but be sure you discuss all of this with your doctor and cataract surgeon.

For more information, click on:

http://www.mayoclinic.org/diseases-condition/cataracts/basics/definition/con-20015113

 

4. The Gastrointestinal Series-Part 3-Peptic Ulcer Disease

I have discussed the function of the stomach, and reported on gastritis previously. Stomach ulcers can occur almost anywhere in the stomach including the outlet of the stomach into the small intestine (duodenum).

The word “peptic” comes from pepsin, an enzyme secreted by the stomach that breaks down protein.

Gastroenterologists differentiate gastric ulcers from duodenal ulcers for a reason. There is a higher chance of cancer in an ulcer in body of the stomach.

This video will demonstrate gastric ulcers via live endoscopy:

https://www.youtube.com/watch?v=K-Ao6kyoaNk

The cause of ulcers can be several, but it is agreed that it is an imbalance of digestive juices in the stomach and duodenum that sets up the possibility of ulcer development.

The most common cause is an infection from the bacteria Helicobacter pylori (H.pylori). When I was in training this was not known, and acute ulcers were treated with hourly liquid antacids and heavy cream. Stress, alcohol, smoking, and spicy foods were thought to be the culprits. These may be factors, but most are caused the bactriumH.pylori.

Tumors (Zollinger-Ellison Syndrome), corticosteroids, anti-inflammatory meds (Aleve, aspirin, Ibuprofen), and family history all play a role increasing the risks of an ulcer

H.pylori can live in the stomach without symptoms for years. Once thisbacteria makes its way to the raw lining of the stomach, an ulcer can occur.Only 10-15% with culturable H. pylori will develop ulcers.

Techniques diagnosing H.pylori:

1. Blood test for antibodies against the bacteria. It does not differentiate those who have an active infection or one in the past.

2. Urea breath test- a test to prove if an infection is present or if the antibiotic has been successful in eradicating the bacteria.

3. Stool antigen test-this stool test will tell the doctor that antibodies have formed because of the bacteria.

4. Stomach lining biopsy with endoscopy will demonstrate the bacteria.

Symptoms are not much different than gastritis (bloating, pain, belching, nausea, etc.).

Complications of ulcers include acute perforation requiring emergency surgery, obstruction of the outlet of the stomach, and bleeding, which can be silent for some time (dark tarry stools) or be acute (dark or bright red) requiring hospital admission and urgent treatment. With acute bleeding, vomiting bright red blood will occur, which can be severe losing considerable amounts of blood.

Diagnosis begins with X-ray studies (UGI series), gastroscopy to culture for H.pylori and look for an ulcer.

Treatment for H.pyloriulcers:

1. The combination of a bismuth containing liquid (Mylanta, Gelusil, etc.) plus 2 antibiotics  (2 are used to prevent resistance to one drug).

2. PPIs-proton pump inhibitors (Nexium, Dexilant, Prevacid). These promote healing and relieve symptoms. H-2 inhibitors (Pepcid, Zantac, Prilosec, etc.) relieve symptoms but do not heal ulcers. This is an important distinction.

My personal favorite is Dexilant (head and shoulders over Nexium or any other PPIs). Ask your doctor.

3. Carafate-an oral suspension prescription medication to help heal ulcers. Take on an empty stomach and take no other meds for 2 hours.

Refractory ulcers-- If the ulcer does not heal, more aggressive investigation needs to be performed including  ruling out tumors (adenocarcinoma or gastrinoma).

Patients must stop smoking, quit drinking alcohol, relieve stress, stop taking anti-inflammatory medications (Aleve, aspirin, ibuprofen).

This is usually a chronic long term illness that will need continued maintenance of treatment. There is no evidence that a restricted or bland diet is of any value.

A good source of information: www.emedicinehealth.com/peptic_ulcers/page8_em.html

5. The Obesity Series-Part 2—the environment and its influence on childhood and adolescent obesity

  

Last month, we began learning about the latest information on obesity, “the disease”. Obesity is a perfect disease model to study, because it affects almost every organ system. Even if weight is not a problem for you, the information that is being learned about our weight is valuable for so many disease processes.

Before, I begin, I feel compelled to make a statement about Coca Cola’s decision to come out and defend drinking their 10 spoons of sugar per bottle of Coke, by shunting the real problem to not exercising enough. Every study around has proven that without caloric restriction, regardless of exercise, people will not lose weight. Exercise may actually put weight on because you build muscle. Muscle weighs more than fat. Could it be that the sales of Coke are dipping?…….they ,in fact, are. Also, breaking news….Diet Pepsi is coming out with an aspartamine free (sugar free) option (no final answer on the downside of this chemical from research). Aspartamine can increase insulin resistance in those prone to type 2 Diabetes.

Obesity costs $190 billion/yr. to manage the effects of obesity. Consider 1 in 5 deaths in the U.S. are considered overweight or obese (18.2% of all deaths). I have discussed this in previous reports: #6, #24, #25, #26, #43

So much evidence has just come out that reviewing the new information is critical. I listed several sub-topics about obesity in last month’s report, and this month, we need to examine the impact that the environment has on this disease, especially in the young.

Genetics can’t be controlled (yet) but the environment can be helped with a major team effort (social, family, and medical). A recently discovered gene, the FTO gene, increases the likelihood of being obese by 20-30%.This gene determines whether a fat cell stores fatty acids or burns them (thermogenesis). Research has proven if a single amino acid in that gene is mutant, it can turn off the gene and flip the switch to fat burning instead of fat storing. THIS IS BIG! Drugs can be developed to manipulate this gene mutant. It is only a matter of time. Reference-NEJM, August 17, 2015

Perception of being overweight!

Recent studies report that as many as 2/3 of these kids do not perceive that they are overweight and neither do their parents. This creates a serious problem to get them to lose weight. It is already necessary to resort to medication and bariatric surgery in them, because of this phenomenon and lack of motivation to diet and exercise. Being a black female and taller are clearly risk factors.

Two types of obesity

It is all about the fat cell (adipocyte). Fat cells can be larger than normal (hypertrophic) or there can be too many fat cells (hypercellular). Childhood and adolescent obesity tends to be the hypercellular type, and is much more difficult to treat. This is another reason to aggressively address the overweight youth.

High energy and sugary foods constantly advertised on TV andother sources create a huge challenge for all who are trying to manage their weight.

Bullying, low self-esteem, and isolation for those who are significantly obese create depression and even may lead to suicidal thoughts in these in school age children.

In my opinion, a lot of doctors are not helping enough to provide weight management programs for these kids. Parents who are overweight often do not perceive their children are overweight and feed them high caloric foods. The school system does not require physical exercise programs, and the average teenager does not exercise on a regular basis choosing electronic social media and TV instead.

The future for our youth is pretty grim with this kind of negative environmental influence. A high percentage of overweight or obese will continue as adults.

Low income is another significant factor in obesity. Neighborhoods not conducive to safely walking or providing asports facility is a real problem.

Being overweight leads to hypertension, hyperlipidemia, and type 2 Diabetes at a very early age (part of the metabolic syndrome) and potentially leads to many of the co-morbidities listed on the diagram below.Physicians are more likely to treat the results of obesity rather than losing the weight.  In the near future, I will review all the effects of obesity on the organs.

If parents could use some type of family intervention, it would be beneficial (as studies have shown). It is a family affair, and if the parents are overweight (which they frequently are), it will require a very influential pediatrician or family doctor to initiate a plan and support a true weight loss program that will be successful over many years. Over weight parents must accept the fact that even though they are overweight, their child can have a better life if they address their problem as an adolescent.

The CDC announced that 12.7 million children and adolescents are obese totaling 17% of the population age 2-19 years of age (36% in the adult population).

Treatment of adolescents with medications: The only medication FDA approved for adolescent obesity is Orlistat, a lipase (fat enzyme) inhibitor that directly affects fat absorption with the 120 mg dosage. This must be accompanied by exercise and nutritional (and behavioral perhaps) counseling.

Loss of 5-10% body weight is the goal!! (same as type- 2 Diabetes). There are other weight management medications if the adolescent is type 2 diabetic (glucagon-like peptide agonists (GLP)--I just discussed this hormone with the pancreas). The other medications approved for adults have not been studied in adolescents.

Surgical treatment:

There are several approved techniques for adults to reduce the surface area of the stomach including endoscopic placement of adjustable gastric bands, gastric bypass to small intestine (Roux-en-Y), and the gastric sleeve. These have all been approved for the obese adolescent if other conservative means fail. The gastric bypass yields the best results.

In a communication with a friend who is a bariatric surgeon (and had the gastric sleeve himself) prefers the gastric sleeve, because it creates the least side effects and yet yields almost as good results as the gastric bypass procedures without creating as severe a “dumping syndrome”(diarrhea upon eating—this is caused by the gastro-colic reflex).He also stated that endoscopic gastric banding frequently requires revision and is least effective.

Below is a list of options for bariatric surgery. Seeking out a very experienced surgeon is critical. With refinement of these procedures, the complications from these surgical options has been minimized and has become the treatment of choice for resistant obesity:

Specifics for these procedures are easily obtained on the internet. Discussing each of these procedures is beyond the scope of this report. Your surgeon will have his or her favorites.

Recently, it has been reported that many of the co-morbidities (other medical diseases) associated with obesity arise from increased intra-abdominal pressure, in addition to the negative effects of the metabolic syndrome. These risk factors are the core abnormalities of most weight-challenged patients. How all these risk factors work exactly is still being investigated.

The metabolic syndrome is defined once again. 3 out of 5 of these risk factors define a person as having the syndrome and the cardiovascular risks that come with it.

1) Hypertension(>130/80)

2) Hyperlipidemia (triglyceride higher than 150mg/dl; HDL cholesterol of 40mg/dl in males and 50mg/dl in females)

3) Large waist circumference(40 inches for males and 35 for females)—this must be modified for children and adolescents

4) Abnormal blood glucose (greater than 100mg/dl)

5) Family history of premature coronary artery disease

Click on this reference for more detail on the metabolic syndrome:

http://www.nhlbi.nih.gov/health/health-topics/topics/ms

Insurance rarely pays for these surgical procedures in adolescents even though they are as effective as in adults where they do pay. This is just wrong!!

Behavioral approaches are more effective in adolescents than adults, therefore, surgery must be a last resort. It should be noted, however, bariatric surgery can cure type 2 diabetes, and is much more effective than any other form of treatment.

Next month, I will discuss the pathophysiology of obesity (underlying physical and chemical causes that contribute to the disease including the hunger hormones). This is very recent information.

Reference: Medscape-General Surgery

Kisses!

 

6. The Best Hospitals in America(U.S. News and World Report), 2015-2016

For over 20 years, the U.S. News and World Report havescored over 4000 hospitals on the basis of excellence, patient safety, reputation, results, and ability to handle the toughest cases. There are 16 different specialties tested, and the same hospitals score the best every year. The rankings are created by thousands of physicians.

Overall scores of close to 100% were Mayo Clinic (Rochester, Minn.), Massachusetts General Hospital (Boston), Johns Hopkins (Baltimore), Cleveland Clinic, UCLA, NY-Presbyterian, University of Pennsylvania (Philadelphia), UC-San Francisco, Brigham and Women’s Hospital (Boston), and Northwestern Memorial Hospital (Chicago).

The highest ranked by specialty:

Cancer- MD Anderson (Houston) and Sloan Kettering Memorial (NYC).

Cardiology/Cardiovascular Surgery-The Cleveland Clinicfollowed by Mayo Clinic and NY-Presbyterian.

Orthopedics-Hospital for Special Surgery NY

ENT/Head and Neck Surgery-Massachusetts Eye and Ear Hospital

Eye-Bascom Palmer in Miami, Wills Hospital at Thomas Jefferson University Hospital in Philadelphia, and Wilmer Eye Institute at Johns Hopkins in Baltimore

Pediatrics-Boston Childrens Hospital, Children’s Hospital in Philadelphia, and Cincinnati Children’s Hospital

Gynecology-Mayo Clinic

For the entire list and an additional list of the highest rank by region, click on: www.health.usnews.com/best-hospitals

 

7. Follow up on last month’s report on the high cost of breakthrough drugs!

Last month, I reported on the enormous cost of some of the top 10 “breakthrough drugs”. Most of these medications are cancer drugs and need to be taken for a year or more.

Cure Today magazine cited  that ASCO (the American Society of Clinical Oncology) and NCCN (National Comprehensive Cancer Network) have begun to analyze the cost of thes new cancer drugs based on several factors including benefit, lack of side effects, impact of extending life, etc. This is great news and will impact the cost of these drugs if the doctors refuse to use these drugs without Big Pharma dropping the price; many of these drugs are over $100,000 per year.

 Oncologists have to look into the face of their patients and families and ask them to accept these medications knowing in many cases the treatment will send them into medical  bankruptcy. Even though there is some help from the pharmaceutical companies, as many as 25% of cancer patients face severe financial strain or bankruptcy. If you would like to read more about this subject, click on to:

http://www.curetoday.com/publications/cure/2015/immunotherapy/considering-cost-whats-an-immunotherapy-worth

For cancer survivors and their caregivers, I highly recommend this free magazine (print and or online)

To subscribe, click on http://www.curetoday.com/subscribe

Next month, some of the subjects will include updates on  the FDA approved female “Viagra” , liver cancer, gender dysphoria, the hunger hormones in the Obesity Series, deep vein thrombosis, and STDs (sexually transmitted disease)-part 1. It should be an interesting report.

Stay healthy and well, my friends, Dr. Sam