The Medical News Report #63

April, 2017

Samuel J LaMonte, M.D., FACS

www.samlamonte@gmail.com

www.themedicalnewsreport.com

Subjects for April, 2017

1. Stem Cell Therapy-what you need to know!

2.Medical Marijuana update

3. A new breakthrough in treating resistant psychological diseases- using psychodelics (psilocybin)- Back to the Future

4. Sugar and artificial sweeteners in the U.S.

5. Heart Valve Disease-Part 1-diagnosis

6. Human Abuse Series—Part 3—Child Abuse

7. Single payer healthcare system-Part 2-The potential advantages

8. “A quick note”-Series-Some question routine pelvic exams when having screening for cervical cancer (Pap smear, HPV)

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I want to remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your personal 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. I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act, however, 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, friends, and physician, but remind them about this being informational only. You must be proactive in our current healthcare environment.

   Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, guidelines for healthcare, 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 will treat you accordingly. Always write down your questions before going for a visit.

  Now, on with this monthly medical report!! Thanks!! Dr. Sam

1. Stem Cell Therapy

A. Warning—“Stem Cell Tourism”—abuse of a treatment

  Stem cell research is one of the hottest areas of interest. There has been encouraging evidence that stem cells are capable of regrowing cells in many parts of the body. Spinal cord injuries and neurologic diseases such as multiple sclerosis, heart damage from heart attacks, and immunologic diseases are but a few areas of intensive investigation, but most are not proven yet!

For that reason, I begin this report with a caution for all who are tempted to believe local newspaper ads, go to seminars offered, or go to “clinics” touting stem cell injections for regrowth of tissue without scientific evidence and in the face of some potential devastating complications.

B. Legitimate treatments

  Stem cell therapy has proven value in many blood cancers, and the FDA has approved only for treating these diseases.

The NEJM (New England Journal of Medicine) recently reported blindness in 3 patients from injections into the eye of patients with macular degeneration.Another report found a patient with kidney failure treated with stem cell injections into the kidneys that developed lupus. Another child with a brain condition had injections and developed a glioblastoma (malignant tumor of the brain).

Most of the unproven methods are using the patient’s own fat cells, but this source is currently not under control by the FDA. This method skirts the jurisdiction of the FDA. In fact, because of this abusive technique, the FDA is currently considering any stem cell from any part of the body that is injected into another area as a drug, and therefore, these procedures would come under the control of the FDA.

  The adequacy of the FDA is coming under greater question about their ability to police our health issues. They have been unable or unwilling to police health advertising and patient safety issues. This was pointed out in a recent issue of the Journal Cell Stem Cell, June 30, 2016.

  I continue to encourage my readers to be very cautious in believing ads on the internet without in-depth research and checking with their doctors. The number of scams is increasing exponentially.

C. Online scams 

The University of Minnesota conducted a search of online companies and discovered 351 businesses marketing stem cell therapy in 570 clinics, concentrated in California, Florida, Arizona, Texas, and New York. Buzz words such as autologous cell-based therapy, amniotic tissue, umbilical cord, and placental cell therapy, etc. These unregulated companies undermine the authenticity of legitimate research.

  The fact that these cells are removed from the same person (autologous) that would receive them allow the rationalization that stem cells can sense the particular environment needed to treat, and there is no scientific proof that that is the case. FDA

  A recent report on spinal cord stem cell therapy cites many clinics around the world using it from El Salvador to India to the Middle East.

  There may be some value in these treatments, but until they are based on evidence through standard research methods, please beware.

  A valuable patient guide to stem cell therapy is available:

www.ipscell.com/patients-guide-to-stem-cell-treatments/

Dr. Paul Knoepfler, Professor of Cell Biology and Human Anatomy at the UC Davis School of Medicine.

D. Background of legitimate stem cell use

  The source of the stem cells can originate from fat, bone marrow, umbilical cord blood, and even teeth. The promise of these cells to regenerate, restore, repair, and replace damaged cells all over the body is great, but most unproven.

E. What are stem cells?

  Stem cells (the master cells) are primordial embryonic cells, which are undifferentiated and are the precursors to the cells of organs. 

  The most commonly used stem cells originate from bone marrow inside bones and umbilical cord blood. This is currently the only FDA approved source of stem cells.

  For over 30 years, bone marrow transplants have been used to treat leukemia and lymphomas. Chemotherapy and or radiation is given to kill the malignant cells in the patient. Unfortunatelynormal cells are destroyed as well, and therefore the stem cells are injected into the bone marrow to regenerate the marrow. Like any transplant, if it comes from another source, it creates an immune response and can result in rejection of the cells and failure.  Immunosuppressive medications must be taken to prevent this phenomenon.Recent research is underway to manipulate the genetic makeup of these stem cells to reduce the need for drug-induced immunosuppression.  This reprogramming takes months to accomplish and is still investigational.

 Researchers are now finding ways to isolate and culture embryonic cells to produce other cells creating controversies in abortion politics and human cloning.     

F. The only FDA approved stem cell product is—Hemacord

  There is only one actual stem product approved by the FDA—Hemacord, a cord blood-derived product produced by the New York Blood Center for Blood Cancers. This product is similar to going to a blood bank for stem cells. For more information consult the FDA website under Consumer Protection. But please be aware, the internet is full of unapproved stem cell products.

  Below is a potential list of possible future uses for stem cells (on the left), and the drawing of stem cells is seen on the right.

    

G. Potential of Stem Cell Therapy

  When one looks at the potential uses of stem cells, it should be very obvious why there is so much room for excitement, research, and hopes for cure of a multitude of diseases.

Recent research on mice, showed that stem cells could regenerate hair cells in the inner ear (cochlea). These hair cells are permanently damaged with noise, and do not regenerate normally. They are the cause of most cases of nerve deafness. 

Multiple sclerosis has been a neurological disease that has responded to autologous stem cell transplants in a study presented in the JAMA Neurology. 280 patients with remitting-relapsing or progressive MS were given these transplants and at 5 years, there was a 46% progression free period. There was a 3% death rate within 100 days of treatment thought to be treatment related. Younger patients fared better, and if the patient progresses in the face of standard therapies, stem cell treatment could be considered. This therapy is still in clinical trials, and is not FDA approved.   

H. Three types of bone marrow transplants:

  1. Autologous transplants (auto=self)—stem cells are removed before the patient is given high dose chemotherapy and or radiation to kill cancer cells. After treatment, these cells are injected into the patient to regenerate normal cells.   This is called a rescue transplant.

  2. Allogeneic transplants (allo=other)—these cells are donated by family members who are genetically similar to the patient. There is a national transplant registry for people to choose donor cells from non-family members who are genetically similar. Umbilical cord blood is an alternative (removed right after birth which is frozen and stored).

  3. Syngeneictransplants—donor is from a twin.

For an excellent discussion on stem cell transplants for cancer treatment, click on www.cancer.org   (American Cancer Society), and then search for stem cell transplants.

I. Donor cells—2 ways to collect cells

 a) These bone marrow cells are removed from the donor’s hip usually under anesthesia.

 b) The second method is from a process called leukophoresis. Certain medications are given to the donor that encouragestem cells to separate from the other blood cells which are collected. The white cells are separated from the red cells by a machine and the stem cells from the white cells. The red blood cells are returned to the donor.  These stem cells are placed into the blood stream of the patient similar to a transfusion. These cells travel to the bone marrow, where they are stored and allowed to go to work creating normal bone marrow cells.

J. Centers for Transplantation—There are centers designed to collect the stem cells and isolate the patients to prevent infection. Anti-rejection medicines, antibiotics, anti-fungal medication, and blood transfusions are used to increase the likelihood of a success. These patients must be monitored carefully for side effects and complications.

K. Side effects and complications of stem cell transplant

  For a list of consequences from stem cell therapy, click on this National Institutes of Health Medline website: www.medlineplus.gov/ency/article/003009.htm

L. Graft versus Host disease (GVHD)

This side effect is serious. GVHD occurs with allogeneic donor cells.

There are two forms of the graft versus host disease—acute and chronic:

Acute-This form can occur in the skin, liver, eyes, and gastrointestinal tract. Rashes, yellow jaundice, dry irritated eyes, nausea, vomiting, and diarrhea are the most common symptoms and are treated with corticosteroids.

Chronic-(slow and delayed)—patients who have antigens to their white cells, called HLA (human leukocyte antigen), are more prone to the chronic reaction. A blood test prior to stem cell transplantation is usually performed. The chronic form of GVHD can occur relatively soon or years later.

The same symptoms mentioned under the acute form can occur but also pulmonary, oral (dry mouth, fungus), esophageal (swallowing and pain), and neuromuscular (fatigue, muscle weakness, and pain) symptoms can occur.

Long term immunosuppressive medications are given to prevent this complication, but if it occurs, antibiotics, antifungals, and other medications may be indicated.

M. Success in stem cell transplantation

There are many factors that influence the success of transplants. Older age, general health conditions, genetic markers, and the presence of certain antigens (HLA) all play a role. Careful scrutiny in selection of candidates is just the beginning of a long list of issues that must be addressed.

N. Summary

  The risks are many, and at this time stem cell therapy in the U.S. is not FDA approved for spinal cord injuries, MS, Alzheimer’s, Parkinson’s disease, orthopedic issues, and many of the diseases listed as potential candidates, however, clinical trials are under way. (Medscape Orthopedics, 2016). The field’s future is bright, and proper controlled repeatable research is necessary before other diseases can be approved for treatment.

  An article in the NEJM from the FDA (3 doctors) cite the need for fast track acceptance in life-threatening illness, but using stem cells to treat orthopedic injuries is not part of their acceptance without more studies to prove their effectiveness.

Reference--Foundation for the Accreditation for Cell Therapy

The National Marrow Donor Program

The FDA, NEJM, March, 16, 2017

Mayo Clinic and Dana Farber Cancer Centers are two programs well known for stem cell therapy for cancer treatment (blood cancers)

 

2. Medical Marijuana—update

 

    

A. Widespread use already

 Marijuana is the most common illicit drug consumed in the world with a history of use for 5000 years starting with the Chinese using it as a medicinal treatment.

There are 28 states that allow medical marijuana. Each state has possession amount limits. For specific laws by state, please click on:

www.medicalmarijuana.procon.org/view.resource.php?resourceID=000881

The federal government still has laws that contradict state use. It has hampered good clinical research from being performed, because federal grants will not pay for an illegal drug to be studied.  It is prudent to have restrictions on the growth and distribution, but legislators have got to move faster for deserving patients. As usual the “swamp” is working its magic slowness with too many regulations hampering the progress of allowing medical marijuana use for specific patient groups.

B. The concept of “Harm reduction”

This is a term that has been used in many instances before….using potentially harmful drugs to treat even more serious addictions….methadone for heroin addiction, buprenorphine for opiate addiction, nicotine patches, gum, and e-cigarettes for smoking cessation. Marijuana should be considered in this same light.

C. Potential uses of THC

THC (tetrahydrocannabinol) and CBD (cannabidiol) have many medical properties and potential uses: pain relief, anti-nausea, antioxidant, anti-inflammatory, anti-anxiety in certain cases, anti-PTSD, anti-psychosis, and is used to treat serious drug and alcohol addiction. There are studies reporting a 25% reduction in drug overdoses in states where medical marijuana is legal. Other studies report a lower domestic abuse among women whose partner smoked pot.

D. Abuse is an issue

  Federal laws still are in contradiction to certain state laws, and theoretically a doctor can be prosecuted for writing a prescription for it unless they attend a licensed course and are certified. Personally, the feds have “bigger fish to fry”, and that is why prosecution for the sale and distribution of all types of marijuana is not a priority.

Over-use of marijuana can have adverse effects as well, so the amount of intake for medical use must be monitored including neurocognitive functioning (memory, attention, motor skills, learning, and verbal skills). Current research reports that less than 10% of the general population will become addicted to pot if used regularly, however, the rate jumps to 18% in adolescents.

E. Medical Marijuana

  The product for medical use is mainly a low euphoria THC (tetrahydrocannabinol), however stronger THC is often used. If stronger THC and CBD (cannabidiol) are used, this must be carefully monitored with incremental increase in dosage. By the time all the requirements are met thanks to the state legislators, the price will be too high for some, especially when it can be bought almost anywhere for less. And what physician is going to be willing to risk prescribing it?  Just today, I saw a big ad in the Sarasota Herald from a medical doctor (MD) advertising that his clinic prescribes it for medical issues.

  The FDA has just cleared a new drug for chemotherapy- induced nausea which contains THC—Syndros.

  Finally, patients with underlying psychological disorders should be under psychological treatment before cannabis is considered, and the psychiatric community in partnership with the primary care physicians should play a role in properly selecting patients for the use the medical use of marijuana.

  I have previously discussed medical marijuana:

www.themedicalnewsreport.com #10 #30 and #38

 

3. A new breakthrough in the treatment of certain psychiatric diseases using Psychedelic drugs-Psilocybin

 

The hallucinogen, psilocybin (from certain mushrooms), has been reported to successfullytreat some resistant psychiatric diseases with a single dose, as reported by the Journal of Psychopharmacology (December, 2016).  

 In fact, psilocybin and LSD (l-lysergic acid) were studied intensively in the 50s and 60s, but when street use blossomed and President Nixon signed the Controlled Substance Act in 1970, it shut down all research on these illicit drugs. Even then it was showing success in alcoholism, obsessive compulsive disorder, autism, depression, schizophrenia, terminal cancer patients, and volunteers who took the single dose were tested on creativity and spirituality. One of my OU medical school professors (Dr. J. West-psychiatrist) was an early investigator.

 In recent years, the government has finally been more open to funding investigations on these psychedelics. Considering the failure in addressing mental healthcare in this country, I welcome all efforts.

A single high dose of psilocybin (21mg/kg) derived from special “magic mushrooms”, has been tested on patients with resistant anxiety and depression. The control group took niacin (250 mg-Vitamin B3), which has some similar sensation properties when taken. This dose was given in a controlled environment by trained professionals. Both groups were given psychotherapy for 7 weeks.

  There was an 83% clinical response in the psilocybin group compared to the control group (14%). The response (relief of anxiety and depression) was measured by 2 standard depression/anxiety rating systems. Amazingly this positive response was still present6 months later in 60-80% of the cases after that single dose. Patients reported a better quality of life with improved mood, enhancedrelationships, optimism, attitude, and spirituality.

  Another study treating 51 cancer patients, most with recurrent or metastatic all diagnosed with anxiety and depression were treated with psilocybin. They were treated with either a low or high dose. 5 weeks later, the doses were reversed. All were told they received psilocybin but not the dose. 92% of the high dose group showed a significant response, whereas the low dose group had a 32% response. At 6 months, the positive response averaged 80%.

  There is a mystical experience reported that allows these patients to “move forward” with their lives, not feeling anxious, and feeling optimism and even joy. Their coping was greatly improved in the cancer patients. There is a placebo effect in these studies but cannot explain the high degree of response. Placebo can allow response in the 35% range but not 80% or higher. 

Other studies need to substantiate these results with greater attempts at less bias and suggestibility (called demand characteristic) and diversity of races, but the psychiatric community is excited, declaring these studies are landmark in importance!

The same reluctance to study other unlawful drugs (even marijuana), dietary supplements, and herbs have hampered discoveries for proven health benefits because of the protective highly overregulated attitude of our government. Since psilocybin is considered an illegal drug, federal research is not possible. Big Pharma won’t touch it either because it does not qualify for a patent.

This report should not encourage anyone to experiment with psychedelic drugs (LSD and magic mushroom tea). I will update this exciting information when there is more to report.

 

4.Common sense information about the consumption of sugar and artificial sweeteners

A. Sugar

Sugars are basic carbohydrates that include fructose, sucrose, lactose, and glucose. Fructose is considered by some researchers to be toxic and feel it should be regulated.

Sugars are directly responsible for tooth decay. The maximum recommended daily limit is 3 teaspoons or 3% of total daily calories. It is almost impossible to prevent sugar from being in the diet. Approximately 80% of food has added sugar in it. So we must focus on the foods that are high in sugar content like sugary drinks including soft drinks, fruit juices, candy, and cookies.

  Coca Cola Co. has been cited for spending millions of dollars in research proposing that sugary drinks were not a significant factor in the obesity epidemic, and the lack of exercise was the real culprit.

Johns Hopkins University stated that to date there is no credible evidence that any threshold of sugar intake is strongly linked to negative health effects. It is the calories consumed in sugar rather than any toxic effect.

  How do we as consumers view the hazards of sugar?  It is a proven fact that preventing younger people from buying sugary drinks can be reduced through taxation (sales tax). Price does matter. Will it be proven that people will not become obese because of this legislation (California).

As stated previously, half of the sugar we consume is anadditive in foods we would not normally associate with (ketchup, salad dressing, bread, etc.). A third comes from sugary drinks and about 16% from junk food (candy, ice cream, and cookies). Sugar is added to 80% of all processed foods.

  The World Health Organization has called for a 20% excise tax on sugary drinks containing fructose. It has been proven that increase in excise tax on tobacco has decreased consumption of those products in the youth. This is an attempt to curb the global obesity epidemic by decreasing consumption.

  California has taxed these drinks and seen a substantial drop in purchase of these drinks.The controversial soda tax has shown a drop in consumption of 26% in low income Californians. It is premature to see whether it will benefit weight. American J Public Health, 2016

  Nutritionists recommend that sugar not be more than 3% of our total caloric intake (about 3 tsp. of sugar per day).

  Regulation including prohibition of ads may also help if more federal regulation is supported by the public.

Recommended low fat diets which require an increase in carbohydrate consumption has been another negative for this subject.

Here are some food consumption recommendations from an article in Cure magazine

  • Focus on real food that the earth made.
  • Vegetables should be eaten daily. The more the better. Starchy vegetables like sweet potatoes and winter squashes are a good choice, and these veggies do not need to be counted as a starch.
  • Beans and lentils are healthy vegetarian proteins, but also contain carbohydrates, and need to be considered a starch when meal planning, especially for people with pre-diabetes or diabetes.
  • Quality whole grains are substances like bulgur, barley, wheat berries, faro, quinoa, oats, brown rice and spelt.
  • Sprouted grains and sprouted grain products like Ezekial 4:9 bread and Alvarado Street Bakery products are recommended. Sprouted grains are higher in protein, pushing levels of starch down. Sprouting grains also may make digestion easier for people who tend to be sensitive. You can sprout anything by rinsing and soaking overnight on the counter before cooking as usual.
  • Experiment with flours made from whole grains or sprouted grains. Sprouted grain flours are considered flourless because they’re not traditional flour. That does not mean they are gluten free, nor does it mean they are something to be eaten in excess.
  • Liquid sweeteners, such as maple syrup or honey, can be consumed in small amounts and is preferred over agave.
  • Agave is high in fructose and sweeter than table sugar. 1 tsp of agave contains 60 calories compared to 40 calories in 1 tsp of table sugar.
    - See more at:
    http://www.curetoday.com/community/amanda-bontempo/2016/04/carbs-and-cancer?p=2#sthash.zGfR3FoS.dpuf

Reference: Amanda Bontempo, nutritionist and certified dietician, Cure Today Magazine, www.cure@curetoday.com

B. Low calorie sweeteners—are they bad?

30% of Americans consume low or no calorie sweeteners daily. These sweeteners have been around for some time and many articles have come out maligning them. For diabetics there is the concern for insulin resistance when drinking large amounts of low calorie or no calorie drinks.

Aspartamine, a common non-sugar sweetener has been implicated as neurotoxic for patients with neurological conditions such as multiple sclerosis.

  A recent study looked at the effects of these sweeteners on the DNA, teratogenicity (causes cancer), toxicity, and effects on blood sugar and insulin levels. Studies have also looked at childhood development, growth, and intellect.

Aspartame (Nutrasweet, Equal)has been considered safe below 50mg/kg/day by the FDA (40mg in Europe) With lower than that dose, there is no effect on pregnancy, blood sugar or insulin levels. However, individual sensitivities can vary widely. Controversy is plentiful on the internet with one group debunking Snopes for their claim that there is nothing toxic about aspartame below an acceptable dose per day.

  Aspartame is made from aspartic acid and phenylalanine, both amino acids, and one of the breakdown products is methanol, which is toxic. It is all about dosage. There is a disease called phenylketonuria, a rare genetic disease.  These patients can’t metabolize phenyalanine and should avoid aspartame.

  The FDA regulates sweeteners, and allows 50mg/kg, which equates to 3750 mg per day and most people can’t reach that limit. This would require a person to drink 19 cans of diet soda or use 107 packets of Nutrasweet or Equal per day. There is, however, one study that reports a slight increase in risk of developing leukemia, lymphoma, and multiple myeloma in men not women. Yet, the FDA still concludes that it is safe below 50mg/kg/day.

  For people concerned with this substance, please read food labels, as many foods contain some aspartame.

Sucralose is an artificial sweetener which is used in Stevia. It cannot be absorbed by the gut and the bacteria in our intestines metabolize it. So, it is apparently safe.

  In other words, it is normally hard to take in enough of these sweeteners to be toxic. However, long term studies are lacking.

What is the value of substituting these sweeteners for sugar in soft drinks….about 150 calories/day?

The sad news is the consumption of these sweeteners is associated with obesity. It may give those who fight their weight a reason to rationalize eating other high caloric foods. However, there also are studies that show that artificial sweeteners do help some in losing weight and do not promote weight gain if the patient is on a strict low calorie diet.

 

5. Heart Valve Disease-Part 1-Diagnosis

3 million Americans are diagnosed with heart valve disease yearly.

1. Anatomy and physiology- There are 4 heart valves--tricuspid, pulmonary, mitral, and aortic.

Blood flows through the heartnormally in one direction,only because the valves close to prevent reverse flow. The deoxygenated blood enters the heart from the major veins and flows into the right atrium, which contracts and pushes the blood through the 3-leaflet tricuspid valve into the right ventricle. The right ventricle contracts and squeezes the blood through the pulmonary valve into the pulmonary vein to the lungs for oxygenation. The blood flows out of the pulmonary artery into the left atrium and proceedsthrough the mitral valve into the left ventricle, which contracts and sends blood out of the heart through the aortic valve into the aorta and into the arteries of the body. The coordination of the chambers relaxing and contracting requires the valves to open and close at the correct time. Irregular heartbeats (arrhythmias) can interfere with this flow coordination.

  These are one-way valves (unless damaged or deformed) to keep the blood flowing in one direction.

 For more in-depth information on heart and valve function, go the American Heart Association’s website.

2.Diseases of the valves

A. Congenital—genetic defects usually involving the pulmonary and the aortic valves

B. Stenosis-the leaflets of the valve can be fused or stiff causing narrowing

C. Insufficiency(leaky)-the leaflets do not close tightly enough and therefore blood can leak backwards. It is also called regurgitation.

D. Prolapse of the mitral valve—the mitral valve flops back into the left atrium occurring in 1-2% of adults not usually needing treatment.

E. Acquired infections—rheumatic fever (strept) and endocarditis

F. Other causes include syphilis, coronary artery disease, heart attack, cardiomyopathy, hypertension, tumors, drugs, and radiation. Normal aortic and tricuspid valves below

 

Normal Valves

Aortic valve

Tricuspid valve

 

Abnormal valves

 

 

Bicuspid aortic valve (instead Of 3 leaflets) with calcification

Deformed and calcified Mitral valve

 

Normal aortic valve comparison with a stenotic valve

3.Symptoms of valvular heart disease

  Shortness of breath, weakness or dizziness, chest discomfort, palpitations (rapid pulse, irregular heartbeat), swelling in the legs and ankles, or abdomen. Rapid weight gain from fluid accumulation in the body can also occur as the heart fails.

4. Diagnosis

  --Auscultation-Listening to the heart with a stethoscopewill illicit abnormal sounds suggestive of specific valve disease.

 --Echocardiogram

   --Cardiac catheterization (angiogram)

   --Heart scans, and MRIs all can be used to determine the magnitude and effect of the abnormal valve(s)

5.New guidelines for management of heart valve disease from the American Heart Association and the American College of Cardiology:

3 goals for management:

A. Prevent endocarditis—any abnormal valve is more prone to infection of the valve(s).

a-- At the first sign of an infection, antibiotics may be prescribed to prevent bacteria from getting into the blood stream and collecting on a heart valve.

b-- Dental checkups, compulsive dental cleaning, and flossing can prevent bacteria from getting into the blood stream. Dental and gum disease is a common source of bacteria getting into the blood.

c-- Prophylactic antibiotics before any dental or surgical procedure is recommended to prevent valvular infections endocarditis.  

   B. Medications recommended

a-- Diuretics (water pills)

  b--Anti-arrhythmic drugs—to control the heart rhythm

c—Vasodilators—to help the heart function better and assist with proper flow of blood through the heart.

 d-- ACE-inhibitors—to manage hypertension and make the heart function better (as in heart failure)

   e-- Beta Blockers—another class of anti-hypertensives that helps valve disease

    f--Anticoagulants to thin the blood to prevent blood clots from forming on the valvesis recommended especially if atrial fibrillation is also present.

C. Surgery of the heart valve(s)- open vs closed procedures will be covered next month.

 

 

6. Human Abuse Series—Part 3—Child Abuse

A.A recent study reported that children who are abused carry that trauma into mid-life (ages 23-50) and is linked to poor socioeconomic outcomes. It is worse for those who experience multiple types of abuse. This study in the UK involved over 8,000 participants. 21% reported a single form of abuse while 10% had two or more types.

 

B. Types of abuse

They include neglect, sexual abuse (1%), physical abuse (6%), witnessing abuse (16%), and psychological abuse (10%.  

Belt bruises

Hand slap

 

Buttock burns from being held down on hot cement (below)

C.Signs and symptoms of physical child abuse-clues:

1- injury pattern in the child not consistent with history given by parents

2- multiple injuries

3- injuries at various stages of healing

4- classic patterns of abuse marks-loop marks, retinal hemorrhage, skull fracture with subdural hematoma

5- brusing over boney prominences, ears, face, buttocks, palms or soles

6- skeletal injuries with dislocated joints or classic fractures. Xrays will show old fractures.

7- classic burn patterns (cigarette burn, genitalia, buttocks

8- poor hygeine

9- choke injuries

  The National Center for Child Abuse estimates that 37% of abuse victims will develp disabilities and or special needs!

D.Why do caregivers abuse children?

  Caregiver often have anger,discipline issues, and psycholgical impairment. They act out because of frustration from it. There may be substance abuse issues in caregivers, and come from families with superimposed domestic abuse. Special needs children are a major target.

Parents who believe in corporal punishment are at higher risk to abuse their children. Many of these parents are using the child as an outlet for frustration, anger, etc. 90% of parents report some degree of spanking, but the extent of this form of punishment is the question to answer.Discipline is an integral part of child-rearing, however, the line between legitimate discipline and abuse must be defined and is often based on culture, race, and socioeconomic factors. Alternative forms of discipline are preferred. A parent must figure out what is most effective for each chikd based on multiple factors.

E.The shaking-impact syndrome

  Shaking a child can have many results including retinal hemorrhage, head trauma with subdural hematoma, and skeletal fractures. Slamming against a wall is possible and should be considered.

F. Consequences of abuse as an adult

  These victims tend to have an extended time off from work because of prolonged sicknesses; smaller chance of owning a home; neglect influences the cognitive abilities and psychological profile of these patients but not in the other groups. Intervention is recommended if cognitive issues are present with neglected children (as early as possible).

  Emotional abuse (more than physical) in children leads to migraine headaches as adults. One study cited 2/3rds of these patients who develop migraines also have depression and anxiety. Migraines increase with multiple types of abuse. 18% of the participants in this study had migraines and 73% were female. 

  Post traumatic stress syndrome must be looked for in these patients.

  Cognitive behavioral therapy should be offered in patients with all forms of abuse. Conversely, primary care doctors need to think of possible abuse in young adults who present with migraine, depression, anxiety, etc.These children grow up with 4-12 fold higher rates of alcoholism, substance abuse, depression, and suicide.

  Rates of smoking, STDs, and poor health is 2-4 fold higher.

  Physical inactivity and obesity is 1.5 fold higher.

G.Child Protective Services report 3.3 million formal reports in 2009. Over 2500 children died because of abuse.

Ages from 4-7 have the highest rates of abuse (4.6 cases per thousand-23.4% of the total number of cases).

  Careful evaluation is necessary along with an index of suspicion to accomplish a diagnosis of child abuse. Child Protective Services is responsible for the investigation and follow through.

  If parents accididentally injure a child, they must assess their methods, their own demons, and change behavior with psychological counseling before it is too late.

Medscape

7. The potential advantages of a single payer system

Since the Republican alternative to Obamacare could come to a vote, we are stuck with the status quo, and personally I think that is the way the conservatives should have handled, but with campaign promises and the need for reform, it was their thinking that to get meaningful tax reform, they needed the savings on healthcare. Therefore, ii is my opinion, we are one step closer to a single payer system unless there can be an agreement on major overhauling of Obamacare.

  Last month, we looked at the negative effects on our healthcare system if a federal socialized system were put into place. This month, it is fair to look at the positive aspects of a single payer healthcare system.

There are many organized medical groups that are supporting this kind of system including hospitals, because with a single payer system, they see the small reimbursement for all patients outweighing the millions that won’t sign up for healthcare with the current system or even a reformed one, and it is this group that has to be cared for without payment.

Every developed country in the world has some form of socialized medicine, but their tax rates are extremely high to finance them, and with the refugee immigration issue, it will put a huge burden on their systems. Univeral healthcare was begun in Germany in 1883.

This system requires:

1) A strong well-run healthcare system with no financial burden on the recipients. This includes vision, dental care, long term care with open choice for the site of care. In England, hospitals, nursing homes, pharmacies, and medical device companies are owned by the government.

2) A system for financing the program (healthcare in the U.S. consumes one fifth of the GDP). Taxes will be hiked on taxpayers (that leaves out the poor having to pay).

3) Access to prescription medicines without cost and research to further medical advances.

4) A workforce of medical professionals motivated and well-trained, who will be paid substantially less than American doctors.

The pros of the system:

1)The overutilization of this type of system is supposed to be balanced with less administrative costs.

2) Equal access to the system for all recipients without discrimination.

3) Improves pubic health since all are covered.

4) Less paperwork for medical professionals (the electronic medical record has consumed doctor’s time and will not change).

5) It will stop medical bankruptcies.

6) Self-employment could rise 2-3.5% because of not needing coverage.

7) Businesses will no longer have to provide healthcare for their employees.

8) It will boost economy because people will be healthier. (?)

9) Boosts human rights since healthcare will be deemed a right. (That is a huge debatable issue)

  So there it is!! Last month was the cons, and now I have reported on the pros.

  There are many internet sites that discuss the pros and cons. They all site the same points.  I took these bullet points from www.formosapost.com

 

8. A Quick Note Series-Should women have a routine pelvic exam when undergoing a cancer screening test (Pap smear/HPV)

There is breaking medical news constantly, and it is quite difficult to stay up with just one specialty, much less all fields. This series will focus on some of these items each month and will be a short. Here is a good example below.

Several studies have confirmed that there is little benefit in having a routine screening pelvic exam at the time a woman is having a Pap smear/HPV test. If there are symptoms in the pelvis, however, an exam is certainly indicated. The American Academy of Family Practice and the American College of Physicians do not recommend routine exams now.

  In contrast, routine Pap smears are, however, very important, and guidelines are available from the CDC, the American Cancer Society, OB/Gyn organizations, etc. Taken from my # 60 Medical News Report:

It is felt by some primary care organizations that feeling abnormaities in the pelvis with a bimanual exam does not yield many abnormalities especially if the woman is large.An ultrasound can easily be ordered if there are concerns in the pelvis.

  The American College of Obstetrics and Gynecology, however, still recommends that a pelvic exam be routinely performed. There are 3 parts to the exam:

1. Direct inspection of the external genitalia, urethral opening, and anal area.

2. Speculum examination of the vagina and cervix.

3. Bimanual exam (hand pressing on the lower abdomen and vaginal manual exam) to palpate for abnormalities of the uterus and areas on each side of the uterus (where the ovaries are). A rectal exam to discover cancers and other abnomalities can be included. Fibroids and ovarian enlargement can be felt with a bimanual exam.

4. Pap smear and HPV testing.

  Of course, it is up to a woman and their doctor, but it is no surprise that OB/Gyn specialists still recommend it, because they are much more expert with pelvic exams.

 

  This completes the April, 2017 Medical News Reort.

  Next month, the subjects will be:

1. Surgical treatment of heart valve disease

2. Herbs and dietary supplements

3. Drug interactions; the problem of patients taking their medicines as prescribed

4. Human abuse-Part 4-Sexual abuse

5. The controversy over vaccines

6. Cancer survivorship-side effects of treatment

7. A “Quick Note” Series-The benefits and risks of Coffee and Tea

Stay healthy and well, my friends, Dr. Sam