Doctors do make ‘educated guesses’ when it comes to prescribing. Experience and prevailing wisdom along with what has worked in past come into play. What if a simple blood test could help in some of these situations? Commonly when we become ill, let’s say sore throat, cough, running nose maybe fever, many of us think did I catch a virus, or perhaps do I need antibiotics? Remember: Antibiotics (Abx) only work when an infection is caused by bacteria. For the sake of accuracy, there are many other possible causes. It could be an allergy reaction environmental, or a hereditary illness showing up. Mostly and most commonly these symptoms are from an infectious condition. Even if that is simple to determine, the healthcare provider is often in a clinical dilemma, using their best-educated guess as to whether the symptoms are caused by a bacterial or viral infection. It’s not always as clear as oh, it’s a bacterial infection, ‘oh, it’s a virus’.
Many times they are clinically indistinguishable. You might think well it’s an infection that’s all you need to know but the question of whether or not to treat it with antibiotics versus antivirals is important. I’m sure by now you know about the overuse of antibiotics in the United States and the creation of bacteria resistance to these antibiotics. Often the decision is educated, guessing whether or not to give antibiotics or antivirals.
Presently a new FDA-approved test is available to help. LIAISON® MeMed BV® analyzes three host immune proteins – TRAIL, IP-10, and CRP in our blood when we are infected and can identify if the illness is from a bacteria or virus. This would make the determination of what to prescribe less of an educated guess, yes, and make life so much easier for us physicians.
How does the test work? Our body makes proteins in response to acute infection, this is the immune response so by measurement of the presence and levels of the three proteins a differentiation can occur. Levels decide a bacterial or viral infection. Machine learning generates a score determining the likelihood of a bacterial immune response vs. a viral immune response. The test is carried out using the established credible technique of chemiluminescence immunoassay (CLIA).
The test takes about 15 minutes and is already used in ERs across US, inc. Tucson, AZ, and Tulsa, OK. There are so many medical settings where this can be helpful.
As you can imagine, this will cut down on antibiotics being overprescribed and also unneeded hospitalization which both translates to better care.
A cost-effectiveness study in Europe, Israel, and the US of 20,000 patients shows a saving of $223- $809 for healthcare providers. This was excluding test cost which is covered by insurance.
Ask next time you are in a medical setting if this test is available.
Make this one of your top resolution for 2023! Bone Health is up to you! It makes sense, given that 20 percent of American women ages 50 and older have osteoporosis and that more than another 50% have detectable bone loss (osteopenia). For men, the respective figures are lower: 4 percent and a third. Worldwide, one out of three women over the age of 50 and one out of five older men will develop a fracture from poor bone strength (osteoporosis) — a hip, a wrist, a vertebra, or two.
Several study results on nutrition and bone health have been wildly inconsistent.
Fact: bone is constantly changing, remodeling, and reshaping hence our gut must absorb the needed building nutrients.
Calcium, Vitamin D as well as boron, and Vitamin K2 have been identified as important.
Do we get enough calcium and vitamin D in our diets?
Today more than a third of American adults ages 60 and older pop supplements
Surprisingly, a study published this summer in the New England Journal of Medicine, found after five years adults having the correct level of vitamin D did not improve bone density, or for that matter decrease the risk of cancer or heart.
Individuals in the study did not have osteoporosis to start with, so the question remains do adults with osteoporosis need more Vitamin D and calcium or for that matter supplements
Break out the tofu and sardines!
Calcium recommendations are age dependent. Sadly federal surveys show only 61 percent of Americans and about half of the children meet these recommendations.
So for me to get the needed 1200mg of Calcium daily I must have three cups of plain yogurt or nearly nine cups of cottage cheese a day, I miss it! Supplements are often needed. It is always best to get nutrition from food rather than from pills because so many other wonderful things come along with it.
Other things in our diet like coffee for example affect bone health. If you have over 6 cups a day you actually will cause bone loss. Excess alcohol is not good because it does not allow vitamin D to work.
It is a MYTH that sparkling water affects bone health. However, soda pop may affect bone growth.
I don’t want to close without mentioning exercise, along with nutrition for bone health. Exercise is important because muscle action on bone helps mold, form, and reshape our bones. Because your body weight is supported by bones, simple walking helps. Studies say daily at least 4,000 steps for those over 70 or 10,000 if you are younger. Running, up and down steps, are also helpful for good bone health.
If supplements are recommended (I use them) please recall not all are helpful. In the past, I have mentioned Consumer Lab as a reliable tested site for OTC supplements. Please reread the blog.
To a health 2023!
By the year 2023, the number of individuals with pacemakers and defibrillators is expected to increase to 1.43 million units worldwide.
So do these patients or for that matter, any of us need to be concerned about the potentially dangerous effects of portable electronic devices (PEDs)? Although implanted, the pacemaker and defibrillator are PEDs. You do know PEDs depend on electromagnetic fields. Magnets can inhibit the pulse generators of these devices. The human body is alive with electromagnetic fields, most obviously, generated by our nervous system! That’s why a medical MRI scan can give you a metallic taste and even nausea and make you dizzy – but it is only short-lived.
Maybe you already keep PEDs away from vital organs, your brain, and gonads but what if you have a life-saving medical device planted under your skin (commonly in the chest area)? You have noticed how close proximity of PEDs to each other can causes problems and you are instructed to move further away from the ‘interference’?
Many medical devices especially implanted ones have magnetic activities. Interference, therefore, is possible. Cardiac implantable electronic devices (CIEDs), such as implantable cardioverter defibrillators (ICDs) can suspend rapid heartbeats (tachycardia) and/or cardiovert-defibrillate a failing heart. Another implanted device can pace a heart that no longer can pace itself (asynchronous pacemakers).
In a medical setting, a special magnet is placed over the chest to place the implanted devices in the Magnet mode. In this mode, the device’s operation is interfered with hence it can be tested and/or set then returned when the magnet is removed to standardized mode.
Therefore care must be taken, with the use of any PED, not to ever place them near implanted devices as they can cause interference.
Swiss investigators, to learn more about PEDs and implanted medical device safety, studied the Apple AirPods Pro and their wireless charging case, the Microsoft Surface Pen, the Apple Pencil 2nd generation, and iPhone 12 Pro Max. They compared the field strength of these PEDs around implanted medical devices. This study used 3D mapping, a more realistic and accurate method than the one-axis mapping that the FDA uses to test in this area. The results were quite interesting. For example, case open vs. case closed for the Air Pods Pro had different safe distances. It was noted that the proximity of an 8 mm difference of magnetic field effect depends if the AirPodsPros case was open or closed – a safer distance if open!
The location of each PED’s strongest magnetic field and 3D mapping of its distance to affect a medical device were measured.
Magnet reversion mode was triggered at a distance between 8 mm (.315 inches) and 18 mm ( .708 inches) for the tested devices. Pretty close I’d say! The NIH & FDA state ‘To be safe, keep your PEDs at least 6 inches away..” from implanted medical devices
Note: Electronic cigarettes are also a culprit in the malfunctioning of medically implanted devices. Vape pens contain magnetic components used in charging and can interfere with the magnetic features of certain medical devices, including pacemakers. There have been reported cases of this interference. Hence, the global statement, keep electronic magnetic devices like vape pens, at least 6 inches from where the implant lies.
America spends over $3.8 trillion a year on healthcare (2019)—and more per capita than any other country in the world, despite that our life expectancy is 76.1 years at birth – the lowest level since 1996. BTW South Korea boosts 83.5! So you will not be surprised as you read on – more spending!
Amazon Has A Plan For Your Healthcare
Amazon continues inroads in healthcare delivery with a stated objective to make medical care more affordable. It had launched and closed down recently a healthcare project targeting corporations (in 2021, after 3 years). So now they will go directly to patients, not insurance billing. You pick from a list of conditions and then choose from a list of providers. As expected there is a questionnaire to complete. You will use a non-video message-based portal to contact a licensed physician for consultation. Encounters may even end in prescriptions!
So they present this as a healthcare store allowing customers to hook up with someone in a telehealth network. The cost starts at $30.00. Again convenience and accessibility are what is being ‘sold’. At this time, Amazon has not given specifics about the medical providers they will use, however it is well known that Amazon has an existing relationship with Teladoc©, the biggest virtual care company in the U.S. Even Alexa™ has Teledoc integrated!
Another New Healthcare Trend
Elsewhere, the Cleveland Clinic says it will start to charge as much as $50.00 for messages in ‘My Chart‘™. patient portals when a message requires physician time and opinion. Up to now, this has been a free interaction. Relax, as refills requests, making appointments, and informing your physician of a healthcare update are still gratis. But you will see a bill if there is a medication change needed or forms to be completed. Note the fine print in your plan, some healthcare plans do not cover messaging. Cleveland Clinic plans to bill insurance companies for any interaction requiring five or more minutes of the medical provider’s time. Medicare patients with secondary insurance will not have co-pays, but some Medicare beneficiaries may see a $3 to $8 fee. Some privately insured patients will not have a copay, but if they have a deductible or their plan doesn’t cover messaging, bills might be $33 to $50 per message.
Thankfully patient portals have circumvented the Health Insurance Portability and Accountability Act of 1996 aka HIPAA concerns. You may recall one of the many papers you sign anytime you receive any healthcare. This law exists to ensure patient information privacy.
Well, it was great while it lasted but now everyone wants in!
Alzheimer’s is a neurodegenerative disease that affects approximately 6.5 million Americans who happened to be over 65 years. Senility is sometimes used by the uninformed. Sadly, the number just continues to grow. This makes me wonder if there is something in our lifestyle or environment that accumulates and contributes to such a high number. Basically, one in nine people over 65 are living with Alzheimer’s (2022 report from the Alzheimer’s Association). Seems with increasing age the numbers do increase. As women, on average, live longer than men, there are now, more women approximately 4 million in 2022 living with Alzheimer’s.
With the stresses on the healthcare system and caregivers during COVID, those living with Alzheimer’s had an increased mortality rate of 17%. That translates to an increase of 44,700 deaths.
Actually, the numbers aren’t projected down. By 2050, unless there is a tremendous medical breakthrough, think either a preventive or slowing measure, or outright reversal innovation, 12.7 million Americans will suffer from Alzheimer’s disease.
2050 is only 27 years away!
Bad news for all of us using artificial sweeteners to try and keep the pounds off. Artificial sweeteners are present in thousands of food and beverage brands worldwide, however, they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, and the World Health Organization. FDA states ” Based on the available scientific evidence, the agency has concluded that the high-intensity sweeteners approved by FDA are safe for the general population under certain conditions of use.” But they do not go on to specify ‘certain conditions of use. “For each of these sweeteners, FDA determined that the estimated daily intake even for a high consumer of the substance would not exceed the acceptable daily intake (ADI). Generally, an additive does not present safety concerns if the estimated daily intake is less than the ADI. That word ‘generally’ to me is worrisome. Same as used in regards GMO foods.
There have been many investigational experiments both in the laboratory and prospective observed patient on studies so I’m even human randomized controlled studies to investigate early markers of cardiovascular health for example wade hypertension inflation gut microbes but many also in association with using artificial sweeteners or artificial sweetener beverages most of these studies have suggested adverse effects. Artificial sweeteners are not good for cardiovascular or cerebrovascular health. The leading cause of death worldwide is cardiovascular disease. And this study below in-depth should put to rest the controversies. Now if only the FDA and world health in the EU food safety authority will take a position to caution the public on the use of these high sugar additives.
The WHO 2022 report on the health effects of artificial sweeteners observed ” an association between consumption of beverages with artificial sweeteners (used as a proxy) and some intermediate markers of CVD, including a modest increase in the unfavourable total cholesterol to HDL cholesterol ratio (meta-analysis of four randomized control trials), and an increased risk of hypertension (meta-analysis of four prospective studies)”.
In a prospective study, carried out in France, the records of 100,000 people focused on diet and activity and do use of artificial sweeteners. The British Medical Journal looked at dietary artificial sweeteners to see if it was a risk factor for cardiovascular diseases (heart and brain). Artificial sweeteners they included were: aspartame (NutraSweet™, Equal®, and in UK Canderel®), acesulfame potassium (Ace K trade names Sunett and Sweet in EU), and sucralose (aka Splenda®). Analyzing 900,000 person-years of data (2009-2021) revealed a distinct association between the two. Researchers actually took food additive composition data and matched with consumption date to account for possible industrial reformulations and changes in the additive composition. The mg/day for each participant was measured. The patient population included diverse breakdown however none were obese average BMI was 23.6. Varying cholesterol and glucose levels, hypertension, education level, also smokers and non-smokers were included.
Noteworthy is that the risk was greater for cerebral vascular disease (brain vessel disease). Further, the study found that not all artificial sweeteners were equally harmful, that specifically, aspartame use increased the likelihood of cerebral vascular events (ex. strokes, TIAs). Acesulfame K and sucralose were associated with increased coronary heart disease risk.
FYI: there are other sugar substitutes that are not in the high-intensity sugar substitutes. They are ‘sugar alcohols’ and include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol. The sweetness of sugar alcohol varies greatly but they are low in calories and do not cause your teeth to rot, or pounds to be upped, and blood sugar rush. Look for them to be in sugar-free candies, cookies, and chewing gums.
What follows in this blog is a few medical Journal reveals I want to share with my followers. Hope you find them as interesting as I did.
AI & ECG Interpretation
At the European Society of Cardiology (ESC), in Barcelona last week, a randomized clinical trial of artificial intelligence (AI) presented that technology was superior -yes, better than humans at interpreting echocardiograms. Quite a bit to ponder! In the field of Dermatology, a recently reported study showed the accuracy of AI versus clinical specialists. AI matched or exceeded the practitioners!
AI & Arrhythmias
In Germany, smartphone-based screening for atrial fibrillation more than doubled the rate of finding the diagnosis when compared to waiting for routine medical care to find this heart rhythm problem. The eBRAVE-AF randomized trial was announced in the publication in Nature Medicine.
A few cups of tea a day might help stave off an early death, a U.K. Biobank prospective cohort study showed. Among nearly half a million middle-aged adults, those who consumed two or more cups of tea a day saw a slight but worthy lower risk for all-cause death. The follow-up was for about 11.2-year (median). No, it was not green tea which has been very studied. Individuals, 90% of them drank black tea. Importantly data was corrected (adjusted) for sociodemographic and lifestyle factors. This is important across any large studies.
Those that were drinking more than two cups of black tea a day, had an associated 14% to 24% decrease in risk for death from cardiovascular diseases. Another revelation was that among the heaviest black tea drinkers there was the most risk reductions.
When someone says heart attack you think of a dramatic pain that could possibly quickly end your life. However, the reality is twenty percent (American Heart Association 2022 data) of heart attacks are silent: there is no dramatic pain. The popularized notion of a load of bricks sitting on your chest does not always occur. Some experts expand that to fifty percent being silent heart attacks.
A Heart Attack occurs when heart muscle blood supply, bringing nutrients and oxygen, is decreased or stopped. You feel pain because of a blockage, partial or complete. Commonly silent heart attacks are written off as indigestion, sprain in the chest muscle, being tired, or just being run down. In retrospect, when you later recognized you’ve had an attack, you recall an experience such as shortness of breath and general discomfort which led to a night of poor sleep.
Often the most subtle body sensations are: not feeling quite yourself, suddenly sweating, becoming dizzy, and angina (pain from a decrease of blood to the heart muscle). For women the sensation of having a tight bra might be the only hint they’re having angina or heart attack. If these symptoms persist, they can lead to a heart attack. Angina may be reversible but the longer the lack of good blood supply, hence lower oxygen to the heart muscle, the more likely irreversible damage will kill heart muscle – that is a myocardial infarction- MI.
If you’re diabetic, recognizing your heart is talking to you may more easily be missed due to pain signals being dampened by neuropathy. Hence a diabetic person is at a greater risk for a silent heart attack.
Those with minimal symptoms, that is no warning sign, are often fooled or are misdiagnosed. The shortness of breath in a slightly obese woman is thought to be a blood clot coming from the leg to the lung or pain in the arm or shoulder is thought to be arthritis but in reality, could be a heart event. One helpful thing is that if your pain does not change with position or taking deep breaths then it is not musculoskeletal, and could be related to your heart. If you’re exerting yourself and your pain gets worse that would mean you’re not getting enough oxygen and the discomfort is related to your heart. If you feel better at rest when the need for oxygen to your heart muscle is less -then your symptoms could be related to the heart.
Past blogs discussed heart disease risk factors. Refresher – women 55 and older, men 45 and older, carrying excess weight, high blood pressure, high cholesterol, lack of exercise, positive heart history, smoker, family history, and of course Diabetes. You do not need to have a specific number to increase risk. Yes, there are young people with heart attacks because they use drugs or have a hereditary or congenital problem.
Not surprising if you have had a silent heart attack you are more likely to have a stroke, sudden death, or obviously another heart attack. Whenever a heart is stressed there is an increased risk for the heart to start beating in an irregular manner (arrhythmia) and cause blood clots to form.
Message – Pay Attention to changes in the patterns in your body. My mantra, you all know, if your body talks to you it’s important to listen. Pay attention to discomforts. their patterns, and predictability like with exertion. Note especially symptoms such as shortness of breath, weakness, fatigue, not quite feeling right, sweating, nausea, vomiting, lightheadedness, dizziness, pain in the back, arms like a sprain or pulled muscle, mild throat pain or chest discomfort,
Please consider the possibility that you are having a cardiac event. Remember they don’t have to be dramatic. Not everyone has the sensation of impending doom when they are having a heart attack. Not everyone clutches their chest like on the big screen!