Interns- Should You Beware on July 1st?

Interns - Should You Beware on July 1st? Every July new medical school graduates appear as interns on the floors of hospitals and clinics throughout the US. Interns are considered physicians in training and cannot practice medicine without supervision. Many have had undergraduate training out of the country. I wanted to share, at this time of year, a bit about changes at your local hospital that you must be aware of. No matter in July you are either already in hospital or about to be admitted into.

This sets up a challenging time for patients, as well as for the new interns. The senior residents are gone and maybe last year’s interns stayed on to become residents in the same program. Rotation also occurs with supervisors that are the ‘attending’. I mention this as they are responsible for your care. Their name is probably on your wristband.

The concern is how the hospital and medical training programs ensure continuity of care. This can be critical to your medical care if you happened to be in a hospital in early July.

The most competitive fields, including family medicine residency, psychiatry, internal medicine residency, anesthesiology, and pediatrics, see more than 70 applications from one candidate.  In 2020 the American Academy of Family Physicians (AAFP) said the most people ever matched to family practice residency. They offered 4935 positions they matched  4470 with medical student graduates, of which 1555 are from US medical schools 1496 were from osteopathic medical schools. 779 matched were US citizens who graduated from international medical schools, and 458 places went to foreign-born international medical graduates. To put in perspective family medicine represents only 12.2% of all US medical graduates that matched in the 2022 programs.

Background:

IMGs -International medical graduates are either US IMGs or Non-US. IMGs can apply to US internships.  US IMGs are citizens of the United States who graduated from international medical schools, while Non-US IMGs are not US citizens who graduated from international med schools. if you are a US citizen educated in one of the Caribbean medical schools, for example, you are a US IMG. There is fierce competition. Recently US IMGs matched at an approximate 59.5% rate while non-US IMGs matched at a rate of 54.8%.   

FYI: recall interns are considered physicians in training and cannot practice medicine without supervision. The average medical intern salary is $65,000. – $30.74/hr. Extremes occur in Alabama pays $45,00 while Vermont ($86,435) and Washington state ($81,700) are highest

PLEASE It is your health so do not be afraid to ask questions, especially for clarification. You have a right to ask to speak to the attending physician.

Break In Routine IS Healthy

Break In Routine IS Healthy

Westport Cloonmonad Co. Mayo Ireland

It was a wonderful vacation, as I imagine anyone who has finally mentally and physically left the COVID safe ‘coup’. However, this is not what my returning blog is about.

NOW TO THE OFFICIAL BLOG!

Invisible Wave

It’s here again, cause it never left. The COVID-19 ‘numbers’ are up but what are the real numbers? Everyone has viral antigen tests at home and if they feel not so bad and test positive they just go to ‘ground’ till they stop shedding (spreading) viruses by testing negative. At least I hope they do. Truly presently we really do not know how many active cases there are in the US. The most reliable indicator is the number of hospitalizations I think broadcasting test positive numbers needs to stop, it’s a waste, it’s a waste of resources money, and talent as well as an artificial and misleading headline.

Yes, new SARS-CoV-2 sub-variants BA4-BA.5 are guilty, but so is nice weather going outdoors, meetings, and gatherings. Recall this virus can spread even outdoors but to a LESSER EXTENT. It is naive to think one is ‘safe’ from infection if outdoors.

Remember the whole logic of quarantining, especially in China, is because the hospitals can easily become overwhelmed by a sudden massive number of ill people. Please let this concept sink in, it is the only rationale for ‘lock-down’. 

No matter what potential pathogens are endemic, pandemic, or epidemic, those of us with underlying conditions, poor immunity, and hence considered high risk should always be extra careful. This means avoiding exposure to ill individuals, social distancing, hand washing, and wearing a mask.

Yes, I know about monkeypox as the latest health concern, but honestly, gun issues are so much more concerning! If we all were to use basic common sense strategies when it comes to our health, I believe we can be safe from monkeypox.

Avocado To The Rescue

It’s long been known that the Mediterranean diet, fiber, a modest amount of wine preferably red, and exercise can help to reduce the risk of a heart attack. There are many actions we can take to insure a healthy heart. After all Cardiovascular disease is the leading killer worldwide. 18 million people die every year according to the World Health Organization (WHO), and in the US alone the quote from the CDC is that heart disease takes a life every 36 seconds. Research now has suggested another helpful dietary consideration for us. Recent study strongly shows that both men and women eating avocados, will have a heart disease reduction of up to 21%

This study published in the Journal of the American Heart Association (JAHA) revealed that eating two servings of avocados  makes the difference. A serving of an avocado is defined as half an avocado or half a cup of avocado roughly 80 grams. This amount was used  in this Harvard School of Public Health study. American Heart Association (AHA) publishes suggestions as to a heart healthy diet. Perhaps now they wanted to add to the famous Mediterranean diet that’s rich in vegetables and fruits -avocados? Don’t forget the olive oil.Avocado To The Rescue

The study was formidable. It followed over 108,000 people, including 68,000 women. Government studies have used data from the healthcare profession,  famously called the Nurses Health Study and the Health Professionals Follow Up Study. These offer ongoing data from decades. Participants completed a dietary questionnaire every 4 years for 30 years. Be sure, before starting, all were screened to make sure they did not have cancer, stroke, or any signs of heart disease.

Findings

Consuming two servings a week (serving -avocado a quarter a cup ) instead of the eggs, yogurt cheese, butter, processed meats, and bacon actually lowered the risk of heart attacks by 16 to 22%. However incidence of stroke were not decreased. Important point is that you’re swapping out offenders for avocado in your diet. Interestingly noted, if instead of pricy avocado an equivalent of olive oil or any other plants or even nuts was eaten –  the same findings were noted.

Considerations

Can’t get good avocados or they’re too expensive think walnuts or almonds substitute. It is very easy to spread any sandwich, especially ones with high cholesterol with some avocado instead of butter or margarine or processed meat or cheese. Avocados are particularly rich in polyunsaturated fat and fiber and also contain monounsaturated fat. The same is also found in olives, olive oil, almonds and a variety of seeds such as flax and pumpkin. There are other things with lower price points than avocado such as beans, chickpeas, lentils, and quinoa which are enjoying popularity in salads.

Avocados had the lowest levels of pesticides among the 46 foods recently tested, followed by sweet corn, pineapple, onions and papaya. Issued yearly since 2004, the EWG  report uses US Department of Agriculture (USDA) test data to rank 46 foods that are the most and least contaminated with pesticide residues. The USDA staffers prepare the food as consumers would — washing, peeling or scrubbing — before testing each item.

You are thinking avocados have fat, but our body does need some fats, so it is not totally wrong to have some sources of mono & polyunsaturated fats. These are and can be healthy choices. It’s the saturated fats and trans fats that raise LDL or commonly referred to as the ‘bad cholesterol. Recall saturated fats are found in butter eggs, coconut, palm oil, and of course fatty cuts of pork and beef cuts and don’t forget the skin on chicken. Please don’t think if you burn the skin of the chicken on the grill and eat that it’s OK. Proteins that are burnt black are carcinogenic. Carbohydrate that is charred, think bread, acts as charcoal and can absorb toxins in the gut.

Use the above information to help your heart and that of your loved ones. Spread the word and avocado!

Travel Safe

Travel Safe Don’t let the last two years of viral pandemics deter you from enjoying life. For many, travel is one of the real joys of life. If you are like most of us you are planning a trip very soon. We are all ready to get back to the ‘old normal’ and abandon the ‘new normal’. I am not suggesting that the coast is totally clear nor that the authorities of healthcare have given the all-clear signal. There are still outbreaks in many countries of the Omicron sub-variant B.2. The UK just reported last week a daily average of 75,100 new cases. The dominant culprit there is the sub-variant B.2. This is a concern, but as yet we have not seen dramatic outbreaks in the United States, and we may not in the future. This variant appears not to cause severe illnesses, witnessed by the fact there has been no increase in deaths where there are outbreaks. Many are vaccinated and some are still wearing masks but I really think we’re on the downhill of this pandemic. I feel this so strongly, I will be traveling the day this is posted and will be crossing the pond to Europ.

Before we get to personal particulars, we need to consider if you are in the group recommended to have a 2nd booster. On March 29, 2022, the CDC made recommendations, following the FDA, for a second booster vaccine. In summary, certain immunocompromised individuals and people over the age of 50 who received an initial booster dose at least 4 months ago are eligible for another mRNA booster to increase their protection against severe disease from COVID-19. At this time, not much hard data for the merit of this exists. A study from Israel was just published in NEJM. This large study (1.2 million adults over 60) showed a second booster( fourth shot of Pfizer mRNA vaccine) provides short-term protection and a modest absolute benefit. Those who received a second booster were 78 percent less likely to die of Covid-19 than those who had received just one booster shot. Protection against infection appeared to peak four weeks after the second booster and by week 8, protection disappeared. Again this is an ongoing study, and only short duration data is available on these older adults.

Traveling safe means pre-planning and thoughtful packing. Your customary medications must be packed, and carry two days’ worth on your person in case luggage is lost. Recent imaging studies for conditions you are recovering from should be printed and packed. Should you need a refill early for your trip, ask the pharmacy, as they usually will accommodate your need. I carry a typed one-page summary of my medical history including medications. I don’t take my insurance cards unless staying in the US. I am packing masks with me, although shortly (April 18) airplanes in the US will follow others (British Airways, Icelandair, EasyJet) dropping requirements to wear while onboard. Yes, my hand sanitizer (80% alcohol) is on my person. Yes, airplanes are cleaned after flights but I keep it handy for onboard use in the lavatory or before meals and snacks.

I am not discounting a distinct possibility that an outbreak of new variants could emerge while I am on vacation. It has happened, usually, when a large number of individuals become infected, a new or sub-variant arises. Remember Delta variant gave way to Omicron variant and Omicron to its sub-variant- B.2. You know I will be wearing a mask. I don’t count on being able to buy masks, neither should you even if you are staying in the US. A short supply of products like masks is possible. Be prepared for your safe trip.

Being Prepared you will ENJOY YOUR TRIP.

Artificial Sweeteners and Cancer – A Problem!

Artificial Sweeteners and Cancer - A Problem!Today, rather than using natural sugars, man has found so many sugar substitutes. In a recent study, adults, who were attempting to live healthy by cutting out sugars and substituting artificial sweeteners, were followed for approximately 7.8 years. They were found to have a 13% higher risk of developing cancer compared with those who did not use sweeteners. Are all sweeteners equally bad? Specifics of this study in France found aspartame and acesulfame potassium (‘Ace K’) especially were the two culprits that seemed to drive this overall cancer risk. Both are used in the US and approved by FDA with the caveat that no direct evidence has been found that they are cancer-causing.

In this study, artificial sweeteners were associated with an increase (13%) in obesity-related cancers including colorectal, stomach, liver, mouth, pharynx, larynx, esophageal, ovarian, endometrial, and prostate cancers.*

Also noted was breast cancer increase has opposite associations, pre-and post-menopause women. Aspartame especially and sadly alone was linked with a 15% higher risk for obesity-related cancers and a 22% higher risk for developing breast cancer.*

These findings are no surprise to those who have read previous research findings. We are all guilty of ingesting artificial sweeteners, thinking they are a safe alternative to sugar. They are not! Here is yet another study showing a negative impact on our health.

‘Ace K’ is found in many everyday products from lip glosses to toothpaste. Also have a look at ingredients when buying frozen desserts, candies, beverages, and baked goods. THINK AS YOU READ LABELS. I have suggested this before, just because it is on a shelf and available does not equate with the item being good for you.

Surviving Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia and it is on the rise in seniors. Diagnosing, surviving, and preventing complications that harm you depends on early recognition and treatment. Recall an arrhythmia is your heart beating in an irregular manner. AF is commonly described as an ‘irregularly irregular’ heartbeat. You are unable to recognize a pattern of how your heart is beating. Please see a physician if you notice your pulse is irregular or your blood pressure device indicates irregular heartbeat. A physician should be the one to make an AF diagnosis.

There is a reason the Apps stores for smartphones have many applications for recording and recognizing AF. Just knowing that your chance of stroke is increased 5 fold if you have this arrhythmia is motivation enough. Approximately a third of new stroke victims did not know they had AF.

Why this is a concern is that complications can arise that being stroke, heart failure blood clots, and other minor sensations of feeling off. Palpations are a subjective sense that your heart is beating differently. If you become aware please get medical attention, no matter your age. Not all arrhythmia is manifested to you, so you might or might not sense irregular heart rhythms.

Knowing you have AF is very important as then stroke becomes largely preventable with oral anticoagulation. today anticoagulation is a pill taken daily without blood work regularly. According to the European Society of Cardiology guidelines, patients aged over 65 years can benefit from AF screening using single, repeated, or ambulatory electrocardiogram (ECG) recordings. Tracing on mobile devices are tremendously helpful in this age group.

Naturally, it is better to monitor continually for a few days rather than episodic tracing on your personal electronic device. AF ‘runs’ can be sporadic or short-lived. It is best if ECG recordings resulted in higher sensitivity.

Surviving Atrial FibrillationI personally have been using the 2 and 6 lead Kardia app and device for years. With minimal investment, this device can be shared, easily carried, and make a serious impact on your quality of life. There are many other aids for lay individuals monitoring and recognizing arrhythmias, do check with your doctor.

Medical Truths Published

Anyone in academia will tell you, publications are critical. I was in academic medicine and was part of that mentality for decades. Yes, if you didn’t publish you would perish! No longer in academic medicine, I still feel the need to speak out, often doctors do so, in medical journals. I have been working to make the medical community, government, and people at large aware of prehospital medical care. The needs of those in prehospital medicine have increased dramatically with the pandemic and now as endemic. Under PRESS AND PUBLICATIONS, on this website, you can view my participation in spreading the word. I have tried to honestly analyze the data and give a voice to the many practitioners and prehospital medicine. Below are the publications for 2022 to date. The authors represent all the in the field of paramedicine.

Medical Truths PublishedMaguire BJ, O’Neill BJ, Phelps S, Maniscalco PM, Gerard DR, Contreras, GW, Handal KA. Establishing a Personal Protective Technology Center of Excellence to Address Unique Research Needs of Paramedicine Clinicians. JEMS. January 31, 2022.

Maguire BJ, O’Neill BJ, Maniscalco PM, Gerard DR, Phelps S, Handal KA. Protecting Paramedicine Clinicians from Infectious Disease. JEMS. January, 10, 2022Medical Truths Published

Abysmal Flu Shot Preformance

Abysmal Flu Shot Preformance

CDC Data Week Ending March 5, 2022

You probably know, I’ve said it before here, that the flu shot is but an advanced educated guess of the three or four possible viruses that may attack in a given winter season. Vaccines are made using particles to stimulate antibodies against an Influenza A and B type virus. The need to prepare in advance necessitates the educated guessing as to what are the likely make-up of the trivalent and quadrivalent vaccines. Sadly this year’s was a relative bust meaning they did not educate guess correctly. Actually influenza A type H3N2 had been included but a sub-variant lineage is a culprit this season. Although I think the number for the vaccine effectiveness (VE) is 16% coverage of the viruses, according to CDC. The predominant influenza strain, for the 2021-2022 season is A(H3N2). 

So back to respiratory infections, common in winter months with prevention such as continuing to wear a mask, treatment with antivirals (influenza antivirals such as baloxavir (Xofluza) or oseltamivir (Tamiflu) are paramount, especially for high-risk individuals. Most of us will not have complete immunity either from the flu vaccine or having had H3N2, a form of Influenza A. Listening to your body when you are unwell, seeking medical attention, and avoiding spreading your illness are smart moves.

Very possibly and reported, acute respiratory infections can be caused by an Influenza virus and accompanied by SARS-CoV-2.

Illness is on the rise with central and south-central regions of the US reporting more cases. Hospital admissions have been increasing each week for the past 5 weeks. The season has definitely started. CDC estimates that, so far this season, there have been at least 2.7 million flu illnesses, 26,000 hospitalizations, and 1,500 deaths from flu.

Influenza surveillance reports are available weekly do have a look.

In ED, a Respiratory Pathogens test can be done that evaluates many different causes of respiratory infections. Viruses include flu-type influenza A & B, RSV virus, Parainfluenza virus, Rhinovirus, Adenovirus, Coronavirus,Enterovirus, Human metapneumovirus. and that is just viruses, also tested are bacteria including: Bordetella pertussis (whooping cough) and Bordetella parapertussis, Chlamydia pneumoniae and Mycoplasma pneumoniae. A respiratory infection spread rapidly and as you see there are many culprits most no cure and many treated differently. Check with your healthcare provider for information on home tests.

Home care is moving fast as early recognition can go a long way to better outcomes and less spread. One type is the rapid antigen tests: these generally involve inserting a swab into your nostril. The sample can then be analyzed at home with materials that are included in the test kit. Results are typically available in around 15 minutes. Other tests can be mailed in for results. You will be happy to learn rather than going to an emergency room or doctor’s office and being with other ill people, you could do an influenza test at home. Home-based, self-administered tests for influenza are comparable in accuracy to rapid diagnostic tests in clinical settings, according to a recently published. Thompson is the senior author of the study and a primary-care physician at UW Medicine.

Wound Closure Truths

Wound Closure TruthsDoc Handal takes to the air with an insightful podcast conversation about repairing your torn skin. Sutures, stitches with needle and thread, staples, and adhesive glue are all possibilities but require considerations. These are a few ways to get  ‘split’ skin back together, if too messy for mother nature. Today in this podcast you’ll learn about sutures, staples (you may be already had a few), and adhesive glue to repair skin unnatural openings. Trauma is the most common cause be it from a surgeon’s knife, or kitchen knife, a fall, or blunt force insult, the skin is not armor.

 You can listen and subscribe on Apple, Google, and iHeart radio so you don’t miss the next episode. And if you like what you hear, a five-star rating goes a long way.