Monthly Archives: October 2020

Men's Health, Opinion, Resources, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #20: KIDNEY FAILURE (ESRD)

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Our Kidneys and Liver have a lot in common. They are not dramatic, take-care-of-me-now organs like our Hearts and Brain, but usually do their job quietly until they lose almost all of their function. They have lots of reserve; you can donate one of your kidneys or a piece of your liver and notice no change. They are both vital organs, and you will die without them.

Since they both help clear wastes and toxins from the bloodstream and produce hormones, they SHARE SYMPTOMS such as nausea, vomiting, fatigue, and mental changes.Their performance can be checked by blood tests. Healthy habits will protect their -and your- survival.

Certain Drugs impair their operation. They are both composed of many identical functional units, the nephron in the kidney, and the hepatic lobule in the liver.

The GLOMERULUS of the Nephron is a tuft or ball of capillaries and associated kidney cells that allow the fluid and dissolved molecules of the blood to come through, while restraining the larger proteins and cells of the blood, keeping them in the vascular system. The smaller molecules of sodium, potassium, urea and other waste products leak through the glomerulus.

This filtered liquid travels through the long, folded kidney tubules, where the RIGHT AMOUNT of salt and water are REABSORBED. This keeps the vascular fluids, the internal environment, the MILIEU INTERIOR, perfectly well adjusted for proper cell function. It is when the chemical environment of the body falls out of adjustment, when the kidneys FAIL to do their job, that the cells of the body cannot function properly, and Symptoms-fatigue, lethargy etc. – develop.

BLOOD PRESSURE is intimately involved with the KIDNEYS, which has an Endocrine function. The Renin( Renal=kidneys) Angiotensin system is a major regulator of blood pressure.

You may have heard of the ACE-2 receptor as the binding site of th COVID Virus. This Angiotensin Converting Enzyme receptor is on the surface of cells all over the body and normally functions to control blood pressure.

DIABETES is the most common cause of end stage renal disease (ESRD), bringing our healthy triad of SLEEP DIET and EXERCISE to our attention once again.

POLYCYSTIC KIDNEY DISEASE is an inherited condition where many nephrons fail to hook up to the urine collecting system, and the fluid builds up into cysts, which then eventually replace the rest of the kidney. Pressure from urine blockage by an enlarged prostate, or even lack of ureteral valves can also back up into the kidneys and eventually cause ESRD.

Infections and autoimmune diseases can result in ESRD. Treatment of ESRD is usually a Kidney transplant or Dialysis. There is a waiting list for the former and the latter is life-altering. You can’t beat a healthy lifestyle.

–Dr. C.

Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #19: DIVERTICULOSIS

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Your large bowel, or colon, is at the end of the Gastrointestinal tract. It starts on the right side of your abdomen, where the small intestine empties into the caecum. This is also where the Appendix bulges down, looking like a little finger coming from the caecum. The 5 foot long large intestine is the final processing area of your food, after the nutrients have been absorbed.

The Colon contains virtually all of the microbiome, reduces the volume of the fecal matter, and propels it to its final destination. The propelling muscles are an inner circular ring, and 3 outer longitudinal strips. These outer strips of muscle do not completely encircle the Colon, allowing for protuberances of lining membrane and circular muscle to balloon out into prominences called Taenia.

It is in these weakened areas, especially where blood vessels penetrate that little herniations form over the years. Diverticulosis occurs in 50% of people more than 60 years of age, and in almost everybody more than 80 years.

Diverticulosis is a condition where pressures up to 120 mm or mercury, generated by the colonic muscles gradually push out little pouches of lining membrane called diverticula. Nobody knows why some people get an INFLAMMED diverticulum.

Age, of course, is a factor, as are Obesity, diabetes, smoking and poor diet; a tendency toward inflammation is common in all of these risk factors. Comparing diverticulitis with Appendicitis is an interesting exercise. The symptoms are mirror images of each other. Appendicitis occurs on the right side.

Diverticulitis usually occurs on the left side, except in asian people. The asian DIET seems to favor diverticula on the right side. When asians immigrate to the U.S. and start eating more Red meat and fewer vegetables, the diverticula shift to the left side.

Signs of Diverticulitis include gastrointestinal symptoms, such as pain, tenderness,nausea, cramps, constipation, and Fever. Rectal bleeding can sometimes occur. Treatment includes antibiotics.

If the condition worsens, serious complications, such as abcess may develop and require surgery. As usual, Prevention, including diet and exercise, is better than Treatment. A HIGH FIBER DIET is the best prevention.

–Dr. C.

Article #1 to read – Diverticular disease of the colon: New perspectives in symptom development and treatment

Article #2 to read – Management of Colonic Diverticulitis | Effective Health Care Program

Medicine, Men's Health, Physicians, Resources, Women's Health

HEALTH: ‘DIABETES AND CHRONIC KIDNEY DISEASE’ – NEW GUIDELINES (OCT 2020)

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Comprehensive care in patients with diabetes and CKD

Management of CKD in diabetes can be challenging and complex, and a multidisciplinary team should be involved (doctors, nurses, dietitians, educators, etc). Patient participation is important for self-management and to participate in shared decision-making regarding the management plan. (Practice point).

We recommend that treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated (1B).

Lifestyle interventions in patients with diabetes and CKD

We suggest maintaining a protein intake of 0.8 g protein/kg)/d for those with diabetes and CKD not treated with dialysis (2C).

On the amount of proteins recommended in these guidelines, they suggest (‘recommend’ becomes a ‘suggest’ at this level of evidence) a very precise  intake of 0.8g/kg/d in patients with diabetes and CKD. Lower dietary protein intake has been hypothesized but never proven to reduce glomerular hyperfiltration and slow progression of CKD, however in patients with diabetes, limiting protein intake below 0.8g/kg/d can be translated into a decreased caloric content, significant weight loss and quality of life. Malnutrition from protein and calorie deficit is possible.

Physical activity

We recommend that patients with diabetes and CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance (1D).

Read full guidelines

Medicine, Men's Health, Prevention, Resources, Women's Health

INFOGRAPHIC: ‘WHAT IS HERD IMMUNITY?’ – ACHIEVING IT WITH COVID-19 (JAMA)

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What Is Herd Immunity?

Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease, limiting further disease spread.

Disease spread occurs when some proportion of a population is susceptible to the disease. Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease and the risk of spread from person to person decreases; those who are not immune are indirectly protected because ongoing disease spread is very small.

The proportion of a population who must be immune to achieve herd immunity varies by disease. For example, a disease that is very contagious, such as measles, requires more than 95% of the population to be immune to stop sustained disease transmission and achieve herd immunity.

How Is Herd Immunity Achieved?

Herd immunity may be achieved either through infection and recovery or by vaccination. Vaccination creates immunity without having to contract a disease. Herd immunity also protects those who are unable to be vaccinated, such as newborns and immunocompromised people, because the disease spread within the population is very limited. Communities with lower vaccine coverage may have outbreaks of vaccine-preventable diseases because the proportion of people who are vaccinated is below the necessary herd immunity threshold. In addition, the protection offered by vaccines may wane over time, requiring repeat vaccination.

Achieving herd immunity through infection relies on enough people being infected with the disease and recovering from it, during which they develop antibodies against future infection. In some situations, even if a large proportion of adults have developed immunity after prior infection, the disease may still circulate among children. In addition, antibodies from a prior infection may only provide protection for a limited duration.

People who do not have immunity to a disease may still contract an infectious disease and have severe consequences of that disease even when herd immunity is very high. Herd immunity reduces the risk of getting a disease but does not prevent it for nonimmune people.

Herd Immunity and COVID-19

There is no effective vaccine against coronavirus disease 2019 (COVID-19) yet, although several are currently in development. It is not yet known if having this disease confers immunity to future infection, and if so, for how long. A large proportion of people would likely need to be infected and recover to achieve herd immunity; however, this situation could overwhelm the health care system and lead to many deaths and complications. To prevent disease transmission, keep distance between yourself and others, wash your hands often with soap and water or sanitizer that contains at least 60% alcohol, and wear a face covering in public spaces where it is difficult to avoid close contact with others.

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Medicine, Men's Health, Physicians, PODCASTS, Women's Health

TOP MEDICAL PODCASTS: ‘DIVERTICULAR DISEASE’ (BMJ)

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Colonic diverticulosis refers to herniation of the mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease. 

Mohamed Thaha, Senior Lecturer & Lead Consultant in Colorectal Surgery, National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, tells us more. 

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Medicine, PODCASTS, Resources

Podcast: ‘Health Policy After The 2020 Election’

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Dr. Sherry Glied is dean of the New York University Wagner Graduate School of Public Service. Dr. Mark Pauly is a professor of health care management at the Wharton School of the University of Pennsylvania. 

Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S. Glied. Health Policy in a Biden Administration. N Engl J Med 2020;383:1501-1503. M.V. Pauly. Health Policy after a Trump Election Victory. N Engl J Med 2020;383:1503-1505.

Men's Health, TELEMEDICINE, Women's Health

TELEHEALTH: ‘ADVANTAGES & DISADVANTAGES’ (HARVARD)

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Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients’ vital signs remotely. Its definition is broader than that of telemedicine, which only includes the remote delivery of health care.

Telehealth can be delivered in one of three ways:

  • Synchronous—when the doctor communicates with the patient in real time via computer or telephone
  • Asynchronous—when data, images, or messages are recorded to share with the doctor later
  • Remote patient monitoring—when measurements such as weight or blood pressure are sent to the health care provider

What you can do with telehealth

All of the following activities and services are possible with the help of telehealth:

  • Recording measurements like your weight, food intake, blood pressure, heart rate, and blood sugar levels either manually, or through a wearable device, and sending them to your doctor.
  • Having a virtual visit with your doctor or a nurse over your computer or smartphone.
  • Using an online portal to check your test results, request prescription refills, send your doctor a message, or schedule an appointment.
  • Sharing information such as your test results, diagnoses, medications, and drug allergies with all of the providers you see.
  • Coordinating care between your primary care provider and any specialists you visit—including the sharing of exam notes and test results between medical offices in different locations.
  • Getting email or text reminders when you’re due for mammograms, colonoscopies, and other screenings, or routine vaccinations.
  • Monitoring older adults at home to make sure they are eating, sleeping, and taking their medications on schedule.

Downsides to telehealth

Telehealth offers a convenient and cost-effective way to see your doctor without having to leave your home, but it does have a few downsides.

  • It isn’t possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach.
  • The security of personal health data transmitted electronically is a concern.
  • While insurance companies are increasingly covering the cost of telehealth visits during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs.

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Men's Health, Opinion, Prevention, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #18: SKIN INFECTIONS

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The skin is the protective barrier between the inside of our bodies and the outside world of microorganisms, parasites and toxins. It is often the site of inflammation and infections.

In past times, before the advent of cleanliness and antibiotics, mankind was plagued by erysipelas, boils, carbuncles, and other severe infections of the skin, which are rarely seen now. The beta hemolytic streptococcus and Staphylococcus aureus were ubiquitous in the past, and mostly are contained today.

Severe Infections presently require some skin abnormality, immune deficiency, neglect, animal bite or other breach of skin integrity to be a problem. Antibiotic resistance, however, is allowing some organisms like MERSA to make a comeback.

ECZEMA. or Atopic Dermatitis, was common in my medical practice. This condition weakens the skin barrier, allowing Staphylococcal infection to gain a foothold. In my day, If there were a flare of eczema severity, antibiotics would often help. Leg edema and swelling. such as from heart failure, especially coupled with diabetes and blood vessel disease is also an invitation to infection, such as cellulitis.

Redness, swelling, warmth and pain- the classic rubor, tumor, calor and dolor- as well as swollen local lymph nodes and fever often betray infection of the skin. Please see the recently posted infographic on celulitis.

IMMUNE DEFICIENCY raises the likelihood and risk of severe skin infections. Infection from “flesh-eating bacteria”, often beta hemolytic streptococci in deep tissue planes , is a medical emergency. Immediate surgery is often needed.

Disproportionate PAIN after injury or surgery is often a clue. Certain age groups have characteristic skin infections, such as the scalded skin syndrome of infants, and the acne of adolescents. Viruses, molds, and arthropods can also infect the skin.

Viruses, such as herpes in particular can simulate bacterial infection. Ringworm from fungi is easy to distinguish, but arthropod bites, and especially bee sting can look very much like bacterial infection. Scabies and mite infestation are so itchy as to be distinct.

Topical antibiotics applied on skin breaks like cuts or breaks are useful in preventing infection. These ointments and creams are like “artificial skin”. Once again, prevention is key.

–Dr. C.