DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JUNE 20, 2020.
Category Archives: Men’s Health
TECHNOLOGY: “TELESTROKE” NETWORKS ARE SAVING LIVES
From Fast Company article (June 26, 2020):
An increasing number of hospitals are now equipping emergency vehicles to treat stroke patients while en route to the ER. UCHealth is a health system in Colorado that has a tricked-out ambulance, the Mobile Stroke Treatment Unit. A neurologist at the hospital is connected wirelessly through telehealth to the vehicle. First responders’ gear includes portable CT scanners and tPA.
Currently, there are also more than two dozen telestroke networks in the United States. At the hub of each is a large hospital with on-call neurologists, and broadband that connects the hospital directly to satellite hospitals and clinics. There’s always a neurologist on call to guide the smaller hospital staffs’ treatment of a stroke patient.
When I had a stroke five years ago at 10:20 on a Saturday night, telehealth saved my life. At the time, only 3% to 5% of people in the United States were able to get the “clot-busting” drug called tPA in time to avoid brain damage.
In addition to offering telestroke capabilities, healthcare providers should equip emergency vehicles with portable ultrasound devices and defibrillators. Rural communities can consider strategically deploying high-powered wired and wireless hotspots in case patients need immediate medical attention while still en route to the hospital. Following natural disasters such as earthquakes or floods, mobile hotspots configured for telehealth could be helicoptered into isolated communities.
COMMENTARY
SPEED is especially important when a blood clot blocks an artery servicing an important organ. Our Heart and BRAIN top the list of vital organs. TELESTROKE showcases Telemedicine at its best.
RECOGNITION of a stroke is a weak link in the chain of prompt Brainsaving treatment, and a Mnemonic helps.
—Facial assymetry or drooping
—Arm or leg weakness on one side
—Speech disturbance
—Time is all important
FAST is a good mnemonic, and adding B for balance and E for Eye, or vision loss, for BEFAST gives 2 more parameters to think about.
Living alone adds to the challenge, so be as focused as you can. I was interested to hear that some TELESTROKE ambulances are adding mobile CT and drug (tpa) capabilities, in addition to TELECONFERENCING with a NEUROLOGIST. Treating a stroke within 15 minutes is becoming a possibility.
So particularly if you have risk factors such as hypertension, diabetes or obesity, be on the alert for symptoms of stroke.
—Dr. C.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #4: HEARTBURN (ACID REFLUX)
I have been having Heartburn for more than 40 years. The cause of Heartburn is leakage of acid from the stomach, where tissues have evolved to tolerate the highly acidic conditions, into the esophagus, where they haven’t.
The young body has an efficient, functional gate, or sphincter, keeping the food, once swallowed into the stomach, from coming back up. As you eat, you chew your food well to aid digestion. Your taste buds, sensing chemicals in the delicious food, activate saliva.
The salivary enzymes start the digestion of the carbohydrates in the food. If you eat slowly enough, you may be able to appreciate the digestion of tasteless starch, like in bread, into sweet sugar, right in your mouth.
You then swallow the food, which slips past another gate, called the epiglottis, diverting the bolus of food past your windpipe. This gate sometimes does not shut tight, and you choke on the food or drink. The food is then conducted into the highly acidic environment of the stomach.
The stomach evolved to be an acidic, “fiery pit”, inhospitable to any bacteria that came in with the food, thus protecting the stomach from infection. In the old days, there were a lot of bacteria, and the acidity of the stomach was useful, and evolutionarily conserved.
These days, the “fiery pit” tends to be a problem. As you get older, the gate that keeps food in the stomach gets more floppy and relaxed, and allows food to come back up into the esophagus, and sometimes, most often at night when you would rather be sleeping, all the way up to your throat, and is inhaled into your windpipe and lungs in what is called “gastroesophageal reflux”, or GERD.
Even if the food, and acid, doesn’t make it all the way up, and stops at the esophagus, which has not evolved to tolerate acid, you will have “heart burn”. Of course it is not the heart that is burning, but the esophagus, which runs right past the back of the heart as it goes all the way from the throat to the stomach.
When I first developed Heartburn, all that was available was the flavored chalk, Calcium Carbonate, sold as Tums. It works right away, and is a source of Calcium, but can cause trouble, like kidney stones, if you take too much. The relief didn’t last long enough for me, and I had to take more in the middle of the night.
My next medicine was Xantac, a medication that blocks histamine from stimulating acid production in the stomach. The H2 blockers have recently been recalled because of NDMA contamination. I sometimes used H2 blockers like Xantac when my patients would get a bad allergic reaction. In such cases BOTH an H1 blocker like Benadryl, and an H2 blocker are called for.
Zantac was not strong enough for me, and I soon graduated to Prilosec,which directly blocks the secretion of acid in the stomach.
Prilosec was then very expensive, but now is available as the inexpensive GENERIC Medication, Omeprazole. It seems that no medication is without side effects.
Omeprazole, by reducing stomach acid, makes stomach and GI infections more likely, and interferes with the absorption of B12, and Calcium.
If you have had a lot of heartburn over a long period of time, you should check with a Gastroenterologist, who may scope you to rule out Barritt’s esophagus, which can lead to Cancer.
It is interesting that the antacid Tums in excess can cause too MUCH Calcium in the body, and can cause kidney stones and other kidney problems like MAS, and Omeprazole, by interfering with absorption can cause too LITTLE absorption of Calcium, leading to OSTEOPOROSIS.
The best rule is to take as low a dose of ANY medication as possible, preferably none, to understand the possible side effects, and compensate for them if you can.
–Dr. C
INFOGRAPHICS: “THE EFFECTS OF OPIATES ON THE BODY”
SURVEY: 67% OF PENN MEDICINE PATIENTS AND PHYSICIANS VIEW VIDEO & PHONE VISITS AS POSITIVE
From Penn Medicine (June 24, 2020):
After surveying almost 800 gastroenterology and hepatology patients and their physicians at Penn Medicine, 67 percent of both viewed their video and telephone appointments held during the peak of the COVID-19 pandemic as positive and acceptable substitutes to in-person appointments.
From March 16 to April 10, 2020, 94 percent of gastroenterology and hepatology appointments at Penn Medicine were performed using telemedicine in order to mitigate risks of COVID-19 spread while continuing to advance care as patients self-isolated at home. A telemedicine visit meant either a video visit (similar to FaceTime or Skype) or one via phone in which clinicians largely performed routine and non-urgent care.
TELEMEDICINE CASES: CONGESTIVE HEART FAILURE PATIENT IN TEXAS (2020)
On a Friday afternoon last summer, a patient, “Barb,” texted me: “Call me. I can’t breathe.” As a heart failure nurse serving rural patients, getting messages like Barb’s launches my adrenaline. I called her immediately.
A month earlier, I’d trained Barb to send daily vital signs via my clinic’s digital portal—blood pressure, weight, heart rate, and oxygen saturation.
Barb was suffering from a congestive heart failure exacerbation: her lungs were filling with fluid. If we didn’t remove it, she’d need to be hospitalized or worse.
Once I was sure she wasn’t in emergency distress, I called the clinic’s cardiologist for instructions. Then I phoned Barb’s pharmacy and ordered a new diuretic to add to her regimen—a water pill so powerful in its fluid off-loading effect that I’ve nicknamed it the Bellagio. Within two hours, Barb had taken the pill and begun to urinate out the fluid flooding her lungs. By the next morning, she was breathing comfortably.
Without access to a telehealth program, Barb would probably have gone to the emergency room, then to the intensive care unit for expensive intravenous medications.
TELEMENTAL HEALTHCARE: “BENEFITS OF MENTAL HEALTH TASK SHARING”
Lynsay Ayer, senior behavioral scientist with the RAND Corporation, describes how task sharing helps fill the need for more mental health care providers.
ORTHOPAEDICS: “TOTAL JOINT REPLACEMENT” (UCSF)
Hip and knee replacement are two of the most commonly performed operations in orthopedic surgery. UCSF orthopedic surgeon Dr. Paul Toogood takes a closer look at what Total Joint Replacement actually is, how it improves your quality of life, and what some of the considerations are when having this surgical procedure.
HEALTH: “UNDERSTANDING ARTHRITIS” – ORTHOPAEDIC TRAUMA INSTITUTE (VIDEO)
COVID-19: “SUPERSPREADING EVENTS” – HOW THEY LEAD TO 80% OF INFECTED PEOPLE
From Scientific American (June 23, 2020):
In fact, research on actual cases, as well as models of the pandemic, indicate that between 10 and 20 percent of infected people are responsible for 80 percent of the coronavirus’s spread.
Researchers have identified several factors that make it easier for superspreading to happen. Some of them are environmental.
- Poorly ventilated indoor areas seem especially conducive to the virus’s spread – A preliminary analysis of 110 COVID-19 cases in Japan found that the odds of transmitting the pathogen in a closed environment was more than 18 times greater than in an open-air space.
- Places where large numbers of people congregate – As a group’s size increases, so does the risk of transmitting the virus to a wider cluster. A large group size also increases the chance that someone present will be infectious.
- The longer a group stays in contact, the greater the likelihood that the virus will spread among them – The benchmark used for risk assessment in her contact-tracing work is 10 minutes of contact with an infectious person, though the CDC uses 15 minutes as a guideline.
- Some activities seem to make it easier to spread respiratory gunk – Speech emits more particles than normal breathing. And emissions also increase as people speak louder. Singing emits even more particles, which may partially explain the superspreader event at the Washington State choir practice. Breathing hard during exercise might also help the spread of COVID-19.
Doctors Without Waiting Rooms 