26 August 2018 Blog Post: The Lancet where researchers show that alcohol – any alcohol – is bad for you.

26 August 2018 Blog Post: The Lancet where researchers show that alcohol - any alcohol - is bad for you.

Just in time to ruin your weekend, comes the story from The Lancet where researchers show that alcohol – any alcohol – is bad for you – really bad for you.
Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
So bad, in fact, that the researchers conclude, “Our results show that the safest level of drinking is none.”
 
So how did they arrive at that conclusion? Researchers with the Global Burden of Diseases Study 2016 examined data on population alcohol consumption, as well as results from nearly 600 studies on the health effects of alcohol, to estimate alcohol use and its impact in nearly 200 countries and territories. In 2016, 2.2% of deaths among females and 6.8% among males were attributable to alcohol.
 
Digging deeper, however, the three leading causes of attributable deaths for those 18-49 were tuberculosis, road injuries, and self-harm. For populations aged 50 years and older, cancers accounted for a largest proportion of total alcohol-attributable deaths constituting 27·1% of total alcohol-attributable female deaths and 18·9% of male deaths.
 
In the United States, tuberculosis is not a publicized public health issue but the fact that it is highlighted in a study on alcohol shows just how much of a burden it places on global health. This study was funded by the Gates Foundation which has shown an exceptional and well deserved interest in global well being.
 
Drinking and driving has well known risks also highlighted in this article. So, please, from “friends don’t let friends drive drunk” to calling an Uber, this alone will reduce the health hazards of alcohol.
 
Sadly, we have covered the statistics of self harm in our previous post on Anthony Bourdain. Alcohol affects the chemistry of the brain, increasing the risk of depression. The Royal College of Psychiatrists has an informative handout on the link between alcohol and depression:
 
Alcohol and depression
In terms of risks after the age of 50, alcohol increased the risk of cirrhosis, chronic liver disease, stroke and liver cancer.
 
But what about heart disease? Haven’t we been told that modest alcohol intake is associated with improved heart health?
 
Not to put too much of a silver lining on this article which expertly highlights all the terrible effects of alcohol, researchers did demonstrate a statistically significant protective effect of alcohol and ischemic heart disease. For men there was a risk reduction of 14% and for women an 18% reduced risk for women with moderate alcohol intake. This occurring at 0·83 standard drinks daily for men and 0·92 standard drinks daily for women. A similar (but not statistically significant) trend was seen for diabetes and ischemic stroke.
 
So for your heart health, men can enjoy 83% of a drink and women, you can have a bit more (92%).
 
See, your weekend isn’t totally ruined.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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23 August 2018 Social Media Post: New Cervical Cancer Screening Guidelines.

23 August 2018 Social Media Post: New Cervical Cancer Screening Guidelines.

Did you know that we also do Well Woman examinations at Santa Monica Primary Care? We do.
 
Did you know there are new national guidelines for Well Woman examinations? Probably not, since they came out today.
Screening for Cervical Cancer
Since 2012, we have used two kinds of testing to screen for cervical cancer, cytology-based screening (known as the Pap test or Pap smear) and HPV testing. This has been referred to as ‘cotesting’ and these are performed at the same time.
 
Based on today’s recommendations, women aged 30 to 65 years can now choose primary high-risk human papillomavirus (hrHPV) testing alone as one option for cervical cancer screening, according to guidelines from the U.S. Preventive Services Task Force published in JAMA. Women will notice that the frequency of screening is less often than they might be used to:
 
Options for screening for women 30-65 years include:
1. Primary HPV testing every 5 years (a preferred strategy)
2. Cervical cytology every 3 years (a preferred strategy)
3. Cotesting every 5 years (an alternative strategy)
 
For women aged 21 to 29, the national recommendation remains cytology (Pap test or Pap smear) every 3 years.
 
Screening is not recommended for women older than 65 who are not at high risk and have had adequate prior screening. It also is not recommended for women younger than 21. For women who have had a hysterectomy with cervix removal and who have not had high-grade precancerous lesions are also not recommended for screening.
 
And, if you didn’t know already, all of this can be done at Santa Monica Primary Care

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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20 August 2018 Blog Post: Measles Case in Santa Monica

21 August 2018 Blog Post: Measles Case in Santa Monica

I received an email alert this morning that details Los Angeles County Department of Public Health investigation of a confirmed case of measles in the Santa Monica area August 8, 9, 10.
 
When discussing measles with patients, I refer to measles as “the most infectious of infectious diseases.” As the CDC explains more fully:
 
“It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”
 
The symptoms of measles generally appear about seven to 14 days after a person is infected and start with fever (up to 105 F), feeling unwell, cough, and redness in the eyes. Two to four days later, a rash develops around the hairline or ears and spreads downward to the face, trunk, and extremities.
 
For our patients who have symptoms or have been exposed to someone with measles, please do call us immediately at (310) 828-4411 to make an appointment. Special arrangements will made to evaluate you without putting other patients at risk.
 
If you are unsure about your vaccination status, we suggest that you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with measles-mumps-rubella (MMR) vaccine. Another option is to have our office test your blood to determine whether you’re immune (This option is likely to cost more). There is no harm in getting another dose of MMR vaccine if you may already be immune to measles (or mumps or rubella).
 

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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12 August 2018 Blog Post: 10th year of practice

12 August 2018 Blog Post: 10th year of practice

As I enter my 10th year of practice (how did that happen so fast?), I have heard myself say certain phrases as almost “stock answers” to common patient questions.
 
“Does this look infected?” (usually, yes).
“Do I need to finish all the antibiotics?” (If I’ve prescribed it, definitely, otherwise its viral and you don’t need antibiotics).
“Do I really need a colonoscopy?” (pretty much, yes).
 
But, in seriousness, patients will often ask me how often I think they should exercise. I will generally say “30-45 minutes of exercise that makes you sweat, 3-5 days a week.”
 
A recent study has shown that this standard phrase of mine is not only helpful for cardiovascular wellness but also for mental health. Researchers studied 1.2 million adults who completed a survey between 2011 and 2015. On average, participants had experienced an average of 3.4 days in the past month on which their mental health was “not good.”
 
Those who reported exercising in the past month had about 1.5 fewer poor-mental-health days per month than those who did not exercise. All types of exercise were associated with better mental health, but popular sports (mostly team sports), cycling, and aerobic/gym exercises conferred the greatest benefit.
 
And, here’s the kicker, exercising for 45 minutes per session, 3 to 5 times per week, was associated with the best mental health. Interestingly, a longer duration (e.g., 90 minutes per session) and greater frequencies (>5 times a week) were linked to worse mental health.
 
So go sweat! Its good for your (mental and physical) health.
Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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9 August 2018 Blog Post: Is There a (Female) Doctor in the House?

9 August 2018 Blog Post: Is There a (Female) Doctor in the House?

Women More Likely to Survive Heart Attack If Treated by a Female Doctor, Study Shows
An astonishing new study of more than 582,000 heart attack patients in the State of Florida showed that female heart attack patients fared better when treated for by a female Emergency Department physician. In fact, female heart attack patients cared for by female ER doctors were two to three times more likely to survive than those cared for by male doctors
 
The authors suggest several potential explanations for this finding. One theory is that being seen by a physician of the same gender leads to an improved communication of symptoms. However, the study’s own data do not support this idea as female physicians cared for male heart attack patients just as well as their male counterparts.
 
Another explanation is that women may have an ‘atypical’ (this characterization always bothers me somewhat because heart attack symptoms for women are, in fact, typical for them) presentation. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. It may be that female Emergency Department physicians are better able to discern a critical piece of information in the patient history.
 
However, there is some good news for male Emergency Department physicians. Practice makes perfect! Improvements in patient survival rates were noted among male physicians as they spent more time in practice.
 
Also, the composition of the Emergency Department staff was important. The study found that female patients treated in Emergency Departments with a higher percentage of female physicians also experienced better outcomes.
 
Heart disease is the No. 1 killer of women in the United States. A heart attack strikes someone about every 43 seconds. It occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because the arteries that supply the heart with blood can slowly narrow from a buildup of fat, cholesterol and other substances (plaque). The American Heart Association’s Go Red campaign was created in 2004 to encourage awareness and action around heart disease in women.
 
Patients do not typically have a choice of treating physician in the Emergency Department but based on this study it seems that Emergency Departments with a meaningful percentage of female attending physicians is good medicine in heart attack survival. For everybody.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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6 August 2018 Blog Post: Colorectal Cancer

6 August 2018 Blog Post: Colorectal Cancer

Colorectal cancer (cancer that starts in the colon or rectum) is the third most commonly diagnosed cancer and the second leading cause of cancer death in men and women combined in the United States. The American Cancer Society estimates that this year 95,520 people will be diagnosed with colon cancer, 39,910 will be diagnosed with rectal cancer, and 50,260 will die from this disease.
 
One of the concerning trends in colon and rectal rates is that there has been an increase in cases among younger age groups while declining rates have been observed in older age groups,. The proportion of cases diagnosed in individuals younger than age 50 increased from 6% in 1990 to 11% in 2013.
 
Based on these findings and revised national screening guidelines, patients @santamonicaprimarycare aged 45 and older coming in for their annual preventive examination will have a highly sensitive fecal immunochemical test (FIT) every year and/or a referral for colonoscopy. This is a change from years prior when this testing and discussion occurred at age 50.
 
You may have read this week that diet soda can reduce the risk of colon cancer returning.
Could Diet Soda Help Curb Colon Cancer's Return?
There are a number of inherent design limitations in this study that make it difficult to recommend diet soda intake. It is important to note too that the study looked at colon cancer recurrence, not prevention of colon cancer in the first place. (The fact that it was performed at Yale Cancer Center doesn’t make it any less flawed, all due respect to Yale University).
 
The best advice for reducing your risk of colon cancer is from the American Cancer Society:
1. Get screened.
2. Eat lots of vegetables, fruits, and whole grains.
3. Get regular exercise.
4. Watch your weight.
5. Don’t smoke.
6. Limit alcohol (2 drinks a day for men, 1 for women. A single drink amounts to 12 ounces of beer, 5 ounces of wine or 1½ ounces of 80-proof hard liquor because I knew you were going to ask. And, no, you can’t store up a credit from a 6 days of not drinking and have them all on one night).

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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