17 October 2018 Social Media Post: Back to Back commercial on medical apps

17 October 2018 Social Media Post: Back to Back Commercial on Two Medical App

Those of you that watched last night Dodgers/Brewers game may have noticed back to back commercials for two medical apps directed at a clear target audience. The fact that they were juxtaposed made it all the more obvious and somewhat ironic. The first advertisement was for “Roman”, an online service to address erectile dysfunction. In their own words, “Roman is a full-stack men’s health company, providing online diagnosis and discreet shipping of safe, legal ED medication.” I’m not sure what ‘full-stack’ means but it sounds ominous. This was immediately followed by an ad for “Keeps” directed at male hair loss. Keeps self describes as “the easiest way to keep your hair. Get a doctor consultation and personalized treatment plan consisting of the only FDA-approved hair loss treatments.” There’s not any secret to Keeps, it is Finasteride and Rogaine which is how male pattern baldness is typically approached.
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The Roman ad states that “although 52 percent of men experience erectile dysfunction, it’s safe to say that zero percent like talking about it.” The 52% number comes from a the Massachusetts Male Aging Study which was published last century – in 1994!. A more recent study has suggested that the overall prevalence of erectile dysfunction in men aged 20 years and older was 18.4% making the Roman messaging a bit misleading. In this more recent study, erectile dysfunction was highly associated with increasing age but was also particularly high among men with cardiovascular risk factors, hypertension, obesity, smoking, diabetes and coronary artery disease. Here’s the problem with Roman’s statement – by suggesting to men that they not talk about ED, they are also encouraging men to not discuss the underlying health processes that far more likely have contributed to their difficulties. ED can be a sign of underlying cardiovascular risk sometimes appearing as many as five years before a diagnosis of heart problems. This seems like a missed opportunity to promote mens’ health and wellness.
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Another irony of the juxtaposition of Keeps with the Roman ad is that a known potential side effect of Finasteride is erectile dysfunction. Keeps, to their credit, does acknowledge this risk on their website saying, “Though rare, in clinical trials, 3.8% of patients noticed some form of sexual side effects.” Maybe Keeps and Roman have some sort of co-marketing agreement.
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Both Roman and Keeps do connect patients to a licensed doctor. I’m hopeful that these physicians would be able to identify patients with metabolic and cardiac risks that should prompt more detailed evaluation.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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13 October 2018 Blog Post: Flu Shot and Pregnancy

13 October 2018 Blog Post: Flu Shot and Pregnancy

Each season, I’m always asked if the flu shot is safe for pregnant woman. My typical response is, “not only is it safe, it’s actually highly recommended.” In fact, we should actively be encouraging pregnant women to get their flu vaccine.
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To further support our recommendations, a recent study has shown that influenza vaccines can be effective in preventing influenza hospitalizations among pregnant women.
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Researchers studied 1030 hospitalizations among pregnant women who presented with flu like illnesses in four countries over six flu seasons from 2010 through 2016. All were tested for influenza. Just 13% who tested positive for flu had been vaccinated, versus 22% of those who tested negative.
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It doesn’t sound like a big difference, but it points to about a 40% efficacy of the flu shot in preventing hospitalization and yet another reason to vaccinate.
Vaccine May Help Avert Flu Hospitalizations in Pregnant Women

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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10 October 2018 Blog Post: Endemic Typhus (not Typhoid!), The Norweigan Rat, Fleas and Pasadena: What Do These Four Things Have in Common?

10 October 2018 Blog Post: Endemic Typhus (not Typhoid!), The Norweigan Rat, Fleas and Pasadena: What Do These Four Things Have in Common?

You may have read press reports of an outbreak of typhus occurring in downtown Los Angeles and, on Friday, heard that Pasadena reported epidemic levels of flea borne typhus. So what is happening? And how are the four things in today’s post title related?
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Flea-borne typhus spreads across Los Angeles area
When discussing typhus and typhus fever, scientific vocabulary gets confusing and, frankly, somewhat unhelpful. Typhus or typhus fever is actually a group of bacterial infectious diseases spread by lice (referred to as epidemic typhus), fleas (murine or endemic typhus) or chiggers (scrub typhus). Currently, in Los Angeles we are experiencing an unusually high activity (i.e. an epidemic) of flea borne (endemic) typhus. So an epidemic of endemic typhus.
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Confused yet? Wait, there’s more…
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If you are thinking Typhoid Mary, stop! Typhoid Mary who was twice quarantined by the New York City Health Department (1907 and 1915 – the second time until her death in 1938) for spreading a communicable illness. While this is interesting historically,her story is unrelated to what is occurring in downtown Los Angeles and Pasedena. She spread typhoid fever due to Salmonella typhi and poor hand hygeine. In Los Angeles and Pasadena, we are experiencing typhus fever (due to Rickettsia typhi or Rickettsia felis) spread by fleas.
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Even more confused? Understandably so… Let’s clear that up.
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Between July and September of this year, Los Angeles County Health Department has identified nine cases of flea-borne typhus associated with downtown Los Angeles, and six of those cases were in people experiencing homelessness. Additionally, this year, 20 Pasadena residents have been confirmed to have typhus fever, up from the expected one to five cases per year (this makes the illness at epidemic levels as it is above the usual expected number and is a sudden jump). As of Monday, there have been a total of 57 cases of flea-borne typhus in Los Angeles County.
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So where are people getting exposed? In Los Angeles County, the primary animals known to carry infected fleas include the Norweigan rat (see, that’s where they come in), feral cats, and opossums. People with significant exposure to these animals are at risk of acquiring flea-borne typhus. Pet dogs and cats that are allowed outside may also come in contact with infected fleas and could carry them back inside to you. Infected animals are not known to get sick from flea-borne typhus. You can refer to the Los Angeles County Health Department’s publication for more details on murine typhus and transmission patterns (as well as a really cool picture of a snarling opossum):
Answers to your questions about MURINE TYPHUS
And what should I look out for? Flea-borne typhus may be a mild, illness, or can present as severe disease requiring hospitalization. Symptoms occur 7 to 14 days after exposure, and typically include abrupt onset of fever, headache, chills, muscle aches, abdominal pain, or vomiting. Fortunately this infection is easily and effectively treated with a course of antibiotics.
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There are also several steps to take to reduce your exposure. These can include: storing trash in secure bins to avoid attracting animals, discouraging animals from nesting around your home by closing up crawl spaces, avoiding petting or feeding stray animals, using flea control products for domestic pets and using insect repellents on yourself when outside.
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Hopefully this helps clear up any confusion. If you have any questions or are concerned with possible exposure or symptoms, please do make an appointment with us Santa Monica Primary Care by calling 310.828.4411.
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As for myself, I’m going home and giving my dog a bath.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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3 October 2018: Mandatory CURES Consultation in Effect October 2nd, 2018

3 October 2018 Blog Post: Mandatory CURES Consultation in Effect October 2nd, 2018

With very little fanfare (somewhat unexpectedly so from my perspective), a new state mandate went into effect today for all medical and allied health professionals authorized to prescribe, order, administer, furnish or dispense controlled substances in California. All providers must (with some exceptions) check a patient’s prescription history in California’s Controlled Substance Utilization Review and Evaluation System – also known as CURES 2.0 – before prescribing a Schedule II-IV substance.
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This requirement has gone into effect as the US healthcare system grapples with the ongoing opioid epidemic. To ensure proper prescribing and administering of controlled substances, the California Department of Justice therefore certified the CURES database for statewide use. In doing so, CURES 2.0 aids prescribers and dispensers in identifying fraudulent activity and is intended to reduce prescription drug abuse and diversion without affecting legitimate medical practice or patient care.
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At Santa Monica Primary Care, we do not anticipate that this change will cause a significant impact for most of our patients. However, those that are currently taking any of the Schedule II-IV medications will qualify for additional office and/or telemedicine visits in order to fully comply with this new effort. These will be performed to assess ongoing effectiveness of the medication as part of a comprehensive treatment plan. Patients who are affected will be contacted on an individual basis with additional details.
Drug Scheduling

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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