Serious illnesses linked to pet store puppies

The outbreak has sickened at least 39 people in seven states

From: http://www.cbsnews.com/news/petland-puppies-camylobacter-infections-warning/

Should you let your dog sleep in the bedroom?

New research looks at quality of sleep for pet owners who keep their dogs in their rooms at night

From: http://www.cbsnews.com/news/should-dogs-sleep-in-the-bedroom/

PBHS website, social media plan facilitate solo practice's expansion

This is the eighth in a series of articles about Internet marketing that feature interviews with ADA members to describe how PBHS, the website and marketing services provider endorsed by ADA Business Resources, is helping dentists address today's marketing challenges.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/pbhs-website-social-media-plan-facilitate-solo-practices-expansion

Football fans weigh concerns about players' brains

The majority of people surveyed believe head injuries for players pose a major problem for the sport, but that doesn't deter many from watching

From: http://www.cbsnews.com/news/football-fans-still-loyal-despite-concerns-about-players-brains/

National Health Checkup: Obstacles, opportunities in cancer care

From: Mayo Clinic https://www.youtube.com/watch?v=562nLKSK-Uk

Obamacare Paid Off for Poorer Cancer Patients

Health coverage surged in states that expanded Medicaid, research finds

From: http://www.webmd.com/cancer/news/20170908/obamacare-paid-off-for-poorer-cancer-patients?src=RSS_PUBLIC

Immune-focused drug targets advanced melanoma

The drug is a more effective option for patients who've had surgery to remove advanced tumors, according to new research

From: http://www.cbsnews.com/news/opdivo-melanoma-immune-focused-drug/

PARP Inhibitors

From: Mayo Clinic https://www.youtube.com/watch?v=0aPglyeOWHs

Too many pain pills after surgery: When good intentions go awry

As a physician with an interest in reducing opioid-related problems, I frequently hear stories from colleagues and friends about their loved ones who either struggle with opioid addiction or have even died from opioid-related overdose. My follow-up question to them is usually: “How did it begin?” Almost every time the answer is the same: the individual experienced acute pain either from a trauma or surgery, was started on opioids by a doctor, and then couldn’t quit.

My son’s baseball coach, who is not in the medical field, described it perfectly. He went in for a minor back surgery and was discharged with 60 tablets of oxycodone (the opioid medicine in Percocet and Oxycontin). For the first couple of days, he had significant pain and used the pain pills. After the pain began to subside and acetaminophen and ibuprofen were sufficient, he stopped using the oxycodone. But after discontinuing the medication, he began feeling terrible, experiencing body aches, restlessness, and insomnia. He took another oxycodone and felt better. Fortunately, he had the insight to recognize what was going on: he was withdrawing from the opioid, even after taking it for only a few days. Had he continued treating his withdrawal with oxycodone, he may have become hooked. “I dodged a bullet,” he told me.

The problem of adverse effects and unused opioids

This story, repeated time and again, is interesting in light of a recent study published in JAMA Surgery. The paper was a meta-analysis that combined the results of six previous studies investigating use of opioids by patients after seven different surgical procedures. In the era of the opioid epidemic, where we know that the vast majority of pills taken for non-medical reasons (e.g., abuse) are obtained from friends or family members, the results are staggering: 42% to 71% of the prescribed opioids went unused. Furthermore, 16% to 29% of patients experienced adverse effects directly attributed to the opioids.

Multiple government and public health agencies recommend discarding unused opioids. It’s not safe to flush them down the toilet as they can contaminate our water supply, but most police stations and now commercial pharmacies have bins where unused medications can be safely disposed. Despite this, the study discovered that only 4% to 30% planned to dispose of the medications and only 4% to 9% planned to use a safe disposal method.

Why are opioids prescribed often and in larger amounts?

A key question is why overprescribing after surgery is occurring. I believe there are two likely explanations. The first is that surgeons, appropriately, do not want their patients to suffer from pain after an operation. The second is that, in many states, it is impossible to phone in a prescription for a controlled substance (e.g. an opioid pain medication). Therefore, a patient actually has to come back to clinic to pick up a prescription, which causes inconvenience to both the patient and the prescriber. Providing a prescription for 60 or 90 pills makes sense considering this barrier. Several states are implementing ways to provide electronic prescriptions that would make the doctor’s office visit unnecessary if a refill is needed, but it will take time before most doctors can do this.

However, as the study in JAMA shows, these large amounts may be far more pills than is required. As an example, consider another intriguing study of patients being treated for an acute extremity fracture. The researchers provided patients with special pills that contained both oxycodone and a small radio transmitter that became activated in the stomach. The researchers were able to detect exactly when the opioid was taken. Patients were instructed to use up to one week of oxycodone. At follow up, the average number of pills used was eight. Most of the severe pain was gone in just three days. There was no more need for opioids than a few pills, certainly less than 15.

Here’s what you can do to protect yourself and your community

How can the public protect itself? Physicians have a duty to educate about the risks and benefits of all treatments rendered, including when prescribing opioids. That unfortunately doesn’t always occur. So here’s my advice: if you are prescribed an opioid for acute pain, including after surgery, take all of the non-opioid pain medications permitted by your doctor as instructed (e.g. acetaminophen and ibuprofen, if not contraindicated). Add the opioid if, and only if, the pain is not bearable with the other medications. And once the pain is tolerable, stop the opioid and safely dispose of it by bringing it back to your pharmacy, if they have a disposal bin, or any DEA-recommended collection site. Finally, consider having a discussion with your doctor about the number of pills you are likely to need in the first place before the prescription is written. Being informed about safely using opioids could prevent dependence, and, ultimately, save your life.

The post Too many pain pills after surgery: When good intentions go awry appeared first on Harvard Health Blog.

From: Scott Weiner, MD https://www.health.harvard.edu/blog/too-many-pain-pills-after-surgery-when-good-intentions-go-awry-2017091112381

Fewer Kids Injured From Off-Road Vehicles

In Massachusetts, ER visits down as much as 50 percent, study found

From: http://www.webmd.com/children/news/20170911/state-laws-curb-kids-injuries-tied-to-off-road-vehicles?src=RSS_PUBLIC

The Health Risks of Long Work Weeks

Too much overtime may pose a threat to your heart

From: http://www.webmd.com/heart/news/20170911/the-health-risks-of-long-work-weeks?src=RSS_PUBLIC

Immune-Focused Drug New Weapon Against Melanoma

In head-to-head trial, Opdivo outperformed a similar drug, and with fewer side effects

From: http://www.webmd.com/melanoma-skin-cancer/news/20170911/immune-focused-drug-new-weapon-against-melanoma?src=RSS_PUBLIC

Lupus Hits Certain Groups Harder

Studies find race, ethnicity, gender and even geography make a difference for this autoimmune disease

From: http://www.webmd.com/lupus/news/20170911/lupus-hits-certain-groups-harder?src=RSS_PUBLIC

Earn CE, learn about oral health in a corrections environment

Dental professionals who want to learn more about correctional health care issues and refine skills needed to manage dental problems in correctional settings are invited to a conference in Chicago Nov. 4-8.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/earn-ce-learn-about-oral-health-in-a-corrections-environment

Image quality focus of research for 2017 Ahlstrom award recipient

Dr. Brittany Kurzweg wants to make sure clinicians have the best diagnostic image available to them when treating patients. Her innovative research on the subject scored her the 2017 Robert H. Ahlstrom New Investigator Award, which highlights the role dental informatics standards play in dentistry.

From: By Michelle Manchir http://www.ada.org/en/publications/ada-news/2017-archive/september/image-quality-focus-of-research-for-2017-ahlstrom-award-recipient

Mom who chose baby over chemotherapy dies

Doctors say Carrie DeKlyen chose to forgo chemotherapy to treat her brain cancer since it would have meant ending her pregnancy

From: http://www.cbsnews.com/news/carrie-deklyen-brain-cancer-baby-over-chemotherapy-dies-detroit-michigan/

Football Fans Loyal Despite Brain Injury Worries

8 in 10 believe the sport causes long-term damage: survey

From: http://www.webmd.com/brain/news/20170910/football-fans-loyal-despite-brain-injury-worries?src=RSS_PUBLIC

As Hurricane Irma looms, don’t forget senior citizens

Experts offer practical tips to help ensure the safety of this vulnerable population

From: http://www.cbsnews.com/news/hurricane-irma-florida-senior-citizens-safety-tips/

Guinea pigs can harbor a hidden health hazard

Doctors in Europe report three people were hospitalized due to infections from these pets

From: http://www.cbsnews.com/news/guinea-pigs-hidden-health-hazard-chlamydia-caviae-bacteria/

Hurricane Irma poses major challenges for medical care

As Hurricane Irma approaches southeast Florida, the state's health system is mobilizing for a surge in demand for medical care. At least 11 medical facilities in the Florida area are being evacuated and health officials are warning residents to take action now to avoid an emergency. Dr. David Agus joins "CBS This Morning" to offer advice for patients in Irma's path.

From: http://www.cbsnews.com/videos/hurricane-irma-poses-major-challenges-for-medical-care/

"Striking" findings in kids exposed to 9/11 dust

New research finds about half of those tested had higher levels of a certain chemical in their blood

From: http://www.cbsnews.com/news/striking-findings-blood-tests-on-kids-exposed-9-11-dust/

Breast-Feeding Linked to Lower Endometriosis Risk

Hormonal changes may play a role, researchers say

From: http://www.webmd.com/parenting/baby/news/20170908/breast-feeding-linked-to-lower-endometriosis-risk?src=RSS_PUBLIC

Can Cold Med Be Blamed in Woman's Murder?

North Carolina man tells authorities he took cold medicine, woke up to find his wife dead.

From: http://www.webmd.com/cold-and-flu/news/20170908/can-cold-med-be-blamed-in-womans-murder?src=RSS_PUBLIC

The Best Way to Diagnose a Food Allergy

Oral food challenges are safe and rarely result in a serious reaction, researchers say

From: http://www.webmd.com/allergies/news/20170908/the-best-way-to-diagnose-a-food-allergy?src=RSS_PUBLIC

Statins May Help People With COPD Live Longer

Deaths from lung-related causes were reduced by as much as 45 percent, study suggests

From: http://www.webmd.com/lung/copd/news/20170908/statins-may-help-people-with-copd-live-longer?src=RSS_PUBLIC

Pfizer Did Not Investigate EpiPen Problems: FDA

Manufacturer allegedly knew of defects, failed to act.

From: http://www.webmd.com/allergies/news/20170908/pfizer-did-not-investigate-epipen-problems-fda?src=RSS_PUBLIC

HPV Shot May Even Protect Women Who Never Got It

'Herd immunity' effect shows U.S. females now less likely to contract the cancer-causing virus

From: http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20170908/hpv-shot-may-even-protect-women-who-never-got-it?src=RSS_PUBLIC

ADA member travel benefits could save dentists money

ADA members planning travel can take advantage of ADA member travel benefits and save significantly on hotels and car rentals.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/ada-member-travel-benefits-could-save-dentists-money

Center for Professional Success features help on amalgam recycling compliance

The ADA Center for Professional Success has updated material on the amalgam recycling rule, including new information from the Environmental Protection Agency on deadlines, forms and submission processes.

From: By David Burger http://www.ada.org/en/publications/ada-news/2017-archive/september/center-for-professional-success-features-help-on-amalgam-recycling-compliance

How to handle online negative reviews

Patients can use websites such as Yelp or Angie’s List to search for dentists with good reviews.

But what happens if a dentist finds that a patient has posted an unfavorable review? Can they do anything about it?


From: By David Burger http://www.ada.org/en/publications/ada-news/2017-archive/september/how-to-handle-online-negative-reviews

University of Texas dental school volunteers provide emergency oral care to Hurricane Harvey evacuees

Volunteers joined the Hurricane Harvey relief effort by treating nearly 100 patients who were among those who sought shelter with the Red Cross at the George R. Brown Convention Center.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/university-of-texas-dental-school-volunteers-provide-emergency-oral-care

Webinar will teach how to use video in practice marketing

The ADA Center for Professional Success and ADA Business Resources will host an upcoming webinar that will teach dentists how they can incorporate video into their marketing skills.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/webinar-will-teach-how-to-use-video-in-practice-marketing

Six gene regions linked to preterm births

According to CBS News medical contributor Dr. David Agus, the findings are "enormous"

From: http://www.cbsnews.com/news/preterm-births-study-six-genes-linked/

Can't afford the dentist? You're not alone

For many middle-aged Americans even basic dental care is now financially out of reach, a new survey finds

From: http://www.cbsnews.com/news/cant-afford-the-dentist-youre-not-alone/

Health Concerns Linger After Hurricane Harvey

As flood waters recede, dangers from air, water and other survivors remain.

From: http://www.webmd.com/a-to-z-guides/news/20170907/health-concerns-linger-after-hurricane-harvey?src=RSS_PUBLIC

Nurses suspended after opening body bag to view man's genitals

The incident was reported after a different nurse overheard a co-worker make a comment about it, the hospital said

From: http://www.cbsnews.com/news/denver-nurses-suspended-after-opening-body-bag-to-view-mans-genitals/

Here's the Recipe to Keep Colon Cancer at Bay

Increase whole grains and exercise, limit booze and processed meats: report

From: http://www.webmd.com/colorectal-cancer/news/20170907/heres-the-recipe-to-keep-colon-cancer-at-bay?src=RSS_PUBLIC

Sleep Apnea Wreaks Havoc on Your Metabolism

Finding supports use of CPAP therapy for condition, so blood pressure and blood sugar levels don't jump

From: http://www.webmd.com/sleep-disorders/sleep-apnea/news/20170907/sleep-apnea-wreaks-havoc-on-your-metabolism?src=RSS_PUBLIC

Bite of a hot dog stopped boy's heart, revealing rare condition

It led to a medical crisis, and then discovery of a hidden heart defect

From: http://www.cbsnews.com/news/bite-of-a-hot-dog-stopped-boys-heart-revealing-rare-condition/

Sleepless Nights Plague Many Women in Middle Age

Phases in and around menopause play a big role in insomnia, CDC study finds

From: http://www.webmd.com/sleep-disorders/news/20170907/sleepless-nights-plague-many-women-in-middle-age?src=RSS_PUBLIC

Non-surgical weight management program at Mayo Clinic

From: Mayo Clinic https://www.youtube.com/watch?v=hj_sZVQpYhk

What’s up with hiccups?

Follow me on Twitter @RobShmerling

If you do an Internet search on “hiccups” you’ll find lots of supposed cures for this annoying but usually fast-passing condition — one site lists 250 of them! One thing you won’t find, though, is a good reason for why we hiccup.

Hiccupping is a more complex reflex than it might seem: a sudden contraction or spasm of the diaphragm and the muscles between the ribs makes you inhale quickly and involuntarily. It ends with “glottic closure” — the space in the throat near the vocal cords snaps shut, producing the typical hiccup sound. The technical term for hiccups (singultus) comes from a Latin word (singult) that means catching your breath while crying, which seems like a pretty good description of the sound of hiccupping.

In most cases hiccups seem to serve no purpose and go away on their own, usually after 30 or more hiccups. Any of the following may cause a short bout of hiccups:

• an overly full stomach, due to too much food, too much alcohol, or too much air in the stomach
• sudden changes in temperature, either outside your body or internally
• smoking cigarettes
• excitement, stress, or other heightened emotions.

Making hiccups go away

Of the many, many ways to get rid of hiccups, here are a few you can try that are logical, considering the muscles and tissues involved:

• Stimulating the nasopharynx, or the uppermost region of the throat, by pulling on your tongue, swallowing granulated sugar, gargling with water, sipping ice water, drinking from the far side of a glass, or biting on a lemon (not all at once, of course)
• Stimulating the skin that covers the spinal nerves near the neck by tapping or rubbing the back of the neck
• Stimulating the pharynx, or back of the throat, by gently poking it with a long cotton swab
• Interrupting your normal respiratory cycle by holding your breath, breathing into a paper bag (which increases the amount of carbon dioxide you inhale), gasping in fright, or pulling your knees up to your chest and leaning forward
• Distracting your mind from the fact that you have the hiccups.

And when hiccups won’t go away…

Occasionally, hiccups just won’t go away. A farmer in Iowa reportedly had hiccups for 60-plus years. Imagine that annoying, interrupting gasp for air coming every few seconds for 60 years! Luckily, even long-lasting hiccups don’t usually signal a medical problem. Very rarely, though, persistent hiccups may be a sign of disease, usually something that causes irritation of one of the nerves in the chest. Examples include laryngitis, goiters (enlargement of the thyroid gland), tumors in the neck, infections near the diaphragm, and hiatal hernia (usually accompanied by heartburn). Hiccups can also be triggered by excess alcohol use, kidney failure, and infections (especially ear infections). Rarer causes are aortic aneurysms and multiple sclerosis.

Persistent hiccups can also cause problems of their own. Think about it — hiccupping can make it difficult to eat, drink, and sleep, all things you need to do to keep healthy.

If you have hiccups that won’t go away on their own, your doctor will look for problems that may be causing them, and then try to fix that problem. Your doctor may also prescribe a medication (there are some that can reduce hiccups) — or tell you to stop taking a particular drug, because there are medications that can set off the hiccups.

Surgery for persistent hiccups is also an option, though one that’s exercised rarely. Two examples are a “nerve block” that stops the phrenic nerve (the major nerve supply for the diaphragm) from sending signals so that the diaphragm stops contracting, and implantation of a pacemaker to make the diaphragm contract in a more rhythmic pattern.

The bottom line

So, to review: we don’t know why we hiccup and we don’t know how to reliably get rid of them. They are as mysterious as they are universal. And it seems that just about everyone has a cure. Here’s my favorite: waiting a few minutes.

The post What’s up with hiccups? appeared first on Harvard Health Blog.

From: Robert H. Shmerling, MD https://www.health.harvard.edu/blog/whats-up-with-hiccups-2017090512150

CRNAs on Why Choose Mayo Clinic

From: Mayo Clinic https://www.youtube.com/watch?v=ayIHZA_Po_M

CRNAs on Growing your career at Mayo

From: Mayo Clinic https://www.youtube.com/watch?v=mCwgh8lV75w

CRNA Career at Mayo Clinic Health System – Laraine Klunder

From: Mayo Clinic https://www.youtube.com/watch?v=FLMgWCUkiTg

CRNA Career at Mayo Clinic – Cara Mann

From: Mayo Clinic https://www.youtube.com/watch?v=_svwhKSdNx0

10 things parents should know about flu shots

Follow me on Twitter @drClaire

We started giving flu shots at our practice last week, and it made me not just happy, but relieved. I know how bad influenza can be and I always feel better when we can start preventing it.

Every year, influenza sickens millions, hospitalizes hundreds of thousands, and kills tens of thousands. This is not your average common cold. While it is especially dangerous for anyone who already has a health problem (such as a weakened immune system, or heart or lung problems), it can be dangerous for healthy people, too.

Even if you don’t get that sick from the flu, aside from missing school or work there is the very real problem that influenza is very contagious — and you can be contagious before you realize that you have the flu. That means you can spread it to others, some of whom may get very sick. Getting immunized helps keep everyone safe: it’s not just about you, it’s about everyone around you. This is especially true for children, who aren’t always great about washing their hands and tend to touch lots of things and people around them.

Here are a few things all parents should know about the flu vaccine:

1.  It’s the best way to prevent the flu. Hand washing is crucial, and staying away from sick people helps, but we can’t wash our hands every second, and we can’t always know who is sick. It’s true that the vaccine isn’t 100% effective (the effectiveness varies by year) but it’s your best bet if you don’t want to get sick.

2.  You and your children should get it early. The flu season runs from roughly September to March. The sooner you get it, the sooner you are protected. It’s best to get it done before the end of October. This is especially true if your child is young and hasn’t had it before, because…

3.  Children who are less than nine years old and getting it for the first time need two doses, a month apart. So getting started early is even more important for them. If your child is younger than nine and only got one dose last season, they will need two doses this season.

4.  People with egg allergy can get the flu shot. If the allergy is severe you should talk to your doctor, as in those cases it’s recommended that people be monitored and have medications to treat an allergic reaction at the ready, but it’s unlikely that that anything will happen.

5.  There are very few people who shouldn’t get a flu shot. Children less than six months old or who had a definite allergic reaction to the flu shot are the only ones who can’t. Those with a history of Guillain-Barre Syndrome should talk to their doctor, but that’s rare. If a child is significantly ill we will sometimes postpone the shot, but children with a minor illness like a cold can get it.

6.  There are some people who really need a flu shot. That includes babies, who are at higher risk of complications, as well as children with asthma, other lung diseases, heart problems, weakened immune systems, or other chronic illnesses. You should call your doctor right away about getting vaccinated if your child falls into one of these groups.

7.  There’s no more nasal spray version. Sorry. It didn’t work very well. That means a needle for everyone. But there are lots of ways to ease the pain of the needle, so talk to your doctor.

8.  You don’t need to worry about thimerosal. Thimerosal is a preservative that has been used to prevent contamination in vaccines. Some people have worried that it could be linked to autism, but it has been studied carefully and there is no actual evidence that this is true. There is no thimerosal in the vaccines we routinely give to children. There are some formulations of the flu vaccine that contain a tiny amount of thimerosal, but there are also preservative-free formulations available. Either way, your child is safe. Talk to your doctor if you have questions about this.

9.  You can’t catch the flu from the flu vaccine. The virus in the vaccine is inactivated. As with any vaccine, there can be side effects; the most common ones are pain at the injection site or fever. But it cannot give you the flu.

10.  In many states, older children can get the flu shot at their local pharmacy. We pediatricians like you to get shots at our office, so that we have a record of it and can answer any questions. But we mostly want your child to be vaccinated, and we understand that getting to the office isn’t always easy. Check with your local public health department to see what your options are. If your child does get the flu shot at a pharmacy or flu clinic, please bring documentation to your doctor so that they can put it in their medical record.

If you have any questions about the flu or the flu shot, check out flu.gov.

The post 10 things parents should know about flu shots appeared first on Harvard Health Blog.

From: Claire McCarthy, MD https://www.health.harvard.edu/blog/10-things-parents-should-know-about-flu-shots-2017090412363