Vidcast:  https://youtu.be/LNri2WQPAnQ

Cannabis users who also use alcohol are more likely to drink heavily and more frequently.  This is the conclusion from Penn State researchers who surveyed more than 1,000 subjects between the ages of 18 and 25 years about their use of alcohol, marijuana, and the two together.

Those who used the two drugs simultaneously, so-called SAM users, consumed nearly 3.5 times more alcohol, drank 2.4 times more often, drank for 1.7 times more hours, and consumed twice as many drinks on days when they were drinking.  SAM users were predominately younger, male, White, college students past or present, and not living at home.  Nearly two-thirds of SAM users drank and used 2-4 times a week.

One of the chief rationales for legalizing recreational marijuana is that it is safer than alcohol.  It may be safer but not healthier according to some recent studies I’ve reported.  In any event, overusing both together is a recipe for disaster and a premature descent into addictive multi-substance abuse.

Ashley N. Linden-Carmichael, Amy L. Stamates, Cathy Lau-Barraco. Simultaneous Use of Alcohol and Marijuana: Patterns and Individual Differences. Substance Use & Misuse, 2019; 1 DOI: 10.1080/10826084.2019.1638407

#Alcohol #marijuana #alcoholism #substanceabuse 

Vidcast:  https://youtu.be/7PXOk2UMWz0

Sixty percent of children having their tonsils removed are prescribed opioids for 6 to 10 days following the surgery.  This fact comes from study by University of Michigan of nearly 16,000 children ages 1 to 18 years who underwent surgery from 2016 until 2018.

This prescribing pattern flies in the face of American Academy of Otolaryngology guidelines that suggest using NSAIDS such as ibuprofen in place of narcotics.  The study confirms that use of these addicting pain killers does not reduce post-operative hospital visits for pain or dehydration.  The data instead show that narcotics do cause painful constipation and sometimes tragic overdoses.

Having performed thousands of tonsillectomies myself during my 40 years practicing pediatric otolaryngology, I know that narcotic pain medicine can be avoided with the appropriate use of  the T&T plan: Tylenol and Twinkies, a sugar and carb-laden postoperative diet.  I also reject the use of blood-thinning NSAIDs which studies now show do drive a higher rate of post-operative bleeding.

Kao-Ping Chua, Calista M. Harbaugh, Chad M. Brummett, Lauren A. Bohm, Karen A. Cooper, Aaron L. Thatcher, Michael J. Brenner. Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children. JAMA Otolaryngology–Head & Neck Surgery, 2019; DOI: 10.1001/jamaoto.2019.2107

#Tonsillectomy #analgesics #opioids #Tylenol #NSAIDS

Vidcast:  https://youtu.be/M8KGl6VRPSk

A whopping 48% of persons who are victims of the big four, domestic violence, sexual assault, depression, or suicidal thoughts refuse to reveal this fact and ask for help.  A collaborative study of some 4500 subjects questioned in two online surveys was just published in JAMA Open Network.

Digging deeper into the data, the investigators showed that 70% of those concealing these vital pieces of information did so due to embarrassment and fear of being judged.  Then, about half of those avoiding disclosure did so because they didn’t want to commit to follow-up therapy such as counseling sessions or anti-depression medications or they fearing having such information in their medical records.

These findings show the need for better sensitivity and communication skill training for clinicians so that patients feel comfortable sharing their intimate secrets.  Beyond that, there must be iron-clad guarantees of confidentiality.  The clinician-patient privilege must become as solid as the lawyer-client privilege by enforcing the HIPAA regulations and stopping the illegal leakage of personal medical information to third parties including employers who pay for medical and psychiatric services.

Andrea Gurmankin Levy et al. Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9277

#Violence #abuse #depression #suicide #HIPAA

Vidcast:  https://youtu.be/j0AMNiPTals

One in every 14 persons over the age of 65 who undergoes even seemingly risk-free elective surgery may suffer a silent or covert stroke that can permanently impair their cognitive powers or worse.  This warning comes from a Canadian study just published in The Lancet.

Covert strokes are those without obvious symptoms including paralysis, weakness, speech degradation, or visual problems.

Population health scientists at McMaster University studied more than 1100 patients treated in the Americas, Europe, Asia, and New Zealand.  All patients underwent brain MRI scanning within 9 days of their surgery and were followed for a year to determine their cognitive abilities.  Of the 7% of patients that sustained silent strokes, 42% demonstrated a cognitive decline.  Even worse, 29% of those who didn’t suffer a stroke also developed impaired brain function.

Adding it all up, nearly 30% of the elders undergoing elective surgery developed post-operative mental decline.  If you or a family member in the golden years are told that surgery or a general anesthetic should be performed, be certain that the procedure is absolutely necessary.  If you do go ahead, ask your doctors and your family to monitor you carefully afterwards to detect mental changes that may warrant prompt intervention.

Marko Mrkobrada, Matthew T.V. Chan, David Cowan, etal. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. The Lancet, 2019; DOI: 10.1016/S0140-6736(19)31795-7

#Surgery #anesthesia #stroke #mentaldecline 

Vidcast:  https://youtu.be/MatgZ2Jd0-U

Teens who have been bullied are 3 times more likely to have attempted suicide than those who have not be victimized.  This fact is true for adolescents around the world according to a recently published data analysis culled from more than 130,000 adolescents 12 through 15 years by the World Health Organizations Student Health Survey.

The risk of suicide increases with the numbers of bullying incidents a child has sustained.  In the most extreme cases, being bullied on the majority of school days drives up the suicide risk more than 5 times.

This study shows that bullying can be a death sentence for the victims.  Its findings will serve as a basis for convicting bullies of felony murder thereby ruining the lives of at least two teens and their families. 

If you are aware that your child is a bully, put an immediate stop to their behavior before they too become victim of their own bad acts.

Ai Koyanagi, Hans Oh, Andre F. Carvalho, Lee Smith, Josep Maria Haro, Davy Vancampfort, Brendon Stubbs, Jordan E. DeVylder. Bullying Victimization and Suicide Attempt Among Adolescents Aged 12–15 Years From 48 Countries. Journal of the American Academy of Child & Adolescent Psychiatry, 2019; DOI: 10.1016/j.jaac.2018.10.018

#Suicide, bullying, teens

Vidcast:  https://youtu.be/sSbGUgcsl68

As medical and recreational cannabis are increasingly legalized, poison control centers are fielding more calls from emergency rooms and desperate parents.  A report from UMass-Amherst just published in JAMA looks at the rise in calls following legalization of medical marijuana in Massachusetts. 

Legalization of medicinal weed was followed by a 140% increase in poisoning calls with nearly 20% of the calls involving children infancy through 4 years of age.  Calls regarding edible marijuana increased for all age groups reflecting the misconception that edible versus smokable marijuana is less potent and dangerous.

Now remember that Massachusetts only legalized marijuana for medical purposes.  Recreational marijuana remains restricted, yet carelessness is permitting this drug to get into the hands of young children and abused by teens.  

You cannot legislate morality or common sense so cannabis will soon be as available as alcohol.  We as parents must be certain to protect our children from accidental poisonings and overdoses.

Jennifer M. Whitehill, Calla Harrington, Cheryl J. Lang, Michael Chary, Waqaas A. Bhutta, Michele M. Burns. Incidence of Pediatric Cannabis Exposure Among Children and Teenagers Aged 0 to 19 Years Before and After Medical Marijuana Legalization in Massachusetts. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9456

#Cannabis #poisonings #parenting

Vidcast:  https://youtu.be/ByXQXvIfwRg

The obesity epidemic is triggering cancer in ever-younger Americans.  Epidemiologists from Case Western Reserve University studied cancers, both obesity-related and non-related, that were documented in the worldwide SEER18 database over the first 16 years of the 21st century.  They focused on the age of the cancers at diagnosis.

The data included some 6 million cancers.  While the incidence of cancer either remained the same or diminished in the 20 to 49 year and the 65 or older age groups, it increased for those in the 50 to 64 year age group.  In this group, the occurrence of obesity-related cancers was significantly higher than that for non-obesity related cancers.

The obesity-related cancers are gastrointestinal at all sites, breast, ovarian, kidney, thyroid, and myeloma.   Avoidance of these devastating cancers as well as heart disease, diabetes, and stroke is the reward for keeping your weight in a healthy range by moderation in eating and exercise.

Koroukian SM, Dong W, Berger NA. Changes in Age Distribution of Obesity-Associated Cancers. JAMA Netw Open. Published online August 14, 20192(8):e199261. doi:10.1001/jamanetworkopen.2019.9261.

#Obesity #cancer #middleage 

Vidcast:  https://youtu.be/WaX8zsaB2Xg

Recovery from breast cancer surgery is challenging, and much work is needed to regain arm strength, shoulder mobility, and freedom from arm swelling.  A Spanish meta-analysis, just published in the European Journal of Cancer Care, shows that Nordic walking has a significant, positive impact on arm edema, physical fitness, disability, and patient optimism.

The investigators reviewed 4 randomized, controlled studies and 5 before-after studies.  Although the duration of Nordic walking exercise varied widely between studies, this type of exercise reduced arm circumference and extracellular edema fluid, improved upper body strength, increased shoulder range of motion, and improved quality of life.

Although many of the study methodologies could have been better, the overall conclusion is that Nordic walking withworld-wide  ski-type poles is a valuable addition to rehabilitation therapy after breast cancer surgery.

Miguel A. Sánchez‐Lastra Jorge Torres Iván Martínez‐Lemos Carlos Ayán.

Nordic walking for women with breast cancer: A systematic review.  European Journal of Cancer Care. 06 August 2019.  https://doi.org/10.1111/ecc.13130

#Breastcancer #Nordicwalking #lymphedema #rehabilitation

Vidcast:  https://youtu.be/WRdLs2fhXtY

Nearly 90% of American stroke victims with large blood vessel blockages receive less than optimal care.  That statistic is even worse for minority populations suggesting healthcare racism.

Mayo Clinic neurology researchers reviewed more than 200,000 admissions to some 173 medical centers over the most recent 2 year period.  Despite widespread professional acknowledgement that large vessel clot removal is the most effective therapy for acute ischemic strokes, this so-called mechanical thrombectomy occurred in only 8.4% of patients overall.  Only 7% of minority patients were so treated compared with nearly 10% of white and non-Hispanic patients.

More than 800,000 strokes occur in the US every year.  Studies have shown that prompt, aggressive therapy with clot dissolving medications and/or mechanical clot removal leads to the best outcomes.  

That care only occurs if a stroke is recognized.  To spot a stroke, remember FAST.  Face drooping, Arm weakness, Speech difficulty, and Time to call 911.

If you or a member of your family is prone to stroke due to age, high blood pressure, or cholesterol problems, do a little online research and find which local hospitals offer the best stroke care.  This includes a specialized stroke ambulance service, since stroke care can never begin soon enough.

Lorenzo Rinaldo, MD, PhD; Alejandro A. Rabinstein, MD; Harry Cloft, MD, PhD; John M. Knudsen, MD; Leonardo Rangel Castilla, MD; Waleed Brinjikji, MD.  Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke: Analysis of Data From 2016 to 2018.  Stroke. 2019;50:00-00. DOI: 10.1161/STROKEAHA.118.024651.

#Stroke #thrombectomy

Vidcast:  https://youtu.be/4VSFYpvclCQ

A VR trip to far-off lands or a challenging VR adventure game may curb pain without the risks of medicine.  UCLA researchers proved that point by quantitating the pain of 120 hospital patients half of whom were randomized to use virtual reality headsets three times a day for a two day study period.

Those treated to the VR sessions recorded nearly 4 times less pain than controls.  Those with the most severe pain recorded a 3 fold reduction in their discomfort.  The VR helped a broad range of surgical pain including gastrointestinal, musculoskeletal, and neurologic.

Virtual reality is being employed in an ever broader group of medical applications.  I’ve reported its use for treating phobias, but it is also in current use teaching medical students and nurses, training surgeons, interpreting xrays and scans, planning radiation therapy and surgery, speeding rehabilitation, and enhancing telemedicine.

PLoS ONE, online August 14, 2019. https://doi.org/10.1371/journal.pone.0167523

https://medicalfuturist.com/category/virtual-reality

#VR #virtualreality #pain