Paging Dr. Frischer: Pet allergies

My wife grew up with her beloved Mittens the cat…and a box of tissues always within reach.

Some 10% of us are allergic to dogs, and cat allergies affect about twice that many. Some of us also react to birds, rabbits, guinea pigs, ferrets, and rodents.

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Why do allergies afflict us? Our immune system produces antibodies to fight off harmful germs. An allergen is a normally harmless substance, but for those with allergies, it triggers the immune system to react. This can lead to symptoms like itching or watery eyes, runny nose, coughing, sneezing, wheezing, asthma and eczema. Interestingly, allergic reactions can change
over time and even disappear. As we age, some of us leave our hay fever, pet allergies and food allergies behind.

It is actually the proteins found in a dog or cat’s dander (tiny flakes of skin), and not their fur itself, which cause allergic reactions. Dander is also found, in smaller quantities, in an animal’s saliva and urine. Dander can be carried on our clothes, circulate in the air, settle in furniture
and bedding, and stay behind on dust particles. In addition, pet hair or fur can collect pollen, mold spores and other outdoor allergens.

What can we do to reduce the symptoms of pet allergies? The best treatment is to avoid contact with cats, dogs, and the spaces they live in. Keep pets out of your home or especially your bedroom, and avoid visiting homes with pets. However, if a pet-free household is not an option:

■ Washing a dog weekly can reduce the dust and dander significantly. Regular human shampoos are not the best choice; a dog’s skin might become dry or irritated, leading to more sloughing of dead skin cells.

■ Keep your home clean. Clean furniture covers, carpets, drapes, and pet bedding often. Keep the pet off of your bed, and consider using air purifiers.

■ Medication for the human can help, including over the counter products like Benadryl, Claritin, Allegra, and Zyrtec.

No pet is 100% hypoallergenic. All dogs produce dander, including hairless ones, but low shedding dogs tend to release less dander. Some of the better dog breeds for allergy sufferers are poodles and many poodle mixes, Portuguese and Spanish water dogs, terriers, bichon frise, Chinese crested, Irish water spaniel, Maltese, standard schnauzer, Italian greyhound, and havanese.

Some of the better cat breeds for allergy sufferers are Siamese, Balinese, Siberian, Bengal, Burmese, colorpoint and Oriental shorthair, Cornish and Devon rex, Javanese, and sphynx.

Pets can be such a wonderful and healthful part of our lives. When seeking a new member of your family, I encourage you to research allergenic potential along with the animal’s size, personality, and other qualities.

Paging Dr. Frischer: Advances in diabetes

More than one in every 10 adults in the United States has diabetes. I repeat: more than one in every 10 adults has diabetes. That comes to 29 million Americans, including some eight million who may be undiagnosed and unaware. 

It can be a devastating disease; monitoring, managing, and treating it is difficult, challenging, and costly. Thankfully, this is an exciting time with new advances in the field.

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How does a healthy, diabetes-free body operate, and why is a properly functioning pancreas so important? Hormone levels (including insulin, glucagon, and others) rise and fall to keep our blood sugar (glucose) in a normal range. Normally, blood sugar levels rise after we eat. Cells in the pancreas then release insulin, enabling the body to absorb glucose from the blood and lowering blood sugar levels back to normal. 

Then, when blood glucose levels are low, the hormone glucagon is released from the pancreas and signals the liver to release glucose back into the blood.

For those with type-2 diabetes, the body builds up resistance to insulin and increasingly greater amounts are necessary in order to bring down blood glucose levels. As the disease advances, the pancreas produces even less insulin. 

With type-1 diabetes, the pancreas doesn’t produce enough insulin, and needs additional insulin injections to bring down the blood sugar levels. Type-2 diabetics often use non-insulin oral or injectable medications or, if that is not effective, insulin injections.

In 2016, the FDA approved the first artificial pancreas. This artificial pancreas is initially being used for Type 1 diabetics, with the more common Type 2 diabetics to follow. The device continuously monitors blood sugar levels and supplies insulin automatically when sugar levels get too high. 

There is constant communication between the monitoring and the infusion devices. The goal is to reduce high blood glucose levels (hyperglycemia) and minimize the incidence of low blood glucose (hypoglycemia) with little or no input from the patient, and to allow a diabetic patient the opportunity to live a “normal” life!

Another recent potential advance in diabetes treatment is a digital contact lens. Patented in 2014 by Google, and in partnership with the pharmaceutical company Novartis, it measures blood glucose levels from tears. Microchip sensors are embedded between two layers of lens material, and a tiny hole allows tear fluid to seep into the sensor, which then measures blood sugar levels. 

A thin wireless antenna transmits the data to a phone app. When blood glucose levels approach dangerous levels, the app notifies the user to act by consuming sugar, injecting insulin, or contacting a physician. 

As with the artificial pancreas, it could eliminate the need to take blood samples (usually through a finger poke) several times a day, and could potentially greatly lower the cost of monitoring blood sugar levels.

We live in exciting times. Stay tuned for these and other advances in diabetes management. 

Dr. Alan Frischer is the former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Hand Washing

I recently addressed a class of 6th graders on the topics of germs and hygiene. As you can imagine, we spent much of the time discussing the importance of hand washing, which in turn led to the subjects of soap, water, and antibacterial cleaners. What’s new in the scientific literature?

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Hygiene plays a significant role in how frequently we get sick. The data is rather depressing regarding hand washing after using a public toilet. Studies show that women are better at it than are men: roughly 62% of women wash after using the bathroom, while only 40% of men do. Even worse, only 5% of all people wash correctly. I’ll get back to that.

A recent study out of the University of Maryland looked at hand sanitizers vs. soap and water. The hands of participants were deliberately exposed to E. coli. Then, one of the following was used for cleansing: alcohol-based hand sanitizer, non-alcohol based hand sanitizer, plain bar soap, or liquid antibacterial soap. Twenty seconds were counted out for each washing (note
that most people spend five seconds with their hands underwater – if they wash at all).

The results? Alcohol-based hand sanitizers worked better than those without alcohol. Antibacterial soap worked only slightly better than regular soap. Washing with soap and water is the first choice, however, especially if the dirt on your hands is visible. Sanitizers do not actually remove the dirt. However, hand sanitizers are indeed more effective than soap and water in eliminating germs.

The bottom line is that technique is actually more important than which product is used.

Just to make it more complex, however, note that the *overuse* of hand sanitizers and antibacterial soap is not a good thing, as not all germs are bad - many are protective.  The overuse of antibacterial products can encourage bacterial resistance, making it more difficult to fight the harmful germs when we really need to.

To properly wash hands with soap and water:

■ Wet the hands with running water (the temperature makes little difference), and add soap.

■ Rub the hands together, making a soapy lather. Wash the fronts and backs of the hands, between the fingers, under the nails, and around the wrists *for at least 20 seconds (the “ABC” song, or two rounds of “Happy Birthday”).

■ Rinse the hands well under running water.

■ Dry the hands thoroughly with a clean towel or air dryer.

■ Turn off the water with a clean paper towel or an elbow.

Soap and water are not always available or convenient. To properly use hand
sanitizers:

■ Apply the hand sanitizer to the palm of one hand

■ Rub the hands together, spreading it over all surfaces of the hands and fingers until dry.

Always wash hands before preparing food or eating, treating wounds, dispensing medicine, caring for a sick person, inserting contact lenses, or touching your eyes, nose or mouth. Wash your hands after using the toilet, preparing food (particularly raw meats), changing a diaper, touching an animal, blowing your nose, coughing or sneezing into your hands, treating wounds or caring for the sick, handling garbage, household or garden chemicals, handling dirty towels, or shaking hands with others.

My talk to the 6th grade class was a good reminder to me and to the parents in attendance, as well as to my target audience. Germs are all around us. Some of the germs can cause illness. Please pay attention to your cleansing routine.

Until your hands are truly clean, keep them away from your eyes, nose and mouth…and from everyone else.
 

Paging Dr. Frischer: Bug bites

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This has been a banner year for insect bites, and I’ve been hearing many more complaints from patients. It’s likely that our last long wet winter, followed by warm weather, is responsible. 
Which insects are causing the problem, and what can we do about it?

■ Mosquitoes are the most common source of bites. In fact, there is a new invasive and aggressive species found here in Southern California called Aedes aegypti, They are black with white stripes, and don’t behave like typical mosquitoes. They will aggressively follow their victim, and bite during daytime hours, unlike the typical dusk biting behavior of most other mosquitoes. 

For the most part, mosquitoes are found near standing water, even very small quantities of water, where they breed. Their bites cause local pain, itching, swelling and redness. Typically, within 20 minutes there is an itchy bump. It peaks within two to three days, and then goes away. 

Some people, particularly young children and highly allergic people, can develop dramatic swelling surrounding the bite, and even a low-grade fever (often mistaken for cellulitis). 
Mosquitoes pose an additional problem; they can transmit serious diseases. Locally, there have been cases of West Nile virus, St. Louis encephalitis, and Zika virus. Worldwide, they also transmit malaria, yellow fever, dengue fever, La Crosse encephalitis, and chikungunya virus.

■  Spider bites pose a variety of problems, depending on the variety of the spider. Symptoms of bites can include itching, rash, bite site and muscle pain, sweating, trouble breathing, headaches, nausea and vomiting, fevers, chills, anxiety, restlessness, and even high blood pressure. 

Venomous spiders found in the United States include the black widow, brown recluse, and hobo. Although they are especially dangerous to those who work outdoors, we all know that they do occasionally find their way inside. 

Stay calm, wash the skin with soap and water, apply cold water or ice, elevate the bite, attempt to identify the type of spider, and see your doctor if necessary.

■ Ticks can transmit several infectious diseases, including Lyme disease (which is rarely seen in California).

■ Flea bites are usually only a nuisance. It’s possible for the site to become infected, though, by scratching that annoying itch!

■ Houseflies can’t actually bite. They can, however, transmit intestinal infections in conditions where the water and general hygiene are poor.

Some insects can cause a general (systemic) allergic reaction. These are uncommon but can be caused by mosquitoes, ticks, fleas, blackflies, deerflies, louse flies, horseflies, centipedes, kissing bugs, and notably…by the sting of a bee. 

The most serious (but rare) generalized allergic reaction is anaphylaxis, with hives, wheezing, vomiting, low blood pressure, and even loss of consciousness. Anaphylaxis needs immediate treatment with epinephrine. Anyone with a history of anaphylaxis should see an allergist for further education and evaluation, and carry an epinephrine autoinjector.

How much trouble should we go to in order to prevent insect bites? It depends on how significant the risk is. If we travel to a foreign country where a mosquito bite can lead to malaria, then it is critical to protect ourselves. 

Strong chemical products (like DEET and Permethrin) are very effective. However, milder insect repellents may be enough in areas with lower levels of disease. Botanical oils, including sandalwood, geranium, and soybean, have been used to repel mosquitoes and ticks. However, they aren’t nearly as effective as DEET or permethrin.

Of course, for those simple insect bites, treatment focuses on the relief of symptoms. Wash the area with soap and water. Reduce any local swelling with ice or a cold pack. Reduce any itching with a topical cream (containing calamine, steroids, or pramoxine), or an oral medicine (products like Claritin or Dimetapp can help during the day, and an antihistamine like Benadryl can help at night).

Whether at home or away, know your risks, and take measures as needed to protect yourself.
Dr. Alan Frischer is
former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Abdominal Aortic Aneurysm

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AAA means one thing to a driver with a flat tire, but quite another to someone with a dilated aorta. 


If you are a man older than 50, you run roughly a 4-7% chance of having an abdominal aortic aneurysm (AAA), and if you are a woman over 50, your odds are closer to 1%.


The aorta is the largest artery in the body, and it carries oxygen-rich blood away from the heart and supplies it to the rest of the body. The problem with an aortic aneurysm is not simply that it is a swelling of the aorta, but that as it grows larger, the risk of the aorta rupturing becomes significant. 


Usually there will be no symptoms before it ruptures, and it may not be possible to have immediate emergency surgery in time to repair it. The risk for rupture depends on the size of the aneurysm, and if it does rupture, 75% to 90% of the time it is fatal. In the United States, ruptured AAA is estimated to cause 4-5% of all sudden deaths. Therefore, screening is critical for those at high risk.


Typically, an AAA is found when an exam is performed for another reason. A doctor may feel a pulsating bulge in the abdomen, or it might be detected through computed tomography (CT), magnetic resonance imaging (MRI), or abdominal ultrasound.


So, should we all be routinely screened? The answer is complicated. The majority of aneurysms never rupture. As the number of screenings increase, so will the number of previously undiagnosed small aneurysms that are unlikely to ever rupture. Elective surgery can prevent aneurysm rupture, but every surgery always carries with it some level of risk. And, since the patient who is most likely to have an AAA is older, the risk that
accompanies surgery is even greater. 


Surgical repair is typically considered an option only for aneurysms that have reached five and a half to six centimeters in size. Imagine knowing that you have an aneurysm of “only” five centimeters! Would it feel like a ticking time bomb? You can see how challenging those borderline cases can be.


Current recommendations suggest that men between the ages of 65 to 75 who have ever smoked cigarettes should have a one-time screening for abdominal aortic aneurysm, using abdominal ultrasound. In addition, men aged 60 and older with a family history of abdominal aortic aneurysm should consider regular screenings. 


On the other hand, the statistics don’t support screening of women smokers ages 65 to 75, or those with a family history. The reason is that when lower risk populations (such as women) are screened for AAA, they are twice as likely to undergo elective surgery within three to five years. While the risk of death from elective surgery is far lower than the risk of death from rupture, many of these elective surgeries are unnecessary, and pose needless risk.


The goal of treatment is to prevent a rupture. If the abdominal aortic aneurysm is too small to justify elective surgery, then it can be monitored. Monitoring would include annual x-rays, controlling blood pressure (which relieves the stress on weakened arteries), not smoking cigarettes, getting regular exercise, limiting alcohol, and eating a healthy diet. To regular readers of my columns, most of this list should look pretty familiar! 


Speak with your doctor about whether you are a candidate for screening.
 

Kaiser hospital in Downey receives 'A' grade for patient safety

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DOWNEY -- Kaiser Permanente Downey Medical Center once again received an “A” grade for their dedication to patient safety by The Leapfrog Group in its fall 2017 Leapfrog Hospital Safety Grade.

“Patient safety is so important to us and we’re constantly working to ensure our patients are safe while under our care, so we’re extremely proud that our hard work has led to us earning recognition in Leapfrog’s Hospital Safety Grade,” said Jim Branchick, senior vice president and area manager, Kaiser Permanente Downey Medical Center.

“Members gain more confidence in Kaiser Permanente's patient-centered, physician-led system knowing that they’re receiving care at one of the nation's safest hospitals.”

“Physicians and staff here at our medical center utilize advanced technology, along with carrying out the highest safety standards, all while delivering exceptional care that Kaiser Permanente is known for,” added Binesh Batra, MD, area medical director, Kaiser Permanente Downey Medical Center.

“Receiving high marks from the Leapfrog Group is a testament to Kaiser Permanente’s commitment to quality health care and patient safety.”

Along with Kaiser Permanente Downey, nine other Kaiser Permanente Southern California hospitals received Leapfrog’s “A” rating, including medical centers in Anaheim, Baldwin Park, Fontana, Irvine, Moreno Valley, Ontario, Panorama City, West Los Angeles and Woodland Hills. 

Developed under the guidance of Leapfrog’s Blue Ribbon Expert Panel, the Leapfrog Hospital Safety Grade uses 30 national performance measures to produce a single letter grade representing a hospital’s overall performance in keeping patients safe from preventable harm and medical errors.

The Leapfrog Hospital Safety Grade methodology has been peer reviewed and published in the Journal of Patient Safety.
 

Paging Dr. Frischer: Overeating

Thanksgiving is one of my favorite holidays. It reminds me to focus on gratitude, and to spend time with dear family and friends. For most of us, it’s also about…the food. 

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Do you leave the table feeling tired, bloated, overstuffed? This holiday marks the beginning of a food glut. We bake cookies, pies, and fruitcakes; give gifts of chocolates; go to parties; and gather for holiday meals. Is pigging out during the holidays a harmless
indulgence, or a real health concern?

Every morsel of food we ingest, whether part of a Thanksgiving feast or a small healthful snack, travels through the body and causes the release of hormones, chemicals, and digestive fluids. The average meal takes between one and three hours to exit the stomach. A large meal can take between eight and 12 hours! On a typical day, the average American consumes about 40 to 50 grams of fat in about 2,000 calories. I find it shocking that those figures can skyrocket to some 4,500 calories and 230 grams of fat on Thanksgiving Day.

The obvious side effects of overeating include indigestion, flatulence, post-meal fatigue (food coma), and perhaps that extra pound or two. However, there can be a more significant price to pay for eating vast helpings of turkey, stuffing, and candied sweet potatoes:

·Overeating makes our bodies work harder. To process the extra food, the heart pumps more blood to the stomach and intestines. At the same time, heavy fat consumption may lead to a higher risk of blood clots. The risk of heart attack surges, with some studies showing a four-fold increased risk of heart attack, two hours after consuming a large meal.

·As the stomach releases food into the intestines, the gallbladder squeezes out bile to help digest the fat. The extra demand for bile may result in a gallstone or sludge being painfully squeezed into the narrow duct that leads to the intestine.

·A large meal can trigger the release of norepinephrine, a stress hormone that raises blood pressure and heart rate.

·For a diabetic, a large meal will not only increase blood sugar levels, but will also impair the ability to process those sugars.

·For those who are prone to heartburn, a large meal can lead to painful gastric reflux.

·Consider that the average stomach holds about eight cups of food. When it is stretched, chemicals are released that inform our brain that we are full. Many of us ignore that signal and just keep on eating. At some point the body will send out nausea signals. Continuing to eat, and stretching the stomach beyond its capacity, can (but very rarely does) lead to an actual rupture!

Here are some classic suggestions for the upcoming holiday season: Don’t arrive at the meal ravenous. Eat slowly and consume lots of filling foods with a high water content, such as soups, salads, and other vegetables and fruits. 

If you are hosting, use smaller plates. Keep the serving dishes in the kitchen, not on the table. Use smaller serving spoons and serving dishes. Serve foods that require utensils (as we tend to overeat finger foods). And finally…push away from the table before you feel completely full, and take a relaxing, sociable walk after dinner.
 

Paging Dr. Frischer: Hepatitis C

Recently, a number of my patients have been mentioning to me a commercial they have seen, instructing them to get a blood test for Hepatitis C.

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Indeed, Hepatitis C has been all over the media lately. As a proud Baby Boomer (those of us who were born between 1945 and 1965), I was surprised to find that the CDC (Centers for Disease Control) is now recommending that all Baby Boomers be tested for Hepatitis C. One in 30 of us have the virus, and most are unaware of it.

Why has this become so important? Science has finally caught up with Hepatitis C, and there is actually a cure! Testing and treating can now make a huge difference.

Hepatitis C is a serious, blood borne infection, and an estimated 3.2 million Americans are living with it. Many have had it for years, or even decades, without any obvious outward symptoms. Although it can be a quiet disease, if left untreated, it may be causing serious damage to the liver, including cirrhosis, liver failure, or even cancer. Currently, there are more deaths annually from Hepatitis C than from HIV.

Why have Baby Boomers been singled out as being at higher risk? Estimates show that a whopping three out of every four people with Hepatitis C were born during those baby boomer years. Evidently, many Boomers were infected in the 1970s and 1980s, when infection control was not up to today’s standards. Note that the Hepatitis C virus wasn’t even identified until 1989, and blood donations weren’t screened for it until 1992. Because it can take up to 30 years for signs of Hepatitis C to appear, Boomers may only now be experiencing symptoms.

Are you at risk for getting Hepatitis C? The virus is primarily spread through contact with very small amounts of blood from an infected person, and can live outside the body for up to three weeks. 

It may be spread from a blood transfusion (prior to 1992) or from other blood products; unsterilized tools at a tattoo parlor; past recreational drug use which used shared needles; from infected medical equipment or procedures (rarely); and possibly from shared personal items that may have had small amounts of infected blood on them, such as razors or toothbrushes. It is even possible to contract the virus from blood that comes into contact with one’s skin, and then enters the bloodstream through a cut or opening.

Hepatitis C is now screened through a simple blood test known as the Hepatitis C Antibody Test. Testing is recommended for all Baby Boomers, for those who currently or have ever injected drugs, for those who received blood products before 1987, for those who have ever been on hemodialysis, for those who had an organ transplant before 1993, for those with HIV, and for those with elevated liver function tests.

As a health care professional, I find it to be truly amazing that Hepatitis C is now curable. In fact, newer treatments offer cure rates of about 95%!

If you are a baby boomer, or have any of the other risk factors listed above, I urge you to speak with your doctor and get tested.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

What is a chakra?

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Today we begin with the first of a seven-part series dedicated to the understanding of the chakras. Whirling energy centers that control and energize our body and internal organs. 

The chakras are energy vortices, which have physical, psychological, and spiritual functions. They absorb and process life force from the sun, air, water, and earth. Feeding our physical body and internal organs with restorative energy. Once the life force is consumed the chakras expel the byproduct. 

They resemble a flower with many petals. Rotating clockwise and counter-clockwise simultaneously. The speed in which they rotate depends on the health of the chakra.

In the field of oriental medicine like acupuncture. It is believed that most of the ailments we suffer from stem from imbalances in the chakras and energy body. Keeping our energy centers clean and energized through meditation, prayer, exercise and healthy eating habits will promote a healthier and happier state of being. 

The study and application of life force falls under complementary medicine, meaning it is not meant to replace any treatment your medical doctor prescribes rather compliment it. 

Have a question regarding this article or maybe you’d like to suggest a topic? Write to me at: m_arrieta@yahoo.com. Next article we will talk about the crown chakra. 

Marcela A. Arrieta is an alternative modality practitioner with over five years of experience in this field. She is also a successful entrepreneur who resides in Downey.
 

Medicare Advantage plan shopping misconceptions and how to avoid them

By Rick Beavin, Market President, Humana

The Medicare annual election period takes place from Oct. 15 through Dec. 7. It’s a time for people with Medicare to make important decisions about their health care – just ask the 17.7 million people who decided on a Medicare Advantage plan in 2016.

There are many factors to consider so that you get the Medicare plan that best meets your health and budget needs.

To navigate your health care options during this year’s annual enrollment period, it is important to remember what not to do.
 
When researching Medicare plans, people often focus on premiums and medical provider networks, but may not realize there’s more to consider. Knowing the benefits offered by Medicare Advantage plans and Medicare Prescription Drug Plans, both of which offer enhancements to Original Medicare, will also be pivotal in your decision making.

While Medicare Advantage provides the same coverage as Original Medicare, Medicare Advantage plans often also include predictable copayments, lower or no deductibles, Part D prescription drug coverage, out-of-pocket limits for financial protection, and low or even zero monthly plan premiums.
 
Some of these plans offer additional features designed to meet members’ needs, such as dental, hearing and vision coverage, a nurse advice line available 24 hours a day/7 days a week and fitness programs.
 
Here are five common hiccups Medicare beneficiaries may experience when considering their options in search of a Medicare Advantage plan that will help them achieve better health and well-being:

1.) Your monthly payments are not the only thing to consider. While it’s tempting to gravitate to a $0 or low-premium monthly plan, it’s easy to overlook extra costs that can be incurred down the road, such as for hospital stays and medical procedures. After you analyze your previous year’s plan and assess the most affordable option for the coming year, consider the total value of the Medicare plan you select, along with your health, medical and budget needs for the coming year.

2.) Your drug coverage is not the same everywhere. Surprisingly, drug prices can vary depending on your location, pharmacy and how much you’ve used your prescription benefits over the course of the year. Be diligent by making a list of your medications; researching drug formularies – the list of drugs a Medicare prescription plan covers; and considering mail-order as you evaluate your prescription drug plan options. Some plans may offer lower costs if certain pharmacies are used.

3.) Your plan is not just for medical visits or emergencies. If you are living with a chronic condition, you may want to look for plans offering personalized care in the forms of health coaching, education and support by registered nurses and other health professionals. Many Medicare Advantage programs also offer benefits, such as fitness programs, to help members maintain a healthy, active lifestyle.

4.) You may not need the same plan as your spouse/significant other. Health needs vary, and what works in your Medicare Advantage plan may not be the best option for your spouse. It’s important for the two of you to sit down and assess your different health needs, health care providers and if your doctors will be covered in your plan. This ensures your Medicare plan makes sense for your individual health, budget and lifestyle.

5.) You’re not on your own in making this decision. Utilize resources, such as a licensed Medicare health insurance agent, Medicare.gov or Humana.com/Medicare, to help identify the best plan for you. Starting in October, you can also call 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048 24 hours a day, seven days a week for 2018 Medicare plan information. Or you can call Humana at 1-888-204-4062 (TTY users can use 711).

Understanding the resources and tools at your disposal will allow you to take “advantage” of all the benefits Medicare plans have to offer in 2018.

Paging Dr. Frischer: Colon cancer screenings

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When my patients turn 50, I routinely recommend that they have a colonoscopy to screen for colorectal cancer. Not surprisingly, my generous offer is sometimes rejected. Patients express concern over drinking the prep, having general anesthesia, or undergoing the procedure itself.
 
This fact has not escaped the medical field, and new recommendations have been issued. Various highly respected organizations, including the American Cancer Society and the US Multi-Society Task Force, currently issue guidelines on colorectal cancer screening. All recommend routine screening for colorectal cancer and polyps, usually starting at age 50 and continuing until about the age of 75. 

What is colorectal cancer? It’s a disease in which abnormal cells in the colon or rectum divide uncontrollably, forming a malignant tumor. Most begin as a polyp, a growth in the tissue that lines the inner surface of the colon or rectum. Polyps are common in those over 50, and the vast majority of them are not cancerous.

However, the type of polyp known as an adenoma has a higher risk of becoming a cancer. Aside from skin cancer, which is the most common but rarely fatal form of cancer, colorectal cancer is the third most common cancer (following prostate and lung in men, and breast and lung in women).

Death rates are declining due to more screening and to a reduction in risk factors, such as a decrease in cigarette smoking. Other risk factors include a family history of colorectal cancer or a familial polyposis condition, inherited Lynch syndrome, older age, excessive alcohol use, obesity, lack of physical activity, inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, and possibly diet. 
    
There are several screening tests developed to help detect colorectal cancer early, when it may be more treatable. In fact, screening can act as a form of cancer prevention as well: some tests detect precancerous polyps, which can be removed.

The standard test continues to be the colonoscopy. The rectum and entire colon are examined with a colonoscope, a flexible lighted tube with a lens for viewing and a tool for removing any abnormal growths. A thorough cleansing of the entire colon is necessary before this test, which is done by drinking large amounts of a laxative prep solution. Sedation is necessary. 

An alternative visualization test is the sigmoidoscopy. This uses a shorter scope that can only view the rectum and the sigmoid colon, which is about one-third of the entire colon. It takes less time, and sedation is usually not necessary, but any cancers beyond the sigmoid colon may be missed. 

There are a few other methods used for visualizing the colon, including computed tomographic (CT) colonography and double contrast barium enemas. The colonography is rarely done because it is expensive and still requires follow up with a regular colonoscopy if polyps are found. The barium enema is also seldom used, as it is less sensitive in detecting small polyps and cancers. 

Other tests mainly detect cancer (but not polyps) and are less invasive, using stool samples to detect the presence of blood. Two of these tests are approved by the FDA: the FOBT (Fecal Occult Blood Test), and the FIT (Fecal Immunochemical Test). Note, however, that there are other reasons why blood might be in the stool, so this is by no means a definitive test for cancer. If positive, it still needs to be followed by colonoscopy and possibly endoscopy. 

Cologuard is a new stool DNA test, approved by the FDA. It detects tiny amounts of blood in stool, similar to the FIT test, as well as nine DNA biomarkers that have been found in colorectal cancer and precancerous advanced adenomas. So, this test can detect some forms of precancerous growths. Of course, any positive test will yet again lead to a colonoscopy. An increasing number of insurance companies, including Medicare, are now covering this test.

Which test is right for you? The standard colonoscopy is still the gold standard. It allows the doctor to view the rectum and the entire colon, and a biopsy can be taken during the test. The disadvantages are that it can still miss some small polyps, flat or depressed growths, and even cancers.

The quality of the results depends on a thorough cleansing of the colon, as well as the skill and patience of the gastroenterologist. A liquid diet, prep, and sedation are necessary. Someone needs to accompany the patient to and from the procedure, and the patient may need to miss a day of work. 

In June of 2017 the US Multi-Society Task Force on Colorectal Cancer issued updated screening recommendations. The most effective choices are:

•    Colonoscopy every ten years, or
•    Annual FIT / FOBT

Less effective choices, but better than doing nothing, are:

•    CT colonography every five years, or
•    FIT or fecal DNA every three years, or  
•    Flexible sigmoidoscopy every five-ten years 

My bottom line? It is absolutely critical that we all select a screening test, and be re-tested on a regular basis. I urge everyone between 50 and 75 to be screened for colorectal cancer, because this is a common cancer and one that can often be treated or prevented.
 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Travel and Safety

Every day my patients tell me of loved ones they see infrequently, due to serious concerns over travel safety. It’s true that all modes of transportation render us powerless to some degree. Just how safe is it to travel?

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Let’s start with motorcycles. They are fun to ride, can be economical, and afford the rider a great sense of independence and freedom. On the other hand, even with safety gear, the rider is not well protected. When a motorcycle is involved in a collision with another vehicle, the motorcyclist invariably receives more serious injuries.

In fact, the ratio of motorcyclist fatalities to those in the other vehicle is a whopping 70:1. Motorcycles account for only 1% of road traffic, but 20% of road fatalities. Bottom line? 123 deaths per billion miles travelled.

Walking is good for us for so many reasons. Statistics show 41 deaths per billion miles travelled. These deaths are largely due to encounters with cars.

We hear about road rage against bicyclists. However, the data shows that riding a bike is safer than walking, at 35 deaths per billion miles travelled. As with walking, almost all bicyclist fatalities involve automobiles.

Ferries come in at 20 deaths per billion miles travelled, and represent the most dangerous mode of public transportation.

Cars represent the most common form of transportation. There are just four deaths per billion miles travelled. Because private individuals operate the vast majority of cars, this risk is highly dependent on personal behavior. Unlike commercial vehicles, where passenger health is in the hands of a “trained professional,” the risk to a car’s driver or passenger varies considerably, depending on the driver’s gender, age, mood, distractions, alcohol and drug consumption, and the type of road.

Men are three times more likely to die in a car accident than women, and those between 18 and 29 are at a 50% to 90% greater risk. Seat-belt use is critical: half of vehicle occupants who die in automobiles and light trucks are not wearing seat belts (or using child safety seats). Alcohol plays a role in approximately a third of all highway fatalities.

Buses are extremely safe, coming in at 0.5 deaths per billion miles travelled. Scheduled and charter service accounted for 44% of these fatalities, with the balance occurring in school buses (23%), urban transit (11%) and a variety of private shuttles, church buses and others (22%).

Travel by airplane also comes in at only 0.5 deaths per billion miles traveled. There is a 1 in 45 million chance of dying on an airplane. Note that the vast majority of aviation fatalities (85%) involved private aircraft.

Excluding acts of suicide and terrorism, commercial aviation is tied with buses as the safest mode of travel in the United States. For every billion miles travelled by air, we would be more likely to be attacked by a shark, struck by lightening, be a billionaire, or become President of the United States.

Can you guess the safest mode of transportation? There are 0.2 deaths per billion miles traveled on trains. Mainline railroads average 876 deaths a year. The majority of deaths involve people and vehicles not at grade crossings, and a significant portion of those deaths may be suicides.

Let’s end with this: travel by space shuttle! There have been 530 people who have ever been on a space shuttle. As a result of the Challenger and Columbia explosions, there have been 18 deaths. So, at seven deaths per billion miles travelled, a space shuttle does come in as more dangerous than driving a car.

My message? Live your life and use common sense, and perhaps avoid – for now – planning your next trip on a space shuttle.
 

Paging Dr. Frischer: Sleep Myths

I’ve heard it all – through the years, my patients have expressed a large variety of misconceptions about sleep. Since we spend about one-third of our lives sleeping, let’s discuss some common sleep myths.

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The myth I hear most often is that *adults need less sleep as we age*. The thought is that as we age we are less active, and therefore require less sleep. Actually, sleep experts believe that we need the same amount of sleep that we did when we were younger adults. We often do get less sleep with age, but that may be because we develop sleep disorders such as insomnia or sleep apnea, or find ourselves getting up frequently to urinate. Age leads to fragmented sleep, which results in fewer sleep hours during the night, and that (plus retirement!) results in more daytime naps. The net outcome is that we get less REM, or deep restorative, sleep.

Do we really* all need eight hours of sleep?* According to the National Sleep Foundation, adults need somewhere between 7 to 9 hours of sleep each night. The current national average is about seven hours per night. Studies show that fewer than six hours of sleep is associated with a higher mortality rate. Sleep deprivation has been linked to health problems including obesity and high blood pressure, negative mood and behavior, decreased productivity, and safety issues in the home, on the job, and on the road. While many of us will claim that we do fine on fewer hours of sleep, objective measures of alertness reveal that we do not.

Can we just *catch up on sleep over the weekend?*  Studies suggest that it takes more than two days to get back to a rested state. While getting extra sleep is helpful, the pattern of going to bed and waking up at different hours (constantly resetting our circadian clock) may also make falling and staying asleep more difficult.

Many people fall asleep while watching TV. The myth is that the *TV can help us to fall asleep. *The fact is that the bright screen, varying volumes, and changing lighting will more likely prevent us from falling asleep, wake us in the middle of the night, and damage the quality of our sleep. Or, the program might actually be interesting, which will keep us awake. If background noise is the goal, use a fan instead, or a white noise generator. A basic rule of sleep hygiene is to train the brain and body to associate the bedroom with sleep alone.

Another common myth is that *nighttime exercise will help achieve better sleep*.  It is indeed true that people who exercise regularly sleep better. However, when we exercise too close to bedtime it prompts our system to release adrenaline, increases the heart rate, and raises the core body temperature – which all work against sleep. As a rule, avoid aerobic exercise within at least one or two hours before bedtime. (Light stretching or yoga is OK.) Please *do* add exercise to your lifestyle, but morning time is generally best.

We have all heard that drinking a *warm glass of milk or herbal tea helps us to fall asleep*. Milk contains tryptophan and herbal teas contain relaxing herbs, including Chamomile, Valerian, St. John’s Wort, and Lavender, so this may be true. A light snack to accompany your milk or tea at bedtime may also be helpful, but don’t go to bed hungry or on a full stomach. Beware of bacon, ham and aged cheeses – they may keep us awake due to tyramine, which promotes the release of norepinephrine. Chocolate, unfortunately, contains caffeine and so is not a good snack before bed either. A balanced snack with protein and complex carbohydrates (like cheese and crackers, or a nut butter on whole wheat bread) may be the best bet for sleep.

Many people believe that *drinking alcohol will put them to sleep*. However, as the body metabolizes alcohol, the chemicals break up the quality of sleep. While a drink or more will generally help us to fall asleep more quickly, chronic use can prevent deep and REM sleep, as well as worsen sleep apnea and gastric acid reflux.

Many assume that *snoring is just an annoyance*. Snoring is usually medically harmless, but it can be a symptom of sleep apnea, a potentially life-threatening condition. If it is accompanied by daytime sleepiness, periods of breathing pauses, or gasping, I urge you to participate in a sleep study to be evaluated.

Driving when tired is clearly unsafe. *Turning up the radio, lowering the window, or turning on the air conditioner is not sufficient to stay awake*. Pull off the road to a safe rest area and take a nap. Caffeine can help in the short-term but takes time to kick in. Plan ahead and get a good night’s sleep before any long drive.

Lastly, do you remember being told to *never wake a sleepwalker*? Well, it is true that it can be quite difficult to wake one, since sleepwalking typically occurs during deep sleep. Also, an awakened sleepwalker would be disoriented and probably not aware that they were wandering. However, there's no danger in waking one if you feel you are protecting them from harm. The best thing to do is to take a sleepwalker by the elbow and carefully lead them back to bed, allowing them to remain asleep if possible.