Paging Dr. Frischer: Sunglasses

AF.jpg

Summer is here, and with it, even more sun and its ultraviolet radiation.

We’ve gotten pretty good at using sunscreen to protect our bare skin from UV rays, right? What about our naked eyes? Here is what we all need to know about sunglasses.

In a recent survey, less than half of 10,000 Americans recognized the health benefits of sunglasses, and 27% reported never wearing them. Does it make sense to leave our eyes unprotected, when a host of conditions are caused by ultraviolet (UV) radiation? Some of the eye problems that the sun can cause include:

* Cataracts, a clouding of the eye’s lens which makes what we see appear darker and blurry. Some 20% of cataracts are triggered by excessive exposure to UV rays, and the World Health Organization reports that approximately 900,000 people worldwide are blind due to cataracts.

*Macular degeneration, a result of damage to the retina that destroys central vision. It is the leading cause of blindness in the United States.

*Pterygium, also called surfer’s eye, is a growth of tissue over the white part of the eye’s surface. This can alter the curve of the eyeball, leading to astigmatism.

*Skin cancers, which can be found on the eyelid. In fact, they are surprisingly common there, representing about 10% of all skin cancers.

*Photokeratitis, essentially a sunburn of the eye. Fortunately, it is temporary, and typically heals within 48 hours. It can be painful, and cause blurred vision, sensitivity to light, and the sensation of having sand in the eye.

So, this is why it is so important to protect our eyes from the harmful affects of UV rays! Now let’s discuss sunglasses. They are not all the same. They can cost very little, or quite a bit. How do we choose the right pair?

The most important thing to consider is that brand and price matter far less than does selecting a pair that blocks out both UVA and UVB radiation (UVB is actually more harmful than UVA). A pair is acceptable if it offers UV protection of at least 95%. 

Avoid sunglasses that are not labeled at all. Recently I visited a sunglass kiosk where there were no such labels, and was told that they had been removed to make the sunglasses look more attractive. Perhaps that was the truth, but nevertheless, I took my business elsewhere!

Consider that the ideal sunglasses are wraparounds, which protect us from UV rays coming in from the sides. And, note that even if your contact lenses have UV protection, wearing sunglasses is still important. Pay special attention to wearing them at higher altitudes where the UV rays are even more intense, and when you are near water or snow. Some medications can cause even greater sensitivity to light, including certain antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics.

Please get into the habit of wearing your sunglasses year-round. Cloudy days do not stop UV rays!  Please remember that children’s eyes are even more susceptible to UV rays. While you’re at it, throw in a wide-brimmed hat for extra protection. It can’t hurt!

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.

Kaiser hospital donates $50K to local non-profits

DOWNEY –  Kaiser Permanente Downey Medical Center recently announced an investment of more than $250,000 in grants to five local non-profit organizations. 

The grants will help support children and the elderly through organizations that provide access to healthcare services, promote community safety and violence prevention, and increase mental health care. 

“Many of the most vulnerable residents in our surrounding communities -- youth and the elderly -- do not have access to health services, and these grants help organizations provide the services they need,” said Jim Branchick, senior vice president and area manager for Kaiser Permanente Downey Medical Center. “We are proud to help support these organizations as we all have one common goal -- to improve health in the community.” 

The following organizations each received grants of $50,000: 

Community Family Guidance will create additional access points for mental health services in the southeast Los Angeles city of Bell. 

Elevate Your GAME will sustain their successful, long-standing one-on-one mentoring program in Compton and help expand the mentoring program to Lynwood High School. 

Pathways Care Navigation Program will keep vulnerable, at-risk seniors stable, safe and independent in their own homes. In collaboration with the Cal State Long Beach Nursing Department, the program engages seniors in Bellflower, Lakewood and Paramount through in-home visits to create personal care plans, which address medication management, monitoring of chronic conditions, and safety assessments. 

St. John’s Well Child and Family Center will launch an online patient portal for patients at their Compton clinic site. This online patient portal will connect physicians with their patients electronically and offer more streamlined care. 

Urban Compass will expand their highly successful one-on-one mentoring program to middle school students in Watts. 

Since 2010, Kaiser Permanente Downey Medical Center has donated more than $1.2 million to more than 100 community partners. 

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.

AF.jpg

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.

AF.jpg

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?

AF.jpg

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

AF.jpg

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

AF.jpg

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

kaiser downey.jpg

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. 

AF.jpg

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.