The Medical News Report

#114

July, 2021

 

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

samlamonte@gmail.com

 

Happy July 4th—Independence Day

 

Subjects:

These are shorter subjects:

1. COVID-19 update

2. Weight loss drugs-one FDA approved and one recalled

3. Statins—who should take them; managing side effects

4. Do Omega-3 fatty acids reduce cardiovascular disease events in people with high risk?

5. Some older people left behind using telemedicine

6. Screening children for high blood pressure

 

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thank you, Dr. Sam

 

1. COVID-19 updates

A. The origin of COVID-19 becoming clearer

  The hottest story this month is readdressing the origin of the COVID-19 virus. Evidence scientifically points directly to the Wuhan Institute of Virology. Whether this a leak intentionally or by accident spread is unknown.

  The science supports the fact that since the SARS CoV-2 virus cannot easily enter human cells, bioengineering was needed to make it easier. This is the basis for “gain of function” research.

  According to the Wall Street Journal (June 6, 2021) stated “ a microbiologist can increase the lethality of a coronavirus by splicing a special sequence into its genome at a prime location (arginine with any number of alternate amino acids instead of another arginine—double CGG).

  This process leaves no traces of manipulation. But it alters the viral protein, rendering it easier to inject this genetic material into a “victim cell”. This method of manipulation is called “gain of function”.

  When the Wuhan lab published a paper in February, 2020 with COVID-19’s genome, it made no mention of this change in sequence (Dr. Shi Zhengli) which was supercharging this virus.

  A few weeks later another virologist, Dr. Bruno Coutard, published information about this virus with the manipulated sequence which was supercharging this virus, which was clearly buried in the original publication. Antiviral Research, Feb. 2020. The authors declared that this omission is the key to the “gain of function” capability of this virus, and does not occur naturally, and is the method used to re-engineer the virus, which can be much more lethal to cells it infects. This sequencing made this virus differ from MERS and SARS which were naturally occurring.

  According this journal article, this specific splicing has occurred 11 times since 1992 with the end results each time supercharged the virus.

  A genome is a blueprint for the factory of a cell to make proteins (amino acids) used to create DNA. The result of this insertion of specific amino acids in a specific location make the viral cell much more able to enter the human cell.

  This specific sequence of amino acids has never occurred naturally. This information was kept from scientists and the public throughout the world, according to records discovered according to the Wall Street Journal.

  There are other issues that must be clarified. There is proof that the U.S. had been financing this research for years, and that it also occurred at U. of North Carolina, Chapel Hill. The grants from Dr. Anthony Fauci’s Institute of Allergy and Infectious Diseases supported such research through a charitable organization, perhaps to keep the government’s name out of the grant transfer to Wuhan Institute.

  It is known that the NIH put a moratorium on “gain of function research” in 2014 because of the risk of a leak, but in 2018, it was refunded by the National Science Advisory Board on Biosecurity, who decided it was “seldom a risk to public security”.

  Even the former Head of the CDC, Dr. Dr. Robert Redfield has stated for the record that the origin of this virus most likely came from the Wuhan Lab. Was it bioterrorism or a clumsy mistake?????

  America’s hands are not clean!! And pushing China to get evidence on this issue will have major consequences, but do we want to be bullied and just accept that over 600, 000 Americans lost their lives to COVID-19 because of Chinese lab mishap or not??

Reference: Wall Street Journal Opinon by Steven Quay and Richard Muller, June 6, 2021; Dr, Joel Zivot, Medpage, june 13, 2021

  The G-7 members are backing an investigation regarding the origin of the virus by the WHO (World Health Organization), who was complicit with the Chinese Communist Party, by covering up the outbreak for weeks, while they shut down all other Chinese Provinces from traveling to or from Wuhan Province, and allowing their citizens to enjoy their biggest holiday of the year by traveling throughout the globe spreading the virus to the U.S., Italy, and other desirable spots.

  Why does anyone think we are going to get anywhere this time, since a few months ago the WHO visited Wuhan and “found no evidence of the virus in that lab”?? Why not an independent task force investigate?? The authorities are just posturing because they know they will get no answers, not to mention world wide counteractions and escalations. The globalist ideology of the current U.S. Administration would not have the will to head such an effort without major support from the free world even with a valid dispute.

 

B. Why is the government ignoring the natural immunity of those infected and only pushing the vaccine to attain herd immunity?

  Epidemiologists estimate 160 million people globally have been infected by COVID-19. Those infected have an amazingly low incidence of reinfection, disease, or death. There is only one reason…..they sre immune to the virus and more recent research has shown that immunity is lasting more than 10 months.

  The WHO announced that 90-99% of those infected totally recover within 90 days and are protecting many populations where vaccines are not readily available.

  So why is the government expecting the vaccines to create herd immunity without considering that an estimated 40% of our population asymptomatically (or with very mild symptoms) have been infected (34 million Americans who had a symptomatic infection). The number of cases has dropped exponentially since the vaccine has been distributed to near 70% of adults.

  If herd immunity requires 70-80% of a population to occur, unless I can’t count, we are there!! And yet, politics continues to play a role in forcing people to get vaccinated.

  I am totally in favor of vaccines, but it is still a free country, and outside of healthcare personnel, I see no reason why businesses should require their employees be vaccinated to retain their job.

  Another large factor that has not been widely known is the power of the immune system to answer the call for future infections.

  The blood cells (T and B-cell lymphocytes) that are memory cells that can fight future infections for up to 17 years. According to Drs. Klausner and Kojima in Medpage, May 28, 2021 However, routine tests to prove this immunologic issue is complex and not available due to the expense in routine medical practice.

  For people to find out if an individual has adequate immunity against COVID-19 require a $135 test not covered by insurance. These tests also cannot differentiate between natural and acquired infection. The FDA in May stated that antibody tests should not be used to find out if adequate immunity is present.

  The FDA states that people who have recovered from COVID-19 should consider themselves protected against reinfection, including variants, similar to those vaccinated. There is no excuse for not counting the population that has been infected, the estmate of those with asymptomatic infection, and those vaccinated.

  They also feel the FDA lags far behind the science and that the CDC and our government continue to not follow the science until it is politically expedient and the FDA approves of the move. Could it be that the vaccine companies have a say in this, since $billions of dollars are at stake.

  These doctors quoted are professors of Preventative Medicine and Internal Medicine at UCLA Medical Center. This is their opinion, but makes considerable sense, if our government could expedite the lag between the science and beaurocrats making decisions, we could get our country back quicker…..or are there those who want this recovery to delay?

  Opinions may differ based on political ideologies. Those who had fear instilled in them by certain TV doctors and the media will continue to be over cautious, but that is their right…just don’t impose that others and listen the science.

 

C. The Pandemic and the lost year for smoking cessation, alcohol and drug abuse and weight gain

  This report refers to people trying to quit smoking as the pandemic hit, but it would be transferable to people trying to quit or cut down alcohol, or lose weight. All were a lost cause.

  Every spring, state quit lines, a mainstay of tobacco reduction efforts, get a spike in calls. The spike comes from campaigns to quit smoking most often run in the Spring (CDC, American Cancer Society, etc.). 1-800-QUIT-NOW.

  When the pandemic hit, the calls dropped off by 39% and over the last year the number of calls never recovered to pre-pandemic levels, and was the lowest since 2007. This occurred even though the CDC warned of a rise in abuse of tobacco, alcohol, and weight gain, it happened anyway.

  When people are under stress they reach for their “relief substances”, and the last thing that happens is success in trying to walk away from these substances when the country was locked down and people socially isolated.

  The tobacco, e-cigarette, alcohol industry, and drug dealers obviously won as the country lost. The U.S. Department of Treasury showed a 1% uptick in cigarette sales during the first 10 months of 2020 after a 4-5% annual declines since 2015.

  There were mixed messages in the public with even some messages suggesting that smokers were somehow protected against COVID-19. Fake news is everywhere, especially on the internet.

  It is well known that smoking damages the lungs as does vaping and increases the susceptibility to respiratory viruses. Several studies have cited worsening outcomes from COVID-19. Out of 8919 patients hospitalized in 169 hospitals 9.4% of current smokers died from the virus compared to 5.6% of former smokers.

  Coping mechanisms such as smoking, drinking more alcohol, eating more calories are used to combat the stress of isolation, lockdowns, having the children home 24/7, losing a job, and even the racial unrest that occurred in 2020 and is perpetuated by academicians in many chools.

  Cancelled doctor’s appointments (with no counseling to quit) and fewer prescriptions written to help quit smoking, worry about health issues that were tabled for a year, all played a role. Psychiatric illnesses worsened which correlates with poor behavior.

  Even clinicians dropped referrals to quit lines by 20%, because they were not seeing regular appointments.

  Of those who did contact these help lines, 45% of quit line callers reported mental illness, 52% were uninsured or enrolled in Medicaid.

  Smokers are more likely to be in vulnerable populations—American Indians and Alaskan natives, Black individuals, and those in LGBTQ+ community, according to the author in the JAMA Medical News and Perspectives, May 18, 2021

  Now that the pandemic has slowed and we are getting back to a semblance of normal, there is hope that vices and addictions can be faced and dealt with more aggressively.  

 

D. Obesity and COVID-19

  I have reported on the effect obesity has on the severity of being infected with COVID-19. Now there is large study showing just how important being overweight is as a risk factor for making this pandemic virus a real threat. Being overweight is the greatest risk factor outside of age for suffering greatly or dying from COVID-19.

  A new CDC study of nearly 150,000 people hospitalized for COVID-19 found that 51% had obesity and the risk of being admitted to the ICU was double in those who had a BMI* of 45 or higher.

*BMI—Body Mass Index and the calculation uses height and weight. The type of body does significantly influence the BMI. You can calculate the BMI by searching online.

  The BMI has created categories of overweight and obese. Many people who do not appear overweight, are in fact in a higher risk category. However, health risks do correlate with the BMI, therefore we can’t deny it. Also the higher the BMI, the greater the risk of dying from COVID-19.

  The immune response to a COVID infection and the antibody response to the COVID vaccine are poorer than those who are normal weight. Studies also report that those under weight are also at higher risk. Have you heard any serious discussion in this country regarding this epidemic of obesity? Clearly, there is an enormous need corrective action worldwide.

  Last month, I reported some studies underway about the size of the dose for obese (need higher dose?) and underweight individuals (need lower dose). There are studies looking at the need for a second dose for individuals who have been infected, and children may not requiring a smaller than an adult dose.

 

Weight loss from diabetic medication

  The diabetic drug semiglutide  (Trulicity, Wegovy, Ryelsus) may be a game changer, in that it is capable of helping an 11% of body weight loss (over placebo). This is a once weekly injection in conjunction with diet and exercise. Behavior modification is a must as well.

  COVID-19 added an average 10-15 lbs on the average citizen. 

  Factors to consider in obesity in relation to co-morbidities (associated illnesses and disorders) include fat mass, fat distribution, waist circumference, age of onset of obesity, and intra-abdominal pressure. Here are the co-morbidities facing those overweight.

Addressing surgical assistance with gastric bypass procedures is undervalued and must be considered in those who fail other conservative attempts. It is my impression, that physicians do not encourage consultation. 

Medscape, March 26, 2021,  emedicine.net

E. COVID is the third leading cause of death in the U.S. for 2020      

  The National Vital statistics provide the most complete assessment of annual mortality. Due to the pandemic, there was a 17% increase in the number of deaths compared to 2019. The provisional leading cause of death for 2020 indicate that COVID-19 deaths was third behind cardiovascular and cancer deaths.

  Heart disease deaths increased by 5% probably due to the viral insults, the largest increase since 2012.

  Clearly, if a person is in good health, even with an an underlying medical issue, and gets very sick from COVID-19, it would be clear that the virus responsible for the death. However, if a person is positive for the virus and dies within 30 days, these cases have been declared a COVID death.

 

Fake News in the newspaper

  On June 23, 2021, there was an article in the Sarasota Herald Tribune written by Associated Press stating that deaths in nursing facilities rose 32%, while in the last paragraph of this fake news article, clearly this number was far less-- (Asian Americans-27% instead of 17% th previous year, and whites-24% instead of 18%, and Blacks and Latinos-23% instead of 15% in 2019. Sad we can’t believe the media).

  There has been criticism for hospital officials declaring many of these deaths COVID caused, because Medicare and Medicaid paid at a higher rate if anyone who has the death certificate stating the cause of death was COVID. Does this increase the numbers more than actual? Many professionals question some of these death certificates. No one is reviewing these certificates.

 

The list of the top 10 causes of death 2020:

1) heart 2) cancer 3) COVID-19 4) unintentional injuries 5) stroke 6) chronic lower respiratory disease 7) Alzheimer’s disease 8) Influenza and pneumonia 9) kidney disease 10) suicide 

JAMA, May 11,2021

 

F. Children and the COVID vaccine; pandemic consequences harsher on children; do children need the vaccine? Don’t forget to catch up on other childhood vaccines

  Dr. Marty Makary, Editor-in-Chief, Medpage, Johns Hopkins Medical Center. These notes are from a discussion with a virologist:

  It is well established that children older than 11 are more likely to be helped by the vaccine. It has been researched and that age group begins to get more infections even though much less severe than older individuals.

  Studies are not as positive about those age 0-12. There have no reported deaths recently in this age group except in those with underlying diseases such as obesity, immunosuppression, etc.

  For the healthy young child, there has been little transmission from them to other children or adults. Most who get infected are asymptomatic. However, although extremely rare there are those who develop multisystem inflammatory syndrome, which can be severe and cause death. Creating community benefit toward herd immunity is important.

  There are those who get vaccine side effects including very rare cases of myocarditis* in mostly young males 12-17, which has led Pfizer to consider a lower dose of vaccine and also just one dose instead of two for previously infected younger people. The estimate is 2-4 cases per 2 million vaccinations according to arstechnica.com

*myocarditis is inflammation of the heart muscle with symptoms of chest pain and shortness of breath. Fortunately, those individuals have a mild case and recover within a few weeks. COVID-19 has caused far more cases of myocarditis than the vaccine.   

  There is some question whether those who have been infected even need the vaccine. However, the CDC and FDA still recommend both doses ( unless J&J) for all 12 and above. Questions being asked create hesitation in parents getting their children vaccinated.

  Dr.Makary does not recommend the vaccine for the healthy child 0-12. Those with underlying conditions should be vaccinated, and if vaccinated, consideration for only one dose is reasonable. This will create problems if a school district mandates vaccines to return to the classroom.

   Most experts are very pro-vaccine for anyone 12 and older, but more studies need to be finalized before a firm decision can be made for those 0-11.

  I just mentioned in the obesity section, under study, that heavier individuals might need a higher dose, whereas thin individuals and children might need a lower dose. Again, the feds still recommend the same dose for all. This might increase the level of immunity for heavier individuals and lessen the side effects for thin and younger individuals.

  Herd immunity is critical in the fight against COVID-19, and should be a strong reason to consider vaccination. Ultimately, the doctor and parents must decide.

Medpage, June 10, 2021

 

--All childhood vaccines must be caught up!

  The American Academy of Pediatrics reminds parents to catch back up on their childhood vaccines*. COVID vaccines and other childhood vaccines will need to be corrdinated. These other vaccines were not given during 2020, and dropped the percentage of those getting vaccinated by as much as 26-60%.

*childhood vaccines include Diphtheria, whooping cough (Pertussis), measles, mumps, Rubella, and HPV (to prevent cervical and other genital cancers including oral and throat cancer).

 

--unintended consequences continue to pile up

  While some say the unintended consequences have been more devastating than the pandemic itself (and rarely discussed by the media or the politicians), children have been most affected with some of the draconian methods that shut our country down. 

  There is more evidence being published regarding the devastating effects of keeping our children isolated from social events, their friends, and home school for over a year. Those who were struggling with even mild psychological issues before the pandemic were the hardest hit.

  Medscape Medical News reported on what is happening to children in just one city in Colorado (Aurora). One hospital declared a state of emergency in youth mental health after the number of suicides overwhelmed their hospital emergency services increasing by 90%.

  In Colorado, suicide is the number one cause of death in youth as young as 10 years of age. Professional psychological services were overwhelmed with suicide attempts, self harm, eating disorders, sleep difficulty, and substance abuse. The increase in depression and anxiety in these youth have not been properly addressed as well.

  School shootings, massive protests with deaths and destruction across our country have stressed the youth more than most age groups. Racial unrest stirred by certain groups has also been a negative factor aggravated by certain racial disparity ideologies being taught in schools to much of our youth. The color of the skin should never be a reason for hatred and separating the races further from each other.

  Now that kids are no longer as isolated, they do not have the tools to reintegrate, according to the authors of a report cited below. This is more difficult in rural communities throughout the country where resources are sparce.

  Although this publication reports this crisis in Colorado, it is happening throughout our country, as teacher’s unions use children like a pawn to get their way keeping schools closed for over a year and in some areas still occurring.

  Their recommendations include massive screening of these children with assistance from primary care and pediatrics.

  The psychiatry field has turned its back on accepting insurance because of the extremely low payments, which has hindered access as well. There is a lot of blame to go around.

Medscape, June 4, 2021  

  Most people are used to a routine in their lives, and when that is disrupted so severely with issues such as the pandemic, people react negatively with abuse of food, alcohol, illegal substances, and their underlying health issues suffer greatly. People who suffer from headaches are one of those groups, especially those with migraine. 60% of those sufferers report more frequent migraines since the virus. Medscape, May 12, 2021

G. Update on COVID vaccines

  The information above covered some of the issues, however, since I wrote that portion, a new study from the UK found that if a person who was vaccinated developed a reinfection (9000 out of 960,000), that these individuals are half as likely to transmit the infection to their own household. Those who do not develop high levels of immunity (those immunosuppressed, the obese, those with some chronic debilitating disease, and very elderly. Those reinfected have relatively mild disease as well. Medpage, June, 2021

  75% of those over 65 have been fully vaccinated, the most vulnerable population, and over half of the population is known to have vaccinated. That, of course, does not include the 40% that were infected and asymptomatic and those who never got tested (a siazable number especially in younger individuals).

  Since the immune response from these vaccines have been robust, experts (outside the CDC) state that a booster is highly unlikely in the fall.

  The predominant variants, even the latest Delta variant, is prevented in the 70% range if fully vaccinated.

  There continues to be little evidence for not receiving the vaccine. For those who are waiting, because the vaccines were allowed on an emergency basis by the previous administration, there continues to be very solid evidence that the disease itself causes more of the diseases highlighted in the media, such as myocarditis in the young than the vaccine. Yet, the pharmaceutical companies are putting warning labels about these few issues to keep the lawyers happy.

  Finally, it is my opinon and many other medical professionals that we have reached HERD IMMUNITY, and the virus is having difficulty finding individuals to infect. The numbers are very encouraging in the U.S.

 

SHORTER SUBJECTS

 

2. Weight loss drugs-one FDA approved and one recalled

Diet to lose weight is just not enough for many who struggle not only losing the weight, but keeping it off.

  I recently reported that anti-diabetic drugs can provide considerable weight loss in conjunction with reduced calories. It simulates a known hormone secreted naturally to curb appetite, ghrelin.

  Now the FDA has approved a higher dose of a popular anti-diabetic medication once a week injectible semaglutide (Trulicity, Wegovy, etc.)) for type 2 diabetics but also for non diabetics. The drug stimulates insulin to drop the blood sugar in diabetics.

  A company funded study found patients could lose on average 15% of body weight, about 34 lbs. for the average person. They lost weight for 14 months before plateaung. The placebo group only lost 2.5% body weight. The existing weight loss drugs provide about 5-10% of body weight, and the existing drugs have more side effects and the star of the group just got recalled bt the FDA.

  As little as a 5% loss of body weight drops blood sugar, cholesterol, and lowers blood pressure, preventing cardiovascular disease. 

 

Weight loss drug recalled

 Weight loss drugs are very effective when prescribed, but to date, they have not been very popular. Now one of the main medications, locaserin (Belviq), has been recalled because of the risk it might cause cancer. Studies in these patients tended to have a higher rate of colon, pancreas, and lung. This study is observational (the least valuable type of study), but was significant enough for the FDA to request the drug be pulled from the market. Sounds like the lawyers got involved.

  The lorcasein group had 7.7% of the cancers compared to the placebo group of 7.1%. Not much difference, but caution appears to rule. 

  Doctors have been requested to contact all their patients and prescribe an alternative drug. Patients should destroy the medicine and dispose of the contents in a plastic bag and put in the trash (not the toilet).

  The FDA does not recommend any special screening of those who have been taking Belviq.

  Patients should be on the alert for any symptoms of these cancers (cough, chest discomfort, bowel changes, vague abdominal symptoms). Remember, these cancers do not show symptoms early.

  Each patient should discuss this issue with their individual doctors for guidance. For a list of other weight loss medications click on: www.drug.com/condition/weight-loss.html

  The antidiabetic drug Wegovy is a welcome addition to the patients who need to lose over 25-30% of their body weight. The one concern with these antidiabetic drugs is a rare chance of a thyroid tumor found in certain families. So if there is a family history of endocrine tumors like thyroid, this is not your choice.

  Check with your weight loss treating doctor about Wegovy, the cost, and whether it is appropriate for each individual.

FDA notice in NEJM Journal Watch, Feb. 18, 2020 

 

3. Statins—who should take them; side effects

(Common statins-atorvastatin, ruvastatin, simvastatin, pravastatin, lovastatin, and pitavastatin) 

 Most individuals need to maintain their total cholesterol below 200mg/dl and the bad cholesterol (LDL) below 100mg/dl. However, if a person has a heart problem or a history of heart attack, physicians prefer the LDL be below 70mg/dl.

  Others who have risk factors for heart disease should consider statins as well: smokers, overweight or obese, diabetic, hypertensive, or have peripheral arterial disease (carotid, abdominal, or lower extremity).

  Physicians usually begin statins at age 40 for most patients unless the risk factors dictate a younger age.

  The American Heart Association does not recommend statins after 75 years of age if healthy without a diagnosed heart problem or elevated cholesterol. However, there are new studies to question that recommendation, and individuals should not stop without discussion with their physician agreeing.

  Statins as a primary mode of prevention of cardiovascular disease or death is recommended for people over 70 (and younger).

  A large study in VA Boston hospitals has now reported in a new study that the risk of dying from any cause after 75 was lower if the individual was taking statins regularly. That includes people who just started at age 70 without heart disease. The risk of dying of a cardiovascular disease (including ischemic stroke) was 20% lower compared to a control group if taking the drug for 2-5 years.  

  Age alone is not a reason to stop statins, but starting them is a decision between the patient and the doctor.  This was published in JAMA, in November, 2020

  A study in France had a large population followed with those who stopped at 75 and those who continued and found a 33% increase of cardiovascular issues requiring hospitalization over those who stayed on them.

 

Dosage

  For patients age 20-75, statins with a total cholesterol over 190mg/dl should be treated with the maximally tolerated dose.

  Type 2 diabetics with ages 40-75 should be treated with a moderate intensity statin. Depending on the extent of cardiovascular disease, the intensity of the dose will vary. All doses should be assessed within 6-8 weeks.

  Statins reduce inflammation, a major cause of many major diseases. Reducing inflammatory markers reduces mortality overall.

 

Other observed benefits

  Statins also reduce adhesions in the bowel after abdominal surgery as another example of the anti-inflammatory capability. Another study found that statins reduce the cardiotoxic effects of chemotherapy. Another study showed some improvement in chronic obstructive pulmonary disease (COPD) and chronic kidney disease, according to the Mayo Clinic.

 

Side Effects

  Continuing statins indefinitely must be discussed with the treating doctor and weigh the side effects of the statins including muscle pain, digestive issues, rarely liver damage, and cognitive problems especially in older patients. Erythromycin antibiotic has the greatest risk of interaction with statins.

  People often stop statins unnecessarily because of aches and pains, while studies have shown that the side effects occur in about 30% of these people regardless of whether taking statins or a placebo. Do not stop any medicine without discussing this with the treating doctor.

  Rarely, statins can raise the blood sugar, therefore blood sugars should be monitored. Liver studies may become abnormal, therefore, those with active liver disease should avoid statins, according to NIH* publications. Those with chronic liver and kidney disease should be cautioned and monitored. If muscle pain persists, a CPK test should be ordered to prove damage to muscles (rhabdomyolysis).

*National Institutes of Health

  Those most at risk for side effects are as follows, according to Mayo Clinic.

 

  The best way to prevent side effects is to discuss with the treating physician to consider taking a short break from taking them, always staying on the lowest dose, switching to another statin (Zocor may cause more problems), and moderate exercise. It is stated that Co-enzyme Q may prevent side effects. Xetia, a cholesterol blocker may be used instead, however, it does not have the advantage of reducing all-cause mortality.

Medscape, May 17, 2021

 

4. Do Omega 3 fatty acids reduce cardiovascular disease events in people with high risk

  Just when you think Omega 3 fatty acids (EPA-eicosapentaenoic acid and DHA-docosohexaenoic acid) are the best thing since sliced bread, a new study comes out and in comparison to corn oil capsules for the control group, there is no decrease in cardiovascular disease events in people with CV disease with higher risk over several years. Why are these studies contradicting previous research? There was more gastrointestinal complaints in those who take Omega-3s.

  The Omega-3 industry was a $1.9 billion dollar business in 2018.

  Unfortunately, unless a person has high triglycerides, there appears to be little value for doctors to prescribe such ultra-refined products in patients who have cardiovascular disease and higher risk of future events (heart attacks, strokes, cardiac stents, and hospitalization for unstable angina). Prescription products include Vascepta or Lovaza, which are very expensive products and are class 4 or 5 in the Medicare Part D in prescription drug plans. All these patients were prescribed statins in both study and control groups.

  All patients should continue taking Omega-3 fatty acids if prescribed and consult with the prescribing physician about the wisdom of continuing them or considering alternative nutritional options. There are other advantages taking Omega-3 fatty acids improving health in general.

  Taking 4-one gram Omega-3 capsules with OTC products would require an individual to ingest 18 capsules a day, which causes considerable burping with a fishy taste, upset stomach, and other gastrointestinal symptoms. Hence, the reason for the prescription products! However, there are similar products on the internet. They contain similar amounts of EPA and DHA and can control triglycerides as well. There is no FDA oversight for these internet products, so buyer beware.  

  There is a generic  prescription form recently approved by the FDA containing EPA and DHA, the primary fatty acids recommended. Check with your doctor.

  Keep in mind, 4000 mg of Omega-3 is the primary product for treating high triglyceride fats in the blood. Cholesterol is not greatly influenced by Omega 3s while statins are the standard therapy.  

  Keep in mind, fatty acids are essential nutrients for a balanced diet, and natural forms of these fatty acids are the best way of consuming them especially in fish (salmon, mackerel, etc.). Previous studies have been found to be valuable from a general health standpoint for the average person.

  These conflicting studies are the reason many people don’t tend to follow guidelines for health benefits when they keep contradicting what was gospel yesterday and now shown to be no better than corn oil.

  Keep in mind, this study was confined to people with diagnosed stable cardiovascular disease and who have had no events 30 days prior to starting this study. The length of the study was only 42 months.

  Clearly, more studies need to be performed, but with this information, the incentive for pharmaceutical companies to finance such research is not there.

  The bottom line is, a healthy balanced diet with high proportions of fruit and vegetables, lower amounts of bad fats and sugars will be the best bet to promote health along with regular exercise, adequate sleep, management of stress, not smoking, and limiting alcohol.

  The obesity epidemic has shown how disastrous that issue is with COVID-19. And cardiovascular disease continues to be the #1 cause of death in the U.S. With the Hispanic population continuing to rise (50% are obese), we are in for continued rising mortality in this country. Black individuals continue to be a close second, followed by Asians.

  Controversy will continue regarding this subject, therefore, depend on the personal physician to weigh in on this subject.

JAMA, November 15, 2020

 

5. Older Adults left behind using telemedicine

A large study of elderly people (4500) assessed telelmedicine unreadiness and found difficulty hearing, using a telephone, problems speaking, making oneself understood, possible dementia, impaired vision, not owning a computer or knowing how to use one, not having a smart phone using email, texting, or the internet were the factors impeding their ability ot take advantage of telemedicine (audio or video).

  38% were unready to use videoconferencing, and 20% were not ready to use the telephone for a medical visit. This was more prevalent in older, male, unmarried, Black or Hispanics, and those living in a metro area. These people had less education, lower incomes, and poorer self reported health.

  Notably, those over 85 were almost uniformly unprepared to utilize telemedicine.

  This presents a challenge not only to older people, but since these individuals are more likely to need continuing care, this also presses the physicians to work out some system that could work for these individuals.  JAMA Internal Medicine, August 3, 2020

 

6. Screening children for high blood pressure

In the 1980s, it was felt that children and young adults had high blood pressure because of an underlying cause, usually kidney disease.

  However, over the past couple of decades, it was hypothesized that children might have elevated blood pressure as a precursor for adult hypertension. In 2017, the U.S. Heart, Blood, anLd ung Associations plus the American Academy of Pediatrics strengthened their recommendations for measuring blood pressure in childhood. There are hundreds of medical journal articles professing that blood pressure elevation can start in childhood and progress to adulthood hypertension and also often was an indicator of young adult subclinical cardiovascular disease.

  The International Childhood Consortium reported a significant relationship between childhood blood pressure levles and mid-adult life hypertension with the highest degree of risk in children with high blood pressure.

  The federal advisory committee, the USPSTF* has not encouraged measuring blood pressure during routine pediatric medical visits, because there is insufficient clear evidence that there is a significant health risk sufficient to recommend testing all children. One study of 43,000 children reported a 4.3% of hypertension, however, that number dropped to half within 3 years. They have essentially left the decision up to the physicians, where it should be.

  *USPSTF=United States Preventative Task Force

  There are two reasons for measuring blood pressure in childhood:

1) discovering an unknown underlying cause for hypertension

2) discovering very mild blood pressure elevations that should be monitored over the years, and stimulate discussion about general health, nutrition, and weight management.

  Having spent several years on the task force for screening guidelines for the American Cancer Society, we came out with recommendations for revising those guidelines sometime years before the federal task force came out with essentially the same recommendations. With that in mind, I would suspect many doctors will incorporate measuring blood pressure in older children, especially if there was is a family history of hypertension and obesity, the child was over weight, or had any underlying medical disorder that might raise the risk of hypertension. Here is an example of recommended blood pressures for 3 age ranges.

 

This completes the July, 2021 report. I hope you enjoyed the subjects.

 

August subjects:

1. COVID-19 updates

2. Cardiomegaly—causes of an enlarged heart

3. Changes coming to asthma medihaler medications

4. Gouty arthritis

5. New oral drug for daytime drowsiness from sleep apnea

6. The polypill—what is it?

 

Stay healthy and well, and enjoy the summer!! Dr.Sam