FLU SHOTS

FLU SHOTS

Its time to get your flu shot. Unfortunately flu shots have to be taken annually. Many people say they are not sure if they are worth paying for, well fortunately after Obamacare almost all insurances pay for them.

Why get a shot?

Apart from the obvious discomfort of being ill, think about all the other inconveniences getting the flu in the winter causes : time out of work, the expense of buying medicines and trips to the doctor, making other people and your family sick etc.

Flu season usually begins with regularity the Monday after Thanksgiving after ‘sharing the love’ and everything else in abundance. The idea is to be adequately protected before then.

School children and certain professions are at particularly high risk of contacting the flu. The elderly and very young are most susceptible to the more severe complications of the disease like pneumonia and death.

Conditions like Diabetes, COPD and Asthma also increase you risk.

Every year I hear a plethora of excuses and rumors as to why people don’t want to get a flu shot:

“I have never had one”, “I don’t get the flu”,  “I got one before and I still got the flu” but I often think they have not really taken the time to understand why the medical profession advocates them.

Every year the most likely strains to cause disease are determined and these are included in that year’s shot. The researchers could be wrong or leave out a strain that could be a problem as its not an exact science but either way you will have an opportunity to boost your immunity to some strains. The downside is minimal.

Every hospital and health care facility now requires all its staff to get that year’s strain of flu shot, they do this based on research and the fact that it works.

Unfortunately you don’t know which year is a particularly bad season until you are right in the middle of it which does not allow time to generate immunity. Every year we have a new viral epidemic, SARS, Chikungunya, Ebola, Zika and no idea what's next. At least protect yourself from things that are known and give your body a chance against things that are not.

If you would rather not get your flu shot at the same place as you pick up your milk, veggies and meat please feel free to stop by the office and get one, you don’t need an appointment. Prevention is always better than cure.  Sincerely, Dr. Tuakli

Anything new in breast cancer?

I read an interview today that was done with Dr. Laura Esserman a famous breast cancer surgeon on the west coast. Among other things she makes the point that a lot of doctors are still arguing about data that is 40 years old when it comes to breast cancer treatment.
I found her comments refreshing and thought provoking. Here is one regarding the condition DCIS that is often treated as "breast cancer":

"Think about cervical cancer for a minute. We used to call it "cervical carcinoma in situ," but they changed the name to "cervical intraepithelial neoplasia" (CIN) because it made people pause and not be so aggressive. Where are we now? If you watch CIN1 for a year, 50% of those lesions go away. This is the lesson. It's not, "If you do not do this, your breast is going to come off and you are going to die." We have to stop telling people that because we have no basis in fact for that. All we know is, this might or might not progress. In itself, it's just a risk factor. The reason why the pathologist probably cannot tell the difference between atypia and low-grade DCIS is because biologically they are the same thing. They are a risk factor."

Here is the link to the interview if you would like to read or watch it:

http://www.medscape.com/viewarticle/866946?src=WNL_topol_1on1_MSCPEDIT&uac=214936CY&impID=1175278&faf=1#vp_6

Are you tired?

A lot of people assume that they are tired because they work too hard.  It is true this may be a cause if they don’t get enough sleep but there are often other things  that are ignored because work or stress is assumed to be the culprit.

It is not normal to feel tired all the time and genuine fatigue almost always has a ‘real’ cause.  It may be due to a vitamin deficiency. I had a patient once who was so tired she couldn’t get out of bed in the morning plus she had convinced herself that she had early Alzheimer’s.  She came into the office crying because she didn’t want to have to tell her children.  Vitamin testing showed her to be extremely deficient in 3 vitamins, once we replaced those she was back working in the garden that she loved.  Another cause of fatigue is adrenal gland dysfunction. Once again this can be so severe that patients cannot stay out of bed for more than a few hours and have to nap all the time.  Bottom line: tiredness and feeling exhausted is not normal and can usually be corrected. Sometimes patients have read on line that being tired comes from a lack of thyroid hormone or low iron and once those two tests are normal they assume nothing more can be done. Others go to the local health food store and start taking all kinds of supplements and stimulants, this is like playing roulette, if you get lucky it may help. Some supplements make you feel like you have more energy for a short while but then you rebound and crash, or cant do without them. It is always best to figure out the cause of the problem and then treat it appropriately. If you have cancer or a connective tissue disease or even depression all the supplements in the world will not fix it. The sooner you get to the root of the problem the better.  If on the other hand the problem is just lack of sleep then that can be worked on too (see my blog on sleep from earlier this year).  Sleep prolongs life.

If you have a problem of tiredness, malaise or fatigue make an appointment now.

My new blog

Welcome to my new look blog. I hope you like it. I have reproduced some of my older blogs to give them a fresh new look.
I welcome your comments as always, regarding the content and presentation of my blogs. As a general rule I try to steer clear of politics and religion but it appears this year is going to be one of political turmoil, what a mess!
One of the biggest concerns of the medical profession is the potential negative impact of these political changes on the general and specific health of the country. Does anyone really believe that we are all richer if 25% of the population has no health insurance? Or if tax payer dollars are being used to allow people to use the emergency room as their primary care?  All I will say for now is its time to speak up before it is too late. Let's join the conversation as soon as possible.
Yours in Health

How does gun violence affect your health?

What do guns have to do with health? Actually a lot. Health is measured in two ways: Mortality (Duration of Life) and Morbidity (Degree of Illness) both of which are being severely impacted by Gun Violence. I actually started this blog a while ago but the events in the Navy Yard today caused me to resurrect it. Are we not yet tired of this violence and the thing that begets it : Uncontrolled Access to weapons? There are age groups were gun violence is the leading cause of death and young people have more to fear from Gun Violence than actual diseases we can be immunized against. The incidence of gun related suicide is directly related to ease of gun access.I'm not a politician and I am not trying to be one but let's get real, look at the numbers, Gun Control has become a Public Health issue and is working its way to the top of the list. Soon we will be more concerned about stopping a bullet than getting cancer. Nail me to the stake if you have to but as a Public Health professional allow me to say what needs to be said. More important PLEASE stop and educate yourself on the situation and be glad it wasn't someone in your family who got killed this year. However would you not rather act before it hits closer to home? I was initially moved to write this blog earlier this year when I read about a University of Maryland student who got killed by another student over some frivolous incident. The first thing that came to mind was: "Yet another parent who thought they had finally got their kid in college, only to turn around and they are gone in a puff of smoke" (How many since Virginia Tech?) Just food for thought. Please Be Well, Oh, and stay alive !

Originally Published in 2013 by Dr. Tuakli

Pap smears

A patient said to me last week “I do believe you saved my life for the second time Dr. Tuakli” And I thought Wow! You know what, she is right. People thank me for saving their lives from time to time and not to sound cavalier but I often think that it is nice to hear but I was just doing my job. Any qualified physician could have been credited with doing the same thing. But this time was different and very stark. This 50 something year old lady has been in my practice for perhaps 3 or 4 years. She has a variety of medical issues that we have been working on and from time to time I would suggest she have a pap. She had told me previously that she had been told that she didn’t need one because she had had a hysterectomy. Interestingly enough whenever I probed further she never seemed sure about exactly what had been done. Was the uterus completely gone including the cervix? How about the ovaries? Why was the surgery done in the first place? It never ceases to amaze me how many times I ask those questions and the answer is “I don’t know”, particularly in over 40 year old women. I eventually convinced her that it would be a good idea to just do a routine check up even though she had no symptoms and so I did a pap. As soon as I started her pap I knew from the look of the lesion in her vagina that it was cancerous. Putting cells on a slide and sending it to the lab quite frankly was a formality and I had her schedule an appointment with a gynecology oncologist pending the results. She told me when she came in last week that the specialist walked into the room and the first thing he said to her was “What is a women your age doing still getting pap smears?!” (I wont be referring any more patients to him). The arrogance dissolved when he saw the cytology report and the patient has since had the appropriate surgery. So why do I tell this cautionary tale? Well, for one thing, the current guidelines imply that she did not need a pap smear, simply based on her age. Secondly, I think that many women are walking around thinking that because they have had a hysterectomy they are immune to genital cancers. Thirdly, standard recommendations are just that, written for the common good but not by someone who knows you. Do not take them as gospel. You could argue that this is the exception to the rule and that is probably true but it also means that someone’s mother and sister will still be alive 3 years from now and she also managed to avoid the trauma of cancer therapy that would have resulted had she found it later. In medicine it is not always easy to argue with “official recommendations” and specialists who don’t know the patients. I believe that I taught myself something with this case, not everything has to be rational, and care must be individualized regardless. I am a strong believer in learning from past experience even if its not written anywhere. I derive no satisfaction from my patient being diagnosed with cancer but I am sure glad I followed my gut. When in doubt get a pap, it sure beats the alternative!

Originally published in 2013 by Dr. Tuakli