Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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9:30 AM
March 14th, 2019

Type-2 Diabetes

 

Type-2 Diabetes and You

 

Prevalence

 

 

In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes, according to the American Diabetes Association (ADA). The Center for Disease Control (CDC) reports that over 90% of these patients had type-2 diabetes. The ADA further reports diabetes as the seventh leading cause of death in the US, being an underlying or contributing cause in over 250,000 deaths in 2015.

 

The US prevalence has more than doubled in the last three decades, largely because of the increased prevalence of obesity. The increase is most concerning among adolescents and young adults.

 

Type-2 Diabetes 

 

Important distinctions exist between type-1 diabetes and the much more prevalent type-2 diabetes.

 

Type-1 diabetes results from the body’s inability to produce insulin due to the destruction of insulin-secreting beta cells in the pancreas. Patients with type-1 diabetes require lifelong insulin therapy. Although onset frequently occurs in childhood, the disease can also develop in adults.

 

Type-2 diabetes results from a combination of diminished insulin secretion by the pancreas and “peripheral insulin resistance.” This “peripheral insulin resistance” is a shorthand way of saying that (1) the glucose is impaired from getting into the muscles and tends to stay in the blood, (2) that the liver produces increased glucose, and (3) that there is an increased fat breakdown. Patients with type-2 diabetes may require oral medication or oral medication plus insulin.

 

Type-2 Symptoms 

 

Many type-2 diabetes patients exhibit no symptoms; the disease can begin insidiously. By the time of diagnosis, some patients have had the disease for 4-7 years and have already begun sustaining eye, nerve, and kidney damage. Other patients have earlier and more obvious symptoms such as excessive eating, drinking, urination, and weight loss.

 

Type-2 Risk Factors

 

Major risk factors for type-2 diabetes are

• Age greater than 45 years

• Weight greater than 120% of desirable

• Type-2 diabetes in a first-degree relative

• Ancestry: Hispanic, Native-American, African-American, Asian-American, or Pacific Islander

• High blood pressure or cholesterol-triglyceride problems

Diabetes during pregnancy or delivering an infant weighing more than 9 pounds

• Polycystic ovary syndrome

 

Complications of Type-2 Diabetes 

 

The death rate among people with diabetes is about twice that of people of the same age without diabetes. Some of the major complications of diabetes, fatal and otherwise, are diabetic retinopathy, end-stage kidney disease, neuropathy/vasculopathy, and cardiovascular disease.

 

Diabetic retinopathy is a major cause of blindness in adults; it accounts for 12,000-24,000 newly blind persons every year. However, laser surgery and appropriate follow-up care can reduce the risk of blindness from diabetic retinopathy.

 

About 44% of new cases of end-stage kidney disease in 2008, were among diabetics. That year, over 200,000 people with diabetes were on dialysis or had received a kidney transplant.

 

Diabetes is the leading cause of lower limb amputations not occasioned by accident. Diabetics have an estimated 15- to 40-fold increase in the risk of lower limb amputation over non-diabetics.

 

For coronary heart disease, the risk is 2-4 times greater among diabetics than among non-diabetics. Cardiovascular disease is the major source of mortality in patients with type-2 diabetes mellitus.

 

Prevention of Type-2 Diabetes

 

For prevention of type-2 diabetes in patients at risk (see “Risk Factors” above), the American College of Clinical Endocrinologists recommends

  •      • Weight reduction
  •      • Proper nutrition
  •      • Regular physical activity
  •      • Treatment of high blood pressure
  •      • Aggressive management of cholesterol-triglyceride problems

 

Weight management is especially important. In some overweight patients, a 5% body weight reduction maintained over three years was effective in reducing the diabetes risk by 58%.

 

While the Mediterranean diet receives most of the good publicity, it seems that any balanced diet, with good calorie management, satisfies the proper nutrition requirement.

 

A worthwhile recommendation for regular physical activity is 30 minutes of aerobic activity five times weekly.

 

For the treatment of high blood pressure and the management of cholesterol-triglyceride problems, the primary care physician now has substantial options to balance good control with safety and comfort.

 

Treatment of Type-2 Diabetes 

 

The goals of treatment are to reduce the risk of complications affecting the eyes, kidneys, nerves, blood vessels, and heart. The foundations of treatment are lifestyle changes involving diet, exercise, and health education. The risks of complications are further reduced by medications to control blood pressure and cholesterol/triglyceride problems. 

 

There are now multiple medications to control blood sugar levels. Frequently, oral medications are sufficient. These can work by decreasing the liver’s production of glucose, decreasing intestinal absorption of glucose, improving the body’s sensitivity to insulin, or increasing the secretion of insulin. Some promote glucose excretion by the kidneys.

 

Injectable medications are also available. These may stimulate insulin release in response to food ingestion and may prolong the life of insulin-secreting cells in the pancreas. These injections may need to be administered anywhere from twice daily to once weekly. They may be used alone or in combination with oral medications or insulin.

 

Insulin is typically associated with type-1 diabetes, but can also be useful in type-2 diabetes. Varieties include rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting. These have durations anywhere from 3-5 hours to 24-42 hours. Finally, an inhaled insulin powder now exists that is rapid-acting and is taken just before a meal.

 

Many options for treatment exist and the physician can design an appropriate one for the individual patient. The goal is to find a treatment that controls the disease, that fits the patient’s life, and that can be continued over a lifetime.

 

Conclusion

 

In brief, type-2 diabetes is a widespread problem in the US. It is increasing among adults and young people as the obesity epidemic prevails. Type-2 diabetes has life-shortening and life-curtailing complications. The cornerstone of treatment is a change in lifestyle. Aiding this is a growing list of medication options. The key for patients is to work with their physician to plan a treatment that works, that fits, and that endures.

 

 

Thomas Falasca, DO

  • Thomas Falasca, DO

 

References 

 

Aathira, R., & Jain, V. (2014, October 15). Advances in management of type 1 diabetes mellitus. Retrieved from https://www.wjgnet.com/1948-9358/full/v5/i5/689.htm

 

Bullard, K. M., Cowie, C., & Lessem, S. (2018, March 29). Morbidity and Mortality Weekly Report (MMWR). Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm

 

Khordori, R. (2019, February 26). Type 2 Diabetes Mellitus. Retrieved from https://emedicine.medscape.com/article/117853-overview

 

Statistics About Diabetes. (n.d.). Retrieved March 1, 2019, from http://www.diabetes.org/diabetes-basics/statistics/

 

 

 

Vaping and Lung Damage

Centers for Disease Control (CDC) and Food and Drug Administration (FDA) have warned  ...See More


Vaping and Lung Damage

 

Vaping and Lung Damage

 

On September 6, 2019, the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) issued a clear warning about lung toxicity related to e cigarette use. They along with state and local health departments are investigating the cause or causes of this potentially life-threatening disease. The investigation stems from a study of 53 patients from the states of Illinois and Wisconsin who presented to the hospital with lung and gastrointestinal symptoms. A third of those patients required mechanical ventilation and one death were reported in this study. The median age was 19 years.

 

E-cigarette, or more colloquially vaping, usage especially among adolescents has increased exponentially. Recent studies from Monitoring the Future, a 44 year old study, show that the increased prevalence of vaping represents the largest increase in risky behaviors since the initiation of monitoring.  Although used as a means to transition from cigarettes, use of the nicotine still carries with it the risk of addiction.

 

Investigations into the cause of lung toxicity are ongoing, but there are several clues at this juncture. The presence of tetrahydrocannabinol (THC) usage by users and use of black market devices and flavorants appear to be the focus of current investigations. More information will be forthcoming. For now, despite the use as a means of tobacco cessation, it is wise to avoid vaping until investigators have clarified more clearly the cause or causes of lung toxicity. At the same time it is important to continue to remain tobacco-free given the heart, lung and stroke risks which are clearly present.

 

Jeff McGovern, MD

Jeffrey McGovern, MD, FCCP, FAASM

Seasonal Flu

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.   ...See More


Seasonal Flu

What Is Flu?

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.  An episode of flu typically runs its course over several days.  Although usually just a severe nuisance, flu can sometimes result in respiratory failure and death.

 

Symptoms

An attack of influenza is usually accompanied by muscle aches, headache, fever, sore throat, red watery eyes, runny nose, and cough.  Only some of the symptoms may be present.

 

These symptoms sound like a cold, and like a cold, flu is a respiratory infection. However, influenza is caused by a different virus and is more severe.

 

Severity

Each year about 200,000 Americans are hospitalized because of flu complications. The number of deaths varies depending on the annual virus strain; but American deaths have recently ranged from 3,000 to 49,000 in a year.  While human lives are most important, it is noteworthy that even mild strains of the flu can impact the American economy by $10 billion annually in lost productivity.

 

Contagion

Influenza is typically spread by the aerosol droplets propelled in the course of a cough or sneeze.  Even people six feet from a sneeze are at increased risk of infection from these micro particles.  

 

Flu can also be spread from surfaces.  If a person coughs into their hand or sneezes into a handkerchief and then touches an object such as a doorknob or computer keyboard, that object becomes contaminated. A person who touches the object shortly afterward can be infected, usually when they transfer the virus from their hand to a mucous membrane such as the nose, mouth, or eye.

 

Because of the high level of contagion, it is important that flu patients remain home to avoid infecting co-workers.

 

Infectivity

Once a person becomes infected by the virus, it takes 1 to 4 days before they exhibit symptoms.  However, they may transmit the virus to others even before symptoms become evident. Thus it is not sufficient to avoid persons who appear to be sick.  It is important to make a habit of frequent hand washing as this can reduce both virus dissemination and acquisition.

 

Complications

Occasionally influenza does not run its normally uneventful course but instead results in complications.  Some of the most serious of these are viral pneumonia, bacterial pneumonia, respiratory failure, an inflammation of the heart (myocarditis), an inflammation of the membrane surrounding the heart (pericarditis), and multiorgan failure.

 

Vulnerability

Fatalities are most common in infants and the elderly. Thus it is important that senior citizens receive vaccination, the “flu shot.”  Vaccination is also important for pregnant women.  Pregnant females are not at risk from the flu shot and they need vaccination because they are at increased risk of complications from flu and they need to pass on their immunity to the newborn.

Others who are at increased vulnerability are those who are immunocompromised from disease or chemotherapy.

 

Pandemics

A pandemic is an epidemic that occurs over a broad area.  Four flu pandemics have occurred in the last century.  These epidemics occurred when a highly contagious and aggressive strain of the virus emerged.  

 

The infamous “Spanish flu” of 1918 killed nearly 675,000 people in the US and a possible 50 million people worldwide.  

 

The “Asian flu” of 1957 killed about 69,800 people in the US.  

 

The “Hong Kong flu” of 1968 took the lives of 33,800 people in the US.  The relatively modest number may have been largely due to the availability of antibiotics to treat secondary bacterial infections.  

 

The “swine flu” of 2009 caused between 9,000 and 18,000 deaths.  The reduced number of deaths in this epidemic may have been due to the fact that 80 million people were vaccinated.

 

Flu Vaccination Does Not Cause Flu

Vaccination against flu can be by injection or nasal spray.  The injection contains virus that is inactivated (“killed”). The nasal spray contains virus that is attenuated (“weakened”) and so altered that it can be active only at the cooler temperatures of the nose and not in the warmer temperatures of the lungs. The result is that flu vaccination does not cause the flu!

 

Vaccination Side Effects

Serious vaccination side effects are quite rare.  They are circumvented by avoiding certain flu vaccinations in specific groups of people.

 

Traditionally, flu vaccine was produced using chicken eggs and was contraindicated in persons with egg allergy.  Since 2012 a vaccine prepared in a different manner has been available for persons 18 years of age and older who are allergic to eggs.

 

An inactivated virus vaccination rather than an attenuated virus vaccination is generally appropriate for persons with weakened immune systems congenitally, from illness, or from chemotherapy.

 

In short, some type of flu vaccination should be appropriate for most individuals 6 months of age and older.

 

So If I Get Vaccinated, I Can’t Get the Flu, Right?

Not quite!  In the recent past flu vaccination has had 70% effectiveness against influenza B and 60% effectiveness against influenza A.  This is so because:

  • The US Center for Disease Control (CDC) must project in advance the virus strains of the upcoming flu season.
  • Different individuals have different capabilities of manufacturing antibodies in response to the stimulus of the vaccine.
  • It takes 1-4 days after infection for flu symptoms to emerge.  Persons can be infected before they receive the vaccination.
  • It requires 7-14 days for the body to build antibodies from the stimulus of the vaccination. Vaccinated people can be infected with flu during this time period.
  • Symptoms of flu can be simulated by other virus infections.  Flu vaccinated persons who seem to get the flu may have these other infections.

 

How Can I Prevent the Flu?

The best method of dealing with the flu is not to have it!  In order to greatly reduce chances of getting the flu, it is most important to take these precautions:

  • Practice frequent hand washing, especially after contact with objects touched by infected persons or the general public.
  • Avoid proximity to infected persons.
  • If infected, stay home and avoid contact with others. Bear in mind that you are infectious for 4-9 days after onset of symptoms.
  • Finally, present yourself for vaccination.  This is your surest way of protecting yourself from flu.  As an added benefit, remember that by getting vaccinated, you are also protecting newborns, elderly, chemotherapy patients, and others unable to fully benefit from their own vaccination.

 

Conclusion

So please stay well this season and protect yourself from flu.

 

Thomas Falasca, DO

View this fact-filled video on flu symptoms from the US Centers for Disease Control!

 

Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

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Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

 

What Is It?

Frostbite is tissue injury resulting from the freezing and crystallization of the body fluids within and between the cells.  The ice crystals then damage the cell membranes.  Further damage results from obstruction within the smallest blood vessels and inflammation when blood flow is reestablished.

 

How Will I Know It?

Frostbite can develop insidiously.  It may begin with coldness that progresses to burning or throbbing.  This can eventuate in numbness and then loss of sensation.  The skin may subsequently become pale or bluish. Finally, frostbite causes finger clumsiness, difficulty walking, and severe joint pain.

 

The areas most often affected are fingers, toes, ears, and nose.

 

What Are the Consequences?

A case of frostbite can leave permanent reminders of the event.  Some consequences are minor, such as cold sensitivity.  Others are substantial, such as squamous cell carcinoma, arthritis, limb growth deformities in children, and gangrene.  Frostbite can result in limb amputations or require nose and ear reconstruction surgery. 

 

Who Is at Risk?

Both the very young and very old are at greater risk for frostbite.  They have greater difficulty producing and regulating heat as well as a proportionately greater body surface area from which to lose heat.

 

Groups especially at risk for frostbite are those of African, Middle Eastern, and Pacific Island descent. 

 

Women are usually more sensitive to frostbite than men.

 

People whose hands tend to become white in the cold are especially at risk for frostbite.

 

What to Avoid?

  • Avoid tight clothing.  It restricts circulation thus promoting cold injury.
  • Avoid smoking.  It also restricts circulation.
  • Avoid prolonged inactivity.
  • Avoid getting clothing wet.  The air trapped between the clothing fibers is an insulator that keeps heat from leaving the body.  Water is a conductor that facilitates passage of heat away from the body.

 

What To Do?

  • Seek shelter from wind as well as cold.  A small envelope of warm air surrounds the body and reduces the dissipation of heat.  Wind continuously blows away this envelope, thus accelerating dissipation of heat from the body.
  • Wear several layers of light, loose clothing.  The air trapped between the layers insulates against heat loss.  It is especially important to wear at least two pair of socks.
  • Wear mittens in place of gloves or on top of the gloves.  The reduced surface area of the mitten compared to the glove reduces the dissipation of heart. 
  • Cover the face and head and use a hat that covers the ears.  The face and head have a large blood supply that can rapidly dissipate heat.  Additionally, the ears and nose can easily have their blood flow compromised, predisposing them to frostbite.
  • Wear fabrics that are especially good insulators, such as fleece, polypropylene, and wool.

So be sure to protect yourself from frostbite and enjoy the many pleasant outdoor activities of winter.

 

Thomas Falasca, DO

Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here ar ...See More


Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here are some helpful tips.

 

First and foremost

  • Check with your doctor. Shoveling stresses the heart because of both exertion and cold. Consider hiring someone for the task.
    Do not shovel after eating or smoking as these activities reduce blood flow to the heart.
    Stop if you feel chest pain, or get excessively tired or have shortness of breath. You may need immediate professional care.
    Dress in layers with water-repellant clothing outermost. Remember hats, gloves, and warm socks because substantial body heat is lost from these areas.

 

Choose an appropriate snow shovel.

  • A curved-handled shovel helps keep your back straighter when shoveling.
    Choose a shovel with an appropriate length handle. The length is appropriate when, at the beginning of the shoveling stroke, it allows you to slightly bend your knees and bend your back less than 10 degrees while still holding the handle comfortably.
    A plastic shovel blade adds less weight to the lift than a metal blade.
    A smaller shovel blade may add to the time of the task; but, by picking up less snow, it reduces the risk of a heavy shovel load.

 

Be mindful of your shoveling actions.The American Academy of Orthopedic Surgeons recommends

  • If you must lift snow, squat with legs apart, knees bent, and back straight.
    Lift with the legs instead of bending at the waist; this reduces strain on the back.
    Scoop small amounts of snow with the shovel and walk to the dumping area.
    Outstretched arms exaggerate strain on the back.
    Remove deep snow in layers of an inch or two in thickness.
    Move feet instead of twisting.

 

In addition, remember that

  • Pushing the snow instead of lifting it reduces strain on the back.
    Gripping the snow shovel with your hands at least 12 inches apart increases leverage and decreases body strain.
    Throwing snow over your shoulder is dangerous. It twists the back and predisposes to injury.
    Warming up muscles before shoveling reduces the risk of strains and sprains.
    Frequent breaks to gently stretch back, arms, and legs reduce stress to these areas and distributes over time exertion on the heart.
    Wet snow is especially heavy and one shovelful can weigh 25 pounds.
    Clearing snow early and often to avoid dealing with a large amount of heavy, packed snow.

 

So follow these tips and avoid becoming a snow-shoveling casualty.

 

For more information, consult
· Colorado Spine Institute http://www.coloradospineinstitute.com
· AMERICAN ACADEMY OF ORTHOPEDIC SURGEONS http://orthoinfo.aaos.org/topic.cfm?topic=A00060
· National Safety Council www.nsc.org
· Toronto Emergency Medical Services
http://www.torontoems.ca/main-site/careers/safety-tips/show-shovelling.html

 

Thomas Falasca, DO



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