Hallucinations and healing
Ecstasy and mushrooms are being used by the medical and psychiatric community to help heal depression, anxiety, and PTSD. Both these substances have recently been approved for further studies of their ability, with highly trained support in a controlled setting with active therapy, to help patients who have not found relief elsewhere.
A story in the New York Times today discusses the use of psilocybin, also known as magic mushrooms, in patient’s whose cancer brought them to a desperate place of depression and anxiety. While the researchers are not clear on how this drug works exactly, the trials thus far show it is effective, and after only one dose when administered in a controlled setting by psychiatrist and a social worker in a session lasting 8 hours. There were two small studies and both reported success with patients in whom traditional treatment had not led to improvement. There are also studies being done to look at its role in addiction treatment and non-cancer depression.
A story linked to in this same article discusses the use of ecstacy, or Molly/MDMA, in treating PTSD (post traumatic stress disorder). We think of this in soldiers who have returned from war, but it occurs in civilians with the same triggers- either a single traumatic event or repeated traumas like abuse. It seems that while the brain is under the influence of this medication, it can finally confront the trauma that caused the condition and this trauma can be dealt with during a therapy session much like the one used in the psilocybin trials. The brain and body overreact in an inappropriate way to a given stimulus and can’t stop- to the point where it interrupts the person’s life. This can manifest in nightmares or panic attacks or other reactions that make daily living incredibly difficult.
While psilocybin is a natural substance, and MDMA was created in a lab, both seem to allow the patient to look at themselves and their experiences from a detached perspective and examine thoughts and emotions. Despite a number of treatment approaches including medications and psychotherapy techniques, there is none that hugely effective in treating PTSD and many other mental illnesses. The FDA is allowing these studies to proceed in hopes of offering a cure, in a relatively short course of treatment, for illness that is resistant to conventional therapies. Moving these drugs off the most restrictive DEA schedules is essential to conducting clinical trials, just like what needs to be done for marijuana (which I wrote about last week). I’m looking forward to a day when all medications that have the potential to be medically useful are allowed to be fully investigated in clinical trials.
Still smoking? Want to quit?
While fewer people are smoking nowadays, there are still plenty of people who smoke. It may be only when they are out with friends, or with family who smokes, or when they are extra stressed. Some people can stop for years but fall back into it quickly due to a big stressor in their life. We understand. Most of us need help with healthier coping mechanisms and can develop addictive behaviors (think food, alcohol, wasting hours on Netflix, or getting grumpy with our loved ones). But nicotine is an incredibly addictive chemical and it’s a behavioral habit. For this post let’s focus on cigarettes. The New York Times this week had an article reporting on a recent study that 28.6% of cancer deaths nationally are caused by smoking tobacco in some way. The rate varies on location, with a low of 21% in Utah and a high of 38% in Kentucky. There is also a big difference rates between genders with men significantly more affected than women. What are these 12 cancers that are directly related to cigarettes? Obviously lung, mouth and throat cancers. But also stomach, colon, bladder and even a type of leukemia. This study did not include cancers due to other types of tobacco like chewing tobacco which would add many more life altering and deadly cancers. How do we get these numbers to decrease? By implementing recommended programs in each state that help people stop smoking and prevent them from ever starting in the first place. The World Health Organization recommendations come down to three basics: prohibitive cost of tobacco products, no advertising, no smoking in public, and an engaged health system.
Here in primary care we can be engaged in finding out your smoking habits and helping you quit when you’re ready. We won’t shame you- promise- but we ask if you are ready to quit or reduce smoking. This upcoming cold and flu season is a great time to quit! Most people don’t have the urge to smoke as much when they’ve got a cold so take advantage of this fact and don’t resume your usual smoking frequency. Come in and see us as you may need antibiotics for your bronchitis (smoking changes the bronchi and lungs and encourages the growth of different types of bacteria) and we can discuss medications to stop smoking at the same time. Whether you’d like some accountability while you use the patches and/or gum from the drugstore, or you’d like to try Zyban or Chantix tablets to help reduce the cravings, we are here for you. People often tell us about some creative ways they have reduced or stopped smoking. They’ve had success with a transition to e-cigarettes, or cigars/cigarillos, or water pipes, to keep up the nicotine while they transition off the physical cigarette habit and then transition off nicotine slowly. Different studies have shown varying levels of success with this type of method, but only you know the method that may work for you. We’ve also had patients who found hypnotherapy incredibly helpful in as little as one visit.
Think about the factors that make quitting difficult or that have caused you to relapse in the past. Do you have a friend or family member to encourage you on the way? What has worked to help you reduce or quit in the past? Did you know you can start on a medication while still smoking? Starting on it for a few weeks prior to a quit date can ease a lot of the anxiety that goes along with quitting. And we will meet with you and support you through the ups and downs of the process for however long it takes. There are many methods to quit or reduce smoking so come in and see us at any of our Kelly Goodman Group Locations so we can find one that will work for you!
Breast Cancer- What’s Your Risk?
In honor of the end of Breast Cancer Awareness Month let’s talk about risks and screenings. When should you get a screening mammogram? At what age should you start? How often should you get one? Do you need an ultrasound or an MRI for further evaluation and how often?
These questions have different answers depending on whose advice you are looking for. All the groups that make official recommendations have their own particular guidelines for routine screening mammograms. They all agree on the risk factors though.
- Family history/ genetics
- Age
- Younger age for first period
- Older age for first childbirth
- Older age for menopause
- Breast density
- Use of birth control and/or hormone replacement
- Obesity
- Lack of exercise
- Alcohol use
- Radiation exposure
The most aggressive guidelines for screening are from the National Comprehensive Cancer Network. They recommend annual mammograms starting at age 40, and clinical breast exams. The most relaxed guidelines are from the US Preventive Services Task Force which does not even give recommendations for women with higher risk but only recommends screening mammograms every 2 years, beginning at age 50, and recommends against breast self-exam. The American Cancer Society recommends screening mammograms annually at 45 and decreasing to every other year at 55. The American Congress of Obstetricians & Gynecologists recommends annual screening mammos at age 40. All but the USPSTF recommend being aware of the feeling of your own normal breast tissue and having an annual MRI if the lifetime risk of breast cancer is calculated to be more than 20% based on family history.
How do you determine a woman’s lifetime risk of getting breast cancer? There are computer programs available that allow us to calculate that based on family history and the personal risk factors listed above. At your next physical exam we can determine if we need to calculate this risk, and at a followup appointment we can take the time to enter your personal and family data into a program that will give us a percentage chance that you could have breast cancer in the next 10 years and also the chances of developing breast cancer in your lifetime. These are sobering statistics (I have entered my own data and even with no family history of breast cancer my lifetime chances of developing it are 12%!). If your lifetime risk is 20% or higher you are entitled to see a genetic counselor and your insurance is obligated to pay for it, as well as an MRI (thank you Affordable Care Act).
Come in and let’s talk about your personal and family risk factors for developing breast cancer and make sure you are getting the appropriate screening to ensure your longest healthiest life.
STD boom!
Congratulations Washington, DC- your rate of syphilis is #3 highest in the US. As STD rates have continued to rise over the past few years, our area has the unfortunate distinction of having high rates of sexually transmitted infections. The latest report released this week from the CDC includes data on chlamydia, gonorrhea, and syphilis. Infections caused by HIV, human papillomavirus, herpes simplex virus, and trichomonas are not tracked in this report and CDC reminds us that the total number of infections shared through sexual contact is in fact far beyond the rates shared in this report. What is shocking is that HALF of all infections occur in people ages 15-24.
So how bad is it? Well the CDC tracks a lot of diseases, but chlamydia has now broken the record of highest number of any disease EVER REPORTED. It is easily treated with antibiotics. But here’s the problem- since many men and women never have symptoms, they don’t know they have been infected. The disease damages the reproductive tract which means women are at greater risk for ectopic pregnancy (life threatening) and that’s if they can get pregnant at all. Gonorrhea is increasing as well and is becoming resistant to antibiotics. Gonorrhea transmitted during oral sex can cause a sore throat and it can cause infertility in both men and women. Both chlamydia and gonorrhea can be “silent” and cause no symptoms, but when there are symptoms they are usually discharge, burning or pain in genital area and/or with urination. While the symptoms come and go, the infection does not resolve unless treated with antibiotics.
Syphilis sounds old-fashioned but it is definitely back and on the rise. It is cured with penicillin, but is often missed in its early stage. The first symptom of syphilis is a sore. This sore can be small, and since it is painless and can be inside the vagina or rectum people may not notice it. Or perhaps they notice it but think it is an ingrown hair, or shaving nick. If it’s on the mouth or lip they may confuse it with a cold sore or canker sore. It is important to be treated at this early stage, because the next stages cause symptoms like rash, flu like illness, hair loss, among others. Eventually the bacteria enters the brain and causes serious symptoms like dementia, paralysis and even death.
All of these infections can be passed on to a fetus in utero, or a baby through birth, and cause serious health concerns, and the pregnancy may end in miscarriage or result in premature birth. If you are pregnant or may become pregnant make sure you’re screened ASAP.
20 MILLION infections each year cost $16 BILLION (yes that’s a “b” in billion) in health care costs.
And that’s not counting the effects and costs of infertility and ectopic pregnancies that are caused by sexually transmitted infections.
Protect your fertility by getting screened for STDs every 6-12 months if you are sexually active. Come talk to us and we will give you a personalized recommendation based on your life. We are easy to talk to- even about sex- and can help you stay healthy.
Gluten-free diets are on the rise. Why?
If you’ve been looking at menus or walking through the grocery store, you’ve likely noticed more and more items labelled “gluten-free”. Why? Who is avoiding gluten and why are they doing it? Why was there a three-fold increase in gluten-free diets when there has been no increase in the medical diagnosis of related diseases?
In honor of National Celiac Awareness Day, we’re talking about gluten. Gluten is a protein found in grains- wheat, rye and barley- and helps give an elasticity to these flours in cooking and baking. These grains are found in breads, pastas, soups, cereals and other baked goods. People can be affected by gluten in a few ways.
First, some people have an immediate allergic reaction to wheat and/or another grain. This is a more obvious reaction and easier to diagnose by blood tests looking for antibodies and skin testing looking for skin reactions. These must be treated by avoidance of the grain. There are no medications or allergy shots for food allergies- yet.
Second, people can be affected by the gluten found in wheat, rye, and barley. This can be found in a serious autoimmune form known as Celiac disease or in a milder form called gluten sensitivity. Certain individuals, about 1 in 100 people, have Celiac, a genetic condition where the body attacks the small intestine when gluten is ingested. This can cause lifelong effects and increases one’s chances of having other autoimmune diseases. The only treatment is avoidance of gluten. Blood tests can be performed to help diagnose this disease. Gluten sensitivity is something we don’t yet have conclusive testing for, but studies have shown that people without Celiac can still have damage to their small intestines if they are sensitive to gluten. Therefore, these individuals should still avoid gluten.
Are you avoiding gluten, or limiting your intake? Is it for health or weight loss? Did you have fatigue, digestive or other symptoms that have improved since you went off gluten? Or are you being encouraged by a friend or family member to eliminate it for a month? If you have a family member with confirmed celiac, or if you have an autoimmune disease you should get tested for celiac before you stop eating it. The blood tests are accurate only when you are actively eating (or drinking) gluten.
Going gluten-free is much easier now than it was 16 years ago when a member of my family was diagnosed with a wheat allergy. We are happy to discuss these issues with you, do any appropriate testing, and manage any diseases that are found.
Do I really need a colonoscopy?
We all hear horror stories from our friends and families about colonoscopies and the dreaded “prep”. Why are we doing this to ourselves? How can we reduce the number of times we need to do this test in our lifetime? Is there a way to avoid it completely?
First let’s talk about prevention as this is what really saves lives. In the US, colorectal cancer is the second deadliest cancer. Men have a 4.7% chance and women a 4.4% chance of being diagnosed with it.
There are risk factors you can’t change, like living longer than 50 years, having a family member with colon cancer or other cancer syndromes, polyps, Crohn’s or ulcerative colitis, having diabetes, or being in certain racial or ethnic groups (African American and Ashkenazi Jewish).
But there are risk factors that we can control- like alcohol consumption, smoking, sedentary lifestyle, obesity, and poor diet. Make sure to talk with your primary care provider about when to start screening if you have a family history of polyps, colon cancer, or a high number of other cancers. Hint: you need to be screened earlier- up to 10 years earlier even without symptoms depending on the situation.
We now have genetic tests to identify familial disorders that link many types of cancers, such as Lynch syndrome (this causes ovarian, uterine, pancreatic, kidney, brain, ureter and bile duct cancers). So we can test people for a genetic predisposition and make sure they are vigilant about screenings. But what if you have no risk factors? What are the screening rules in that case? Our federal government, as the USPSTF (US Preventive Services Task Force- they will be a recurring character in this blog) recommends screening all Americans between 50 and 75 years old. How often during that 25 year span depends on what is found during the screening. If you are minimizing your risk factors and have a normal colonoscopy you can avoid one for up 10 years at a time. That means a lifetime total of 3 at ages 50, 60 and 70. The upside? It’s a day off from work and maybe you even lose a stubborn pound or two with the clear diet leading up to the procedure. But is it possible to avoid the colonoscopy completely? Well the USPSTF and the AAFP (American Academy of Family Physicians) agree that the only methods that we can count on are colonoscopy, sigmoidoscopy (similar to colonoscopy but not as thorough), and stool testing that looks for blood. There are other newer tests such as a stool test that looks for cancer DNA rather than blood (Cologuard) and CT scans specifically for the colon/rectum. But these newer tests have not had time to prove themselves effective in a way that outweighs the risks- like an incorrect result or exposure to radiation.
If you use one of the stool tests or sigmoidoscopy and there is any uncertainty about being cancer-free, then you’ll need to follow up with a colonoscopy. Honestly, other than our skin, we can’t look at an organ directly to look for changes in the cells. Colonoscopy allows us to use a camera, equipped with tools, to look for and take samples of cells to analyze under a microscope. If you want to use the stool tests, you should repeat them yearly. Otherwise follow up frequency for colonoscopy depends on what was seen inside and under the microscope-usually 3-10 years.
Bottom line (pun intended), the same rules for healthy living apply to colon health as for the rest of our body. Don’t smoke, get exercise, eat lots of veggies, fruits, and whole grains, keep alcohol to a max of 1 drink daily for women or 2 for men, and stay at a healthy weight (BMI/ body mass index <25). And make sure to see your primary care provider to discuss your personal and family health history and come up with an individualized plan for your health each year. Call us or visit us at any of our Kelly Goodman Group locations to set up a visit.
Is Anxiety interfering with your life?
We all deal with anxiety at times- it’s part of being human and serves a purpose in keeping us alert when something could have a bad outcome. But sometimes people develop feelings of anxiety that are too frequent, unrelated to a specific event, are out of proportion to a given event, or just don’t go away. More than 18% of Americans seek treatment for anxiety as adults. Unfortunately, only 41% of Americans with mental health symptoms seek medical care each year. Obviously these are terrible statistics in the abstract but when you imagine people actively suffering without access to care or not knowing how to get it, even though we have tools to help, it really brings it home. Don’t ignore your mental health! It’s just as important as your physical health and is interdependent with it. People with chronic physical illnesses are more likely to develop mental health problems and people with mental health problems have physical health ramifications if not physical health causes. Bottom line- these feelings of anxiety or panic are manifested physically in our bodies as part of our “fight or flight” response. So when anxiety is happening too often, this response really takes a toll on us. We can end up with problems like insomnia, headaches, muscle tension, trouble concentrating, as well as the irritability and worry or panic that comes with the feelings of anxiety.
A panic attack can happen when people have a constant low to moderate level of anxiety they are dealing with that will then explode in a panic attack. This includes feelings of doom, shortness of breath, heart palpitations, nausea, sweating and shaking. These attacks often come with no warning and are not related to a stressful or worrisome event. They can wake you up from sleep, happen at work or school, or even while trying to relax with family or friends. These attacks are terrifying and if you have not experienced one before you need to seek immediate medical attention to be sure that you are not in fact experiencing a heart attack, pulmonary embolism, or allergic reaction. Yes, panic attacks are that bad. Your body gives you signals that your life is at stake!
If you are experiencing symptoms of anxiety we want to help. There is a chance your anxiety symptoms are being caused by a thyroid, heart or lung issue so let’s make sure not to miss those. If your diagnosis is in fact an anxiety disorder, there are medications we can prescribe and monitor that can really help as well as excellent therapists who can teach you to manage symptoms. Let us know about your story, especially if these symptoms are interfering with your life- whether relationships, work, family responsibilities or health. We want to help you to live your healthiest life possible- physically and mentally. Kelly Goodman Group
UTIs: uncomfortable, unexpected, but not untreatable
Are you experiencing recurrent UTI/bladder infections? Although most women (50% by age 32 according to Cleveland Clinic) experience a urinary tract infection, for some people these become a recurring concern. Studies claim anywhere from 20% to 40% of women who get one UTI will develop another. And of course they seem to come at inopportune times- the day before a big work event, on vacation, or with a new sexual partner. So what do you do when that first stab of pain occurs or the burning starts with urination? First, give us a call to stop by for a quick appointment that same day- even on your way to work! We can check a urine sample in office and start you on a safe antibiotic that has low resistance in our area and very low chances of side effects. We can send out a sample for culture to be sure we know exactly what it is and make any necessary adjustments to treatment to be sure it doesn’t come back. We can also prescribe medication that effectively numbs the urethra and soothes the pain (although it does turn your urine bright orange… can anything be subtle?).
So maybe this is your first UTI. In that case just be sure to use best practices to avoid another one: stay hydrated, empty your bladder regularly (including after sex), and wipe front to back after elimination and/or defecation.
But what if this is your second infection in recent memory? Or even your third or fourth? What then? Well you have some options. Let’s get a culture to determine if the germ is resistant to the medications you’ve been taking and simply was never treated effectively. Depending on the severity and frequency of infections, we can start you on various types of antibiotic regimens. However, many people would prefer to try to avoid the use of antibiotics whenever possible or are looking for more natural alternatives. In this case, please consider the use of two supplements. One is D Mannose and the other is lactobacillus.
We’ll start with the D Mannose– this can be used to treat an active mild infection and to prevent future infections. In fact a controlled study showed that patients treated with D Mannose went much longer (200 days vs 52 days) between repeat infections than those treated with an antibiotic (Bactrim orTMP/SMX- a sulfa type of antibiotic). This substance naturally occurs in fruits like red berries (such as cranberries) and fruits like apples and peaches. But it’s difficult to get enough through food sources alone to have an impact on urinary health. D Mannose helps keep the bacteria from attaching to the side of the bladder and so it can then be flushed out easily.
The other preventive treatment is lactobacillus aka probiotics. We hear so much about the countless benefits of probiotics for our immune system and digestive system. In this case, the lactobacillus family of probiotics (indicated by a lower case “L.” on the ingredient list) has been shown to reduce recurrences of UTIs by half, almost as much as an antibiotic regimen. If you also suffer from vaginal yeast infections this could be a wonderful way to reduce chances of another yeast infection or bladder infection.
Click on our website Kelly Goodman Group or give us a call at any of our locations to make an appointment. Stop going to Urgent Care over and over and come to Promenade Primary for your UTI so we can try to make it your last one!
Do I have Zika?
Fatigue, muscle aches, rash, red eyes, mild fever. Is it Zika?
Now that the Zika virus has been transmitted by local mosquitos in Florida, we are all wondering when it will come to Washington DC. This city was built on a swamp and we have all experienced the mosquitos here. Our area has the right type of Aedes mosquito and we have lots of international travelers here, given that we are the nation’s capital. Two weeks ago we looked at risk factors for contracting Zika virus, as a resident of the District of Columbia. What happens if you have done your best to protect yourself but are starting to feel ill? How do you know if it’s Zika or just a run-of-the-mill virus? First, call us to schedule an appointment. We can test for Zika- we will draw your blood here and send it to a national laboratory for testing. Second, be on the safe side and only take Tylenol (acetaminophen) even if you’ve only been in the continental US. Given that Dengue has the same symptoms as Zika, and increases bleeding risk, don’t take Advil/Motrin (ibuprofen). If you have been out of the country recently we will discuss your risk factors, test for similar viruses such as Dengue fever and Chikungunya and determine the proper treatment for you. Above all, the treatment for Zika is supportive rather than curative- meaning lots of fluids, lots of rest, and time. The symptoms of the virus can last 2-7 days. Keep in mind that many, if not most, people who have Zika do not have any symptoms at all. That means that Zika can spread more easily, as infected people can remain active and exposed to mosquitos that will transmit the virus by biting an infected person and then an uninfected person and transferring the virus. Keep protecting yourself with insect repellent as needed and safe sex practices.
We are happy to discuss your risks for Zika or any other disease with you further- just give us a call at any of our locations to set up an appointment. Visit our website for more info.
Zika: What is your risk?
As a resident of Washington, DC you may be wondering… What is your risk for contracting Zika virus?
We have all heard about the risks of travelling to the tropical areas of the Caribbean, Central and South America. We have heard from athletes who are avoiding the Olympic Games this summer in Brazil due to the risk of being infected by a mosquito bite while there. We know that the Zika virus can also be transmitted by sexual contact with someone who has the virus. This past week we also learned that there are likely two cases of Zika in Florida (they are being confirmed) where the patient did not travel out of the country nor did they have sexual contact with anyone who did. These are believed to be the first two cases in the continental United States where the infection came directly from a mosquito on US soil. We have also learned of a case in New York State where for the first time we have confirmed transmission of Zika from a woman who returned from the tropics, and had sexual contact with her male partner that day of return. She developed symptoms the next day and her partner developed symptoms a few days after that. And more concerning, we learned of a case in Utah, where a family member who was caring for someone with Zika developed the virus themselves. Research is still being done to determine the method of transmission in that case. We are still learning about the virus and transmission every week as scientists around the world are looking into it.
What do you need to do to reduce your risk?
- The type of mosquito that transmits Zika (Aedes) is active both day and night and it lives in our area. Each mosquito does not travel far and often lives its entire life in or around one home. So wear an effective insect repellent when you’re outside, make sure your window screens are in good repair so that you don’t invite mosquitos into your home, and avoid having standing water in the area around your home (anything that catches and collects water from a toy to furniture to a low area in the yard).
- Use a condom with each sexual encounter. Unless you are in an exclusive long term monogamous relationship you should be using barrier protections- male or female condoms or dental dams.
- If you are not using reliable birth control- get started now to avoid the possibility of transmitting Zika to an unborn child. Even in a monogamous relationship, if a partner in the relationship is capable of becoming pregnant then condoms should be used if a partner travels to tropical areas of the US (like Florida), Central or South America.
So stay educated through trusted sites such as the CDC (Centers for Disease Control and Prevention) and read future blog posts from us about Zika, Dengue, and Chikungunya disease. If you or someone you know has questions about risk or possible infection call for an appointment or have a walk in visit to assess your risks or start testing and treatment if necessary. Kelly Goodman Group is here to help.