Dr. Howard Smith Oncall

Vidcast:  https://youtu.be/sSbGUgcsl68   As medical and recreational cannabis are increasingly legalized, poison control centers are fielding more calls from emergency rooms and desperate parents.  A report from UMass-Amherst just published in JAMA looks at the rise in calls following legalization of medical marijuana in Massachusetts.    Legalization of medicinal weed was followed by a 140% increase in poisoning calls with nearly 20% of the calls involving children infancy through 4 years of age.  Calls regarding edible marijuana increased for all age groups reflecting the misconception that edible versus smokable marijuana is less potent and dangerous.   Now remember that Massachusetts only legalized marijuana for medical purposes.  Recreational marijuana remains restricted, yet carelessness is permitting this drug to get into the hands of young children and abused by teens.     You cannot legislate morality or common sense so cannabis will soon be as available as alcohol.  We as parents must be certain to

Vidcast:  https://youtu.be/ByXQXvIfwRg   The obesity epidemic is triggering cancer in ever-younger Americans.  Epidemiologists from Case Western Reserve University studied cancers, both obesity-related and non-related, that were documented in the worldwide SEER18 database over the first 16 years of the 21st century.  They focused on the age of the cancers at diagnosis.   The data included some 6 million cancers.  While the incidence of cancer either remained the same or diminished in the 20 to 49 year and the 65 or older age groups, it increased for those in the 50 to 64 year age group.  In this group, the occurrence of obesity-related cancers was significantly higher than that for non-obesity related cancers.   The obesity-related cancers are gastrointestinal at all sites, breast, ovarian, kidney, thyroid, and myeloma.   Avoidance of these devastating cancers as well as heart disease, diabetes, and stroke is the reward for keeping your weight in a healthy range by moderation in eating and exercise.   Korouki

Vidcast:  https://youtu.be/WaX8zsaB2Xg   Recovery from breast cancer surgery is challenging, and much work is needed to regain arm strength, shoulder mobility, and freedom from arm swelling.  A Spanish meta-analysis, just published in the European Journal of Cancer Care, shows that Nordic walking has a significant, positive impact on arm edema, physical fitness, disability, and patient optimism.   The investigators reviewed 4 randomized, controlled studies and 5 before-after studies.  Although the duration of Nordic walking exercise varied widely between studies, this type of exercise reduced arm circumference and extracellular edema fluid, improved upper body strength, increased shoulder range of motion, and improved quality of life.   Although many of the study methodologies could have been better, the overall conclusion is that Nordic walking withworld-wide  ski-type poles is a valuable addition to rehabilitation therapy after breast cancer surgery.     Miguel A. Sánchez‐Lastra Jorge Torres Iván Martíne

Vidcast:  https://youtu.be/WRdLs2fhXtY Nearly 90% of American stroke victims with large blood vessel blockages receive less than optimal care.  That statistic is even worse for minority populations suggesting healthcare racism.   Mayo Clinic neurology researchers reviewed more than 200,000 admissions to some 173 medical centers over the most recent 2 year period.  Despite widespread professional acknowledgement that large vessel clot removal is the most effective therapy for acute ischemic strokes, this so-called mechanical thrombectomy occurred in only 8.4% of patients overall.  Only 7% of minority patients were so treated compared with nearly 10% of white and non-Hispanic patients.   More than 800,000 strokes occur in the US every year.  Studies have shown that prompt, aggressive therapy with clot dissolving medications and/or mechanical clot removal leads to the best outcomes.     That care only occurs if a stroke is recognized.  To spot a stroke, remember FAST.  Face drooping, Arm weakness, Speech difficu

Vidcast:  https://youtu.be/4VSFYpvclCQ   A VR trip to far-off lands or a challenging VR adventure game may curb pain without the risks of medicine.  UCLA researchers proved that point by quantitating the pain of 120 hospital patients half of whom were randomized to use virtual reality headsets three times a day for a two day study period.   Those treated to the VR sessions recorded nearly 4 times less pain than controls.  Those with the most severe pain recorded a 3 fold reduction in their discomfort.  The VR helped a broad range of surgical pain including gastrointestinal, musculoskeletal, and neurologic.   Virtual reality is being employed in an ever broader group of medical applications.  I’ve reported its use for treating phobias, but it is also in current use teaching medical students and nurses, training surgeons, interpreting xrays and scans, planning radiation therapy and surgery, speeding rehabilitation, and enhancing telemedicine.   PLoS ONE, online August 14, 2019. https://doi.org/10.1371/journal.p

Vidcast: https://youtu.be/V3eQcWkwLWY   Information technologists from Utah’s Brigham Young University have a simple answer: NOT YET!  They studied 274 adult subjects to determine how they interact with digital assistants versus humans.   The researchers conclude that adults consistently code switch adding please and thank you to their requests of other human beings despite their tendencies to bark commands at their Amazon ECHOs and Apple iPhones.  Although they did not study children as yet, they suspect that kids may pick up bad habits from speaking to machines.     Apparently parents, Amazon, and Google have the same fears, and the tech giants have now added features that request and compliment polite orders from our children.  We as parents should mimic the machines and teach our kids that verbal honey always works better than vinegar.   Brigham Young University. "Are Siri and Alexa making us ruder? Study of 274 adults finds the answer -- for now." ScienceDaily. ScienceDaily, 15 August 2019. www.scienceda

Vidcast:  https://youtu.be/oPpEHSrCrLs   Ok...be honest.  How often during the day do you take a break from report writing or tedious calculations by picking up your cellphone?  Management scientists at New Jersey’s Rutgers Business School are just out with new data that shows such cellphone breaks do not refresh your brain but just the opposite.   The investigators presented each of  more than 400 study participants with multiple word puzzles to solve.  Midway through the timed exercise, a break was offered during which they could use either their phones, a computer, or some paper.  Some took no break at all.   Those who used to break to play with their cellphones took 19% longer to complete the puzzles and solved 22% fewer puzzles than non-phone users who skipped the break entirely.  These “phone users” post break efficiency and cognitive power was only slightly better than those who passed up the break opportunity.   The lesson learned is that, when you want to give your brain a recharge during a particula

Vidcast:  https://youtu.be/yZ2lRytD7kw   Going on alcoholic benders is bad news for your liver, but a new study from the University of Missouri-Columbia suggests that women’s livers may be particularly vulnerable to alcohol injury.  The researchers employed a rodent model and gave both female and male rats three large rounds of drinks at 12 hour intervals.   The females’ do  blood alcohol levels surged twice as high as those in the males, and their livers had 4 times as much fatty buildup.  More ominous is the finding that an alcohol-induced tumor-promoting protein called DGKalpha rises more than four times higher in the females than in the males.   Now let’s talk about humans.  The CDC has data to show that 1 in every 8 women binge drink at least 3 times every month, and each binge consists of 6 drinks on average.  One in 5 high school girls binge drink.     The sudden, sustained burst of alcohol in the bloodstream is even more damaging to our bodies than chronic alcohol consumption.  This latest study is a

Vidcast:  https://youtu.be/A5oZaWBaabk   Insomniacs have a genetic association with coronary artery disease, heart failure, and stroke.  This conclusion stems from a Swedish Karolinska Institute study of more than 1.3 million individuals whose genetic characteristics were found in publicly available databases.   The investigators employed an epidemiological method called Mendelian randomization to identify the associations and reduce bias.  This is a first-of-its-kind study which does have the limitation that it focuses not on those with proven insomnia but only a genetic predisposition to it.   Insomnia is common, and 30-50% of us suffer from it.  If you’re one of those unlucky enough to experience sleepless nights, work with a sleep specialist to find the cause and effective treatment.  Also know, that you should do all you can to avoid cardiovascular disease by exercising and monitoring your blood pressure, cholesterol, weight, and diet.   Susanna C. Larsson, Hugh S. Markus. Genetic Liability to Insomnia a

Vidcast:  https://youtu.be/wMLmrsA4nfc   If your child is a mild asthmatic, you need only use inhalers when symptoms arise.  If you do, your child child will likely receive 74% less steroid medication and you’ll save a bundle of money.   This strategy comes from Washington University-St. Louis study just published in The Journal of Allergy and Clinical Immunology.  The researchers studied more than 200 mild asthmatics 6 to 17 years of age.  They compared asthma control in one group receiving typical therapy, daily puffs of the steroid beclomethasone and as needed puffs of the bronchodilator albuterol, with asthma control in a second group receiving both the steroid and bronchodilator inhalers only in the face of shortness of breath, chest tightening, coughing, and wheezing.   At the end of a year, the two groups of asthmatics had similar numbers of attacks, similar visits to their doctors, and similar numbers of urgent visits to the emergency room.  The “AS NEEDED group” used much less steroid and saved a bun

Vidcast:  https://youtu.be/kj8WxgQ-ZS4   Thousands of young women are having unnecessary radiation exposure via mammograms prior to surgery to right-size their breasts.  A just published University of Michigan study of more than 52,000 women candidates for this surgery shows that one-third of them had mammography prior to the procedure.   The American Society of Plastic Surgeons stated 5 years ago that such routine pre-op imaging should be stopped.  Such procedures in women who otherwise have no indications for breast imaging are economically wasteful and unnecessarily expose patients to radiation.   If your surgeon is recommending this preop imaging, pass on the reference I’m providing and challenge the suggestion.  It’s always good to speak up and take a role in planning your healthcare.   #reductionmammoplasty #mammography #preoperative imaging #health news #health tips   Erika D. Sears, Yu-Ting Lu, Peter R. Swiatek, Ting-Ting Chung, Eve A. Kerr, Kevin C. Chung. Use of Preoperative Mammography During Evalu

Vidcast:  https://youtu.be/eHlGf-j9ZaA   We know all about the dangers of second-hand smoke, those clouds of toxic fumes emanating from cigarettes, cigars, and pipe bowls.  Now a study from the University of Cincinatti and the Cincinatti Children’s Hospital hone in on the vapors that waft up from those yellow stains on walls, ceilings, carpets, upholstery and, yes, the fingers of smokers themselves.  We call these third hand smoke.   The investigators measured the levels of nicotine on the hands of children exposed to these 3rd hand sources but not to parental smoking directly, and these children had the same levels of nicotine as an indirect measure of all toxic chemicals as those kids directly exposed to cigarette smoke.   Also know that these poisonous chemicals accumulate.  The children under 2 years had average hand nicotine levels of 69 ng, and that figure shot up 2.5 times by age 4 years.  The nicotine levels detected were a function of the number of cigarettes smoked by their parents and caregivers. 

Vidcast:  https://youtu.be/kj8WxgQ-ZS4   If you smoked or ate some weed over the weekend, will you flunk that pop drug test your boss springs on you Monday morning?  The answer depends on how much you consumed and the type of test you must take.  Either way, be forewarned that marijuana’s psychoactive agent, THC, is fat-soluble and definitely hangs around in your body longer than alcohol.   Smoking one isolated marijuana cigarette yields a positive test for 3 days.  If you smoke 3 or 4 times a week, you’ll fail a test up to a week later.  If you smoke everyday for awhile, you will test positive for at least a month after quitting.   The most sensitive marijuana test is hair analysis, and with it THC detection can occur up to 3 months after stopping any use.  Next sensitive is the urine test that detects use 3 to 30 days after cessation.   Saliva tests may be positive for 24 hours.  Blood tests only pick up THC for 3-4 hours after use.   If your job depends on a negative unannounced drug test, you’d better thi

Vidcast:  https://youtu.be/fTadT-9r9_k   Another goal for the #metoo movement is suggested by the latest study from Yale psychologists.  As research subjects observed a video of the very same child being subjected to the classic, old fashioned medical torture, the fingerstick, but identified as either Samuel or Samantha, the majority of observers, both men and women, believe that the girl Samantha felt less pain than the boy Samuel.   This gender bias result is in synch with similar impressions of adults experiencing pain.   The result can be explained by the widespread misconception that boys are more stoic than girls, and it would take greater pain to elicit the same response in the male.    Parents of girls and significant others of women undergoing procedures need to advocate for their child or partner if they feel that the  pain management being offered is insufficient whether or not it’s due to gender bias.     Brian D Earp, Joshua T Monrad, Marianne LaFrance, John A Bargh, Lindsey L Cohen, Jennifer A R

Vidcast:  https://youtu.be/ud9tvdV6Kus   School violence is on the rise but, surprise, it’s the bullies themselves who are most likely to be  seriously injured.  This the conclusion of a study by researchers at the University of Texas-Houston who studied of some 4300 5th, 7th, and 10th graders in Houston, LA, and Birmingham, Alabama.   In 5th grade, 17% of children sustained at least one violent injury with a gun or knife, but that percentage rose to 33% by10th grade with gunshot injuries predominating.  Bullies themselves were 41% more likely to be violently injured compared with other children because they engage in more risky and violent activities.   If you are the parent of a bully, don’t think that encouraging your child to “feel his/her oats” will end well.  Aggressively stop this behavior and redirect your child’s energies in more positive directions.   Katelyn K. Jetelina, Jennifer M. Reingle Gonzalez, Mark A. Schuster, etal. Mechanisms and Frequency of Violent Injuries Among Victims and Perpetrators

Vidcast:  https://youtu.be/bZrgrEGpo-A   Women suffering preeclampsia during their pregnancies have a 30% higher risk of later stroke.  Columbia University neurologists studied 84,000 California teachers and found that low dose aspirin at least 3 times weekly virtually erases the greater risk of stroke for women before they reach the age of 60.  Once past 60, aspirin’s protective effect vanishes.   Preeclampsia complicating pregnancy is rising in the US, and one in every 20 pregnancies is now affected.  An increasing incidence of obesity and associated high blood pressure in women seem to be responsible.   If you experienced preeclampsia during your pregnancy and are currently less than a young 60, do ask your doctor about beginning a course of low dose aspirin.   Steven K. Feske, Cheryl Bushnell. Stroke prevention. Neurology, 2019; 92 (4): 159 DOI: 10.1212/WNL.0000000000006802   #preeclampsia #stroke #hypertension #aspirin #healthnews #healthtips  

Vidcast:  https://youtu.be/WmKXvNLFi1Y   One or two hits of cannabis in any form does permanently affect the brain structure of young people.  New studies by University of Vermont psychiatrists looked at brain imaging for 46 teens experiencing cannabis for the first time and compared their brains with those of with non-users.   The data reveals greater gray matter volumes in cannabis-binding zones of the brains in teens who used marijuana only once or twice by age 14.  The differences occur in the emotion-processing amygdala and in the memory processing hippocampus.   The researchers point out the teens’ brains naturally thin during adolescence in a type of pruning or refinement process.  Even a joint or two of marijuana may prevent this vital process from occurring.   The increasing legalization of marijuana means more of us and our kids will have access to it.  Studies like this should make us pause and ask if that’s a good thing.   Catherine Orr, Philip Spechler, Hugh Garavan, etal. Grey Matter Volume Diff

Vidcast:  https://youtu.be/x0ty9N1p3D4   Newborns and infants have very sensitive developing respiratory and gastrointestinal channels.  When parents have brought them to my pediatric ENT office, I found that their breathing issues were usually due to  airway irritation from refluxed feedings and dryness.  These observation became so common, that I began to offer 3 tips to every parent of a newborn or young infant.   1. Never Put Your Baby To Bed With A Full Stomach. 2. Wash Your Baby’s Nasal Cavities with Aerosol Saline After Every Meal. 3. Keep Your Child’s Bedroom At A Comfortable Humidity.   ONE:  Never put your baby to bed with a full stomach.  Newborns and infants under a year of age have developing and poorly functional esophageal sphincters or gates.  Any fluids or foods in the stomach and the stomach acids they induce will easily back up, reflux, into the upper esophagus, the throat, the nose, and fall down into the airway.  The fluids, food particles, and acids are all irritating to linings and prod

Vidcast:  https://youtu.be/50fbFNDy8bE   Repeated miscarriages, that is 3 pregnancy losses in a row each before 20 weeks of gestation, are usually thought to be due to maternal factors including uterine defects, infection, hormonal imbalances, and autoimmune disease.  A study from Imperial College, London, now suggests that flawed sperm may also play a key role in some miscarriages.   After analyzing the sperm of 50 men whose partners experienced recurrent miscarriages and compared them with sperm from 60 males whose partners had delivered successfully, the investigators found twice the incidence of DNA damage in the recurrent miscarriage group.  The damage may be done by an excess of reactive oxygen species that, in normal quantities, protect sperm from bacterial infection.   Isolated miscarriage occurs in about 15% of pregnancies, but recurrent miscarriage happens in only 1-2% of pregnancies.  If you are experiencing recurrent miscarriages, be certain that both you and your partner are studied.   #Recurrent

Vidcast:  https://youtu.be/ANDsWahh5Ow   Metabolic syndrome is a nasty group of problems that might kill you but certainly will make your life miserable.  If you have any 3 of these 5 issues, namely central obesity or a body like a pear, high blood pressure, elevated blood sugar, high blood triglycerides, or low high density lipoproteins, then you’ve got metabolic syndrome.  Metabolic syndrome is accompanied by excess body oxidation and it puts you at risk for heart attack, stroke, diabetes, fatty liver disease, and mental dullness deteriorating into dementia.   Researchers at Oregon State University now show that the type of overeating and fat consumption that triggers metabolic syndrome also causes a body depletion of Vitamin C since less is absorbed.  This critical anti-oxidant works in tandem with another anti-oxidant, Vitamin E, to put a lid on tissue inflammation.  If your Vitamin C levels are low, your Vitamin E stores then begin to drain as your body makes hopeless efforts to prevent oxidative inflamm