‘You’re at risk for artery clogging like a heart attack, stroke, kidney disease. See the plumber.’ Says my General Practitioner.

HEART / ARTERY HEALTH, & ATHEROSCLEROSIS FOR DUMMIES PART I: HISTORY AND CULTURE AND THE SCARY STATISTICS OF ARTERY CLOGGING (AKA ATHEROSCLEROSIS)

By Natan Schleider, M.D.

July 11th, 2019

Vintage Anatomical Print of The Heart

6:00 AM: Opened my weekly pill organizer taking an aspirin, a statin (IE atorvastatin generic for Lipitor), blood pressure medicines, and quickly drank my coffee through a straw (which supposedly prevents teeth staining)

6:15 AM: My 6 year old daughter Ellie wakes up, rubs her eyes, and says ‘Daddy, cereal?’ I pour a bowl of ‘CAN HELP lower CHOLESTEROL‘ Cheerios with Silk Almond milk at 30 calories per serving.

Cardiovascular disease (CVD) which includes clogging of arteries to the heart, brain and kidneys namely accounts for approximately 800,000 deaths in the United States (US), or one out of every three deaths. On an average day in America of 2192 die from CVD. Note these number does not include people that just have non fatal events like heart attacks, angina, and strokes that leave you weak or paralyzed.

To keep things in reference 2,977 people were killed on 9/11 while last year 192 Americans died from opiod overdoses during our media frenzied nationwide opiod epidemic.

As far as I’m concerned, every newspaper headline every day should read “Another 2000 Americans Die From Preventable Illness” and no, it was not a zombie invasion!

I love America, greasy fries, a quality cheeseburger, stagnating in my chair playing chess vs a computer that always wins, and salt be it kosher, seasoned, Tajin, or any of the number of gourmet salts celebrity chefs tout on about.

The causes of our nation’s greatest killer are so woven into the fabric of American culture and history that we not only take it for granted but celebrate it. Tobacco was America’s number one economic export before there was a USA and central to George Washington’s wealth and the Revolutionary war. Which American president didn’t pose biting into a McDonalds or Burger King burger?

So I wanted to give you a smorgasbord of background and education before digging into our nationwide epidemic: atherosclerotic disease.

Part II of this article blog will focus on signs, symptoms, and other things most of us do daily (or neglect to do) that causes the clogging.

Thanks for reading!

Natan Schleider, M.D.

Screening Options for Colon Cancer

THE BEST COLON CANCER SCREENING TEST IS THE ONE THAT GETS DONE!

By Natan Schleider, M.D.

July 9th, 2019

Source: American Family Physician Vol. 100 No,1 July 1st, 2019 p.10-11

As I approach 50 years old, I am thinking about which colon cancer screening test is right for me.

I will likely go with the gold standard, screening colonoscopy. If you don’t know what this is, the patient is put to sleep under mild anesthesia which is quite safe and a fiberoptic tube is placed up the anus all the way through the large intestine to look for colon cancers or precancers which appear as polyps. Pros of screening colonoscopy: you need it only every 10 years (5 if you are high risk or more often if you have colon cancer or have been treated for colon cancer); the procedure only takes about 20 minutes and you are home same day. Cons or the biggest complaint I hear is being up all night with diarrhea as patients are given a strong laxative to flush out their colon (aka large intestine) which allows the doctors to see the lining of the intestine without stool being stuck to the walls.

Screening colonoscopy is my choice because while there are many of good noninvasive tests which I will review below, if they are negative, reassuring; but if positive, you will need a colonoscopy anyway to confirm whether it is a true or false positive.

Other screening tests for colon cancer:

  1. Stool testing for blood also called Fecal Immunotherapy Testing (catches about 58% to 72 % of colon cancers). This is a cheap easy option an with a 97 percent specificity (meaning if the test is negative, you probably do not have colon cancer) this is a nice easy choice.
  2. mSEPT9 Blood Test (Epipro Colon) detects 73 percent of colon cancers with a specificity of 82 percent. This may be a nice option if you are not inclined to sending your poop to a lab, understandable.
  3. Cologuard is a stool DNA test where you ship your poop to a lab where the examine it for colon cancer risk. This can be done every 3 years and I like this alternative option.
  4. Computed tomography colonography means no invasive testing but you will still need to have your intestines cleaned meaning you’re up all night with diarrhea but at least this is not invasive.
  5. Flexible sigmoidoscopy is like a mini colonoscopy which while still approved, is hardly done anymore as it only looks at the first part of the colon potentially missing cancers in the middle or distal colon.

If you opt against colonoscopy, you can do some or all of the noninvasive tests. Any testing is better than no testing and unlike most cancers in the 21st Century, colon cancer is one we can catch and treat early. Go get tested!

Thanks for reading!

Natan Schleider, M.D.

Lofexidine (Lucemyra) for Treatment of Some Opiod Withdrawal Symptoms

By Natan Schleider, M.D.

Source: American Family Physician V.99 No.6 March 15th, 2019

While I am pleased that a new medicine recently FDA approved for mitigating some symptoms of opiod withdrawal (IE sweating, increased heart rate, some of the physical symptoms of anxiety) I am cautiously optimistic at best that this medicine will see much

The pros of lofexidine:

  1. Most importantly it demonstrates that someone / the pharmaceutical industry realizes a need for more medicines to address the current opiod epidemic. This is extremely important given the few resources available for treating opiod dependence so kudos to all who did the work to get this medicine approved seriously.
  2. See point 1

The cons of lofexidine:

  1. It costs about $1,776 dollars for a seven day supply whereas there is an older virtually identical medicine (also commonly used to mitigate withdrawal symptoms) clonidine which costs nine dollars for a 30 day supply.
  2. Dosing is 4 times a day (presuming a patient in acute withdrawal isn’t vomiting everything they try to swallow which is often the case).

I don’t mean to ‘poo-poo’ this medicine and I will certainly prescribed it when indicated. I will be astonished if an insurance company covers it but at least there is one more weapon in the arsenal.

Thanks for reading.

Natan Schleider, M.D.