Welcome to Monthly Medical –News with Josh. Every month I am going to share with you some of the most talked about Medical stories and how they can affect you. For February some of the topics I will touch upon are- New Hope for Hepatitis C, Morning Sickness, Treatment for Cold Sores, and Hormone Vaccine against Breast Cancer. Enjoy Monthly Medical –News with Josh and don’t forget the Doctor is always in so call me at 914-393-4127 to schedule your next appointment.

Hormone Vaccine against Breast Cancer?

Researchers are pursuing a vaccine that could trick your body into thinking it’s pregnant. It is well known that short-term exposure in early adulthood to the hormones of late pregnancy and to the hormones of lactation offers a life long risk reduction against breast cancer. Early in the 1700’s, Dr. Bernardo Ramazzini described breast cancer as an “occupational disease of nuns”. Even if we got rid of the “risk factors” for breast cancer, such as obesity, excess alcohol and hormone therapy, we would drop the incidence of breast cancer from 180,000 cases a year to 140,000. That’s not much! What about genetics? In a study published in The New England Journal of Medicine, in a study that looked at “SNP’s”, which are changes in genes that can cause disease, these changes only elevated the risk by 1.5 fold, which is truly not much, as compared to those without single gene mutations. What is it about pregnancy that decreases risk? No one really knows, but the bet is against it being estrogen and progesterone’s.

Wounds that Won’t Heal: WARNING

Poorly healing wounds are a major problem, and it’s often seen in diabetics and people with poor circulation. Negative Pressure devices have been used to aid in the healing of these chronic wounds. Now, the FDA has issued a warning AGAINST these devices. Deaths have been reported, and have been associated with bleeding, infection and other problems. Negative pressure is appropriate for the right type of wound, however. Some of the problems may have arisen because most wound dressings are changed every day, but negative pressure bandages are not. These are the wounds in which Negative Pressure Devices are NOT appropriate:

1. Exposed nerves, or exposed vessels
2. Untreated infections of the bone [osteomyelitis]
3. Dead tissue present
4. Fistulas
5. Wound Infections

Morning Sickness Alert:

Don’t take Nzu, also sold under the names of Calabash clay, Calabar stone, Mabele, Argile, and La Craie. These are sold in health food stores for morning sickness, and have been found to contain high levels of Arsenic and Lead. My Advice: Acupuncture and Ginger.

The Long QT syndrome:

This is a genetic disease that seems to occur more commonly, maybe due to better patient education about it. The story is “a young athlete that died while training.” The family is devastated and lives are ruined. The truth is that we can screen for this. This disease affects the potassium or sodium channels in the heart. These patients may develop symptoms of fainting, tachycardia and eventually sudden death. In general, in addition to the EKG on the patient, we believe it is important to screen the first degree relatives as well, as this is a genetic disease. A “QTc” longer than 450 msec in men and 470 msec in women is considered worthy of more investigation. It is caused by 12 separate genes. WE call these “LQT 1-12”. The “causative mutation” can be seen in 70% of high-probability cases…not “100%”…so a negative gene test at this point in time does not rule out Long QT syndrome. The arrhythmia, or abnormal heart beat, is typically brought out by swimming, exercise and emotions. Those with a mutation of LQT1 are the highest risk for exercise or emotion-induced rhythm problems, and a group of medications called Beta Blockers are used to treat it. Those with mutations in LQT3 are at a higher risk of getting an arrhythmia when they are at rest or sleeping. In addition to drug therapy, certain drugs must be avoided and these can be seen at www.qtdrugs.org.

New Hope for Hepatitis C?

No vaccine. Not yet. But at least there is some drug therapy. Telaprevir [VX 950: Johnson and Johnson] is a protease inhibitor, something that emerged as a result of HIV research. When it is added to the standard drug therapy for Hepatitis C, it leads to a sustained Virological response [less virus] in those who previously failed drug therapy. This study looked at those with HCV 1 and was called the “PROVE3” study. Another weapon in the war against Hep C has been added!

Acne: Which is Better?

Adapalene 0.1% gel or BenzaClin? In a recent study, BenzaClin won. 43% vs. a 20% response. Wow….we have been using this for years already. Keep in mind that Adapalene is a retinoid and may prevent you from having other aesthetic procedures performed!

New Treatment for Cold Sores?

Combining a 5% acyclovir cream, with a steroid cream can prevent recurrent herpes ulcers. This product was recently approved, but not yet named. This product, however, seems to prevent cold sore development and would be the first topical to do so.

Checking Back Daily for more Blog Posts. Looking forward to seeing you soon.

Dr Josh Fink

What is Private practice? What is Concierge Medicine?

When I was growing up, I remember the doctor my mom used to see. He took so much time with her, listened to all of her complaints, and if he didn’t know the answer, he would research it and call her with the information. He made house calls when we were sick. He knew me, my family and even my dog!!

Something happened in Medicine- HMO’s destroyed the field. Plain and simple-some doctors made a lot of money and businessmen decided that they wanted it. So promised were made of cost cutting and better delivery of care. Neither of these has been shown to be true. Instead, doctors spent less and less time with patients, because they were forced by greedy administrators to see as many people a day as they could, because facilities were paid less and less to see a patient. The doctors couldn’t rebel, because if they organized against this madness, they were threatened with anti-trust law. So, the doctor I wanted to be was no the doctor I was allowed to be. Still, the public got lost in this fantasy of “House”…that somewhere a hospital has a team of “geniuses” they keep around to find out “what the problem is” and cost is never an issue. Tests are done, but nobody has to call for pre-approval. House never gets denied the chance to do the MRI he wanted. Mix in some drama, and you have a series. But, it’s just fantasy!

And then one morning, I said “why not”? Why not do it the way I think it should be done. I know more about medicine than the President, or a Senator, or a lawyer, or an MBA administrator. So, I decided to leave all the insurance plans and open up a “Private Practice”.  The model is simple.  I dedicate myself to each one of my patients and invest in the resources they need to keep them healthy and informed. They pay for my time and skill.  They know they will see me at their bedside if they are home sick and it will be ME calling them with the latest research on their disease. No 6 week waits, no getting blown off in the waiting room for 45 minutes, no rushed appointments!! 

One of my strengths has always been the difficult diagnosis. It’s a challenge. A test. It’s invigorating to have to think about what the problem might actually be. Medical detective, diagnostician, what ever you might want to call it. Is it a perfect model? No. Is it for everyone?  But it’s a choice. An option. …and that is what it should be for everyone!