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

 Our office treats many individuals with asthma. One of the most important things that I need to reinforce with my patients is that asthma is a livable condition, but, unless it is controlled properly, and patient understand the warning signs of “when the asthma is out of control”, the situation can turn deadly, very quickly. Fortunately, warning signs are usually present before this ever happens, and an asthmatic can have a normal and productive life.

Here are the warning signs I tell my patients about:

1.   Using your Proventyl inhaler more than usual. If you use it once a day, and now three times a day, the inflammation is the problem, and it’s the inflammation that needs to be addresses.

2.   Asthma, a cough or “tightness” that waked you up at night, especially between 3-5 AM is a warning sign.

3.   Shortness of breath that limits exercise more so than usual.

    This is not meant to be an inclusive list, but are 3 of the more common warning signs that I have seen  in 20 years of practice. Most importantly, talk to us about your asthma, and together we may be able to figure out your particular warning signs and show you ways to keep yourself in optimum health and condition.

Although aesthetics are a large focus of my practice, keep in mind I have 20 years of experience in Internal Medicine and Pulmonary Medicine.  I am Board Certified in both Internal Medicine and Pulmonary Diseases, and I have  earned the reputation, substantiated by many of my associates and patients, as being one of the best in differential diagnosis and determining the cause of a person’s problems when many other doctors may have given up.

Arthritis can have many causes. It can be caused by degeneration, aging, being overweight or from an immune disorder, such as Rheumatoid Arthritis. Some of these disorders can be treated with an array of drugs, while others are more frustrating. Patients always ask me about Glucosamine and Chondroitin, or Knox Gelatin. They want to know if these can help. Often, you’ll see these combined with MSM, Magnesium, Calcium and anti-oxidants. My answer here is “I think they are over-hyped”.  The only thing that I have found to work, aside from things like Motrin, is exercise and omega-3 fish oils, which need to be taken in high enough doses in order to make a difference. My patients are usually recommended to take the fish oil from The Sear Zone, which sells pharmaceutical grade fish oil without any Mercury or PCB’s.  Usually 4 pills a day, but the dose may vary if the person is already on a platelet thinning drug, such as aspirin. Fish oils, are in many ways, the new Chicken Soup of medicine.

Your Internist can help tell you what type of arthritis you have, with a physical exam and some simple blood work and possibly an X-ray.  Even with the best treatment, sometimes arthritis can progress to the point of a joint replacement, but in general, we believe in an aggressive approach to treating the underlying disorder before this may become an issue.

The treatment of many different types of auto-immune arthritis has changed over many years, essentially with more aggressive and earlier intervention in the arthritis, especially Rheumatoid and Psoriatic arthritis. The use of “anti-TNF” drugs has revolutionized the treatment of these diseases, though these drugs carry risks, such as an increased risk of infections as well as possibly increasing the risk of lymphoma and leukemia. Some of these drugs have been withdrawn from the market due to the fact that they caused a re-activation of the JC virus in the brain and led to severe neurological effects.  This must be considered before starting any type of aggressive therapy.      

Best,

Josh