Diagnose Me Dr. Buzzfeed, DDS

New trends are coming in all the time, especially with social media, it can be the easiest way to promote products to the masses. Companies have promoted things like fat loss teas or using professional healthcare students promoting scrubs which of course would gather interest and hopefully, in the end, the desire to buy that product. One thing in this phenomenon that I have noticed is the use of charcoal toothpaste as a natural alternative to whiten teeth as opposed to spending enormous amounts of money by going to the dental office to do treatments like Zoom Whitening. The question then arises, does it really work? Typical toothpaste contains abrasives that help remove stains like coffee or red wine, taking a look into the ingredients of charcoal toothpaste its evident that it has harsher abrasives. If people were to really research charcoal toothpaste products, they would find out that it isn’t even FDA approved and no scientific evidence showing the effectiveness of charcoal toothpaste. I think people just look for short term solutions and disregard the long-term negative effects of a product. In a product that has harsher abrasives, going back and forth on your teeth causes the wearing down of the enamel and roughening the surface, opening the tooth surface to an easier adhesion of those substances that stain teeth.

Whitening teeth can be done at home, but now products like do it at home retainer teeth straightening kits are attracting the masses. As a pre-dental student and dentists opinions toward these treatments, its our duty to advocate and educate patients the absurdity of this as we are trying to look in the beneficence of the patient. I want them to have cheap treatment, but also quality care. I think it is important for the patients to know that these at home procedures are on a case by case depending on the severity of their condition. Although dentists are the professionals and go to school for a large amount of time, it is ultimately the autonomy of the patient to decide what they want. This brings in the question, are these products bringing in a new age of people feeling comfortable doing procedures that should be done by professionals?

Magnesium Deficiency and HPA Axis Disruption

Over this last year, I've found that Magnesium (Mg2+) is essential to good health, especially my mental health. Among various other roles, magnesium plays an important physiologic role in HPA axis balance, and ultimately in the stress and anxiety-related behaviors of animals. The HPA axis, or the hypothalmic-pituitary-adrenal axis, is one of our central stress response systems. The HPA axis begins at the hypothalamus, which releases corticotropin releasing hormone, or CRH, to bind to the anterior pituitary. The anterior pituitary in turn releases  adrenocorticotropic hormone (ACTH) into the bloodstream, making its way to the adrenal cortex, where it stimulates the release of cortisol into the blood.

Although the mechanisms of magnesium's HPA axis modulation are unknown, a few studies note that a deficiency can lead to altered HPA axis function. More specifically, researchers found that magnesium deficient mice (given only 10% of daily Mg2+ requirement) showed higher levels of anxiety-related behaviors, increased body weight, increased transcription of CRH, and elevated ACTH plasma levels compared to control mice. The research also showed that the magnesium deficient mice responded well to anti-depressant (chronic despiramine treatment reversed axis abnormalities) and anxiolytic (diazepam reduced PVN hyper-excitability) medication treatments. The researchers hypothesize that magnesium may be an essential ion in intracellular and interneuronal processes when considering abnormal anxiety on a neurolobiological basis.

I first discovered the relationship between magnesium deficiency and anxiety about a year and a half ago, much before I read any papers on it. At that time, I had been living in chronic, HIGH stress lifestyle for months and months, and I practically added onto it daily. One day, after a rather strenuous session of moving a slate pool table from the 6th floor of an apartment building to my car in the midsummer heat, the accumulated stress pushed me to my limit and I just broke. I developed a severe form of anxiety called depersonalization and derealization (or DPDR, look up descriptions of it on reddit and you might catch a glimpse of the agony that DPDR is). I thought I had died and gone to Hell. No other way to describe it. This lasted for about 8 grueling months, all the while appearing to be treatment resistant. Over that time, I repeatedly read that DPDR was simply the body's normal response to extremely stressful situations and often occurs during traumatic situations. I also learned it can be caused by magnesium deficiency. I decided to give magnesium glycinate supplements a try, and day by day of taking the recommended dose along with a normal diet (and months of counseling), my symptoms improved significantly. I believe that both the stressful lifestyle and a diet lacking in sufficient magnesium lead my body to be overly stressed, resulting in the DPDR symptoms.

Cited Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198864/

*IUDs are AWESOME* (as stated by me and the American College of Obstetricians and Gynecologists)

Regardless of what kind of health provider we become, we will interact with women and patients affected by and/or connected to women every day. An important health topic is that of sexual and reproductive health and its implications on the patient and those around her. Knowing the range in different types of contraception from fertility awareness strategies to long-lasting reversible contraception (LARC) such as the IUD (intrauterine devices) are imperative.

The American College of Obstetricians and Gynecologists recommends LARCs as the first-line contraception method to be encouraged for most women. LARCs have been reported to be the most effective form of reversible pregnancy prevention methods. However, each woman’s circumstance is unique and it is our responsibility as educated, informed, and ethical providers to provide options that work optimally for each patient and their intended outcomes.

In March 2018, a study published by the Journal of Obstetrics & Gynecology, found that female physicians who worked as women’s health specialists had a substantially higher use of LARC than the general population. From the total population of women who use birth contraception in the United States, 12% elect to use a form of LARC. In the study’s population of Ob/Gyn residents, 49% of women were using LARC as their contraception method, with 91% of them using the levonorgestrel IUD (also marketed as Mirena). Ob/Gyn residents are arguably among the most educated and trained providers on evidence-based family planning (Ziger et al., 2017). This study analyzed surveys from participants in the Ryan Residency Training Program. Currently, 40% of US Ob/Gyn residencies have incorporated the Ryan program in the United States and Canada.

Although there are some studies and political commentaries about perceived “scary” implications of IUDs – we should take time to explore the numerous benefits and “amazing” aspects of IUDs. There are non-hormone IUD options, multiple other tested and supported LARC methods, as well as oral, injectable, surgical, insertable, and attachable methods. There are also options that involve no devices at all such as fertility awareness methods and abstinence. The important thing is to realize there are MANY options with some being more beneficial for others.  The following website outlines EIGHTEEN different birth control methods: CLICK HERE TO LEARN MORE!

Zigler, R. E., Peipert, J. F., Zhao, Q., Maddipati, R., & McNicholas, C. (2017). Long-acting reversible contraception use among residents in obstetrics/gynecology training programs. Open access journal of contraception, 8, 1.

Promising Oncolytic Virotherapy Agents

Recurrent breast cancer patients urgently need new therapies to improve their quality of life. Existing therapies often cause debilitating side effects that severely degrade their quality of life. Oncolytic viruses develop a therapeutic modality that allows it to selectively destroy tumor cells. Oncolytic agents such as herpes simplex virus, vaccinia virus, measles virus, and many others are in general clinical trials for several cancers to demonstrate safety and efficacy. For oncolytic virothearpy to be adopted, it must first show it can eliminate metastatic diseases. Scientists have begun “arming” oncolytic viruses by giving the virus anticancer transgenes (genetic material that has been transferred naturally). By doing so, the virus is able to target tumor environments and inhibit angiogenesis in those areas. In addition, to further enhance viral efficacy the oncolytic agent is given immune-stimulating factors. When the oncolytic agent is given an anticancer transgene and immune-stimulating factor, the virus effectively inhibits growth and metastases of breast cancer. Other studies show if oncolytic viruses are used with other therapeutic strategies, tumor cell apoptosis increases. In addition, combination therapy is shown to inhibit breast cancer cell growth. The way in which the oncolytic agents are delivered is also very important to understand. When administering oncolytic virotherapy intravenously it was noted that the virus mediated tumor growth suppression quicker and within that specific area. In addition, it was seen that primary tumors were completely eliminated when oncolytic viruses were administered. Even though many clinical trials are in progress to further support oncolytic viral therapy, caution must be taken to not interpret these findings incorrectly. Oncolytic therapy must be tested on a case-to-case basis with consideration of the the cell line, the virus, timing, and mechanism. However, their is hope that oncolytic therapy will work for individuals with recurrent cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918380/

Cannabis use for the treatment of Epilepsy

There has always been an interest in the use of cannabis to treat epilepsy, but it was not until recent that appropriately controlled studies have been completed. In this paper Gaston and Szaflarski address the updated research around cannabidiol (CBD), a non-pshychoactive component of cannabis to treat epilepsy. Data from both open-label expanded access programs (EAPs) and randomized placebo-controlled trials (RCTs) of highly purified oral preparation of CBD, which was recently approved by the FDA, is discussed. In EAPs significant improvement in seizure frequency was seen among the  treatment-refractory epilepsy (difficult to treat seizures) population. In addition, RCTs have demonstrated significant seizure reduction in patients with different syndromes. The most common side effects with the administration of highly purified CBD is diarrhea and sedation, with sedation being more common with patients taking concomitant clobazam (drug associated with seizures). There was also an increase of enzymes associated with the liver and heart that were being secreted when administering CBD.  When administering CBD, it is reported that there is a clear interaction with clobazam, by significantly increasing the levels of the active metabolite N-desmethyclobazam, and this is measured by the CBD’s inhibition of the liver enzyme CYP2C19 (the long term effect is still unknown). EAPs also demonstrate POSSIBLE interactions with other drugs that are administered to treat seizures. In some cases it was reported that drug adjustments (related to epilepsy) had to be made after the administration of CBD. Even though, the research being done looks to be promising, the future effects are still unknown. CBDs safety and efficacy to treat epilepsy must be further researched. Future controlled studies encompassing various ratios of CBD and THC need to be done to further demonstrate the potential benefits for epilepsy patients. As of now the data looks to be promising and as a society we are making progress. As we make progress it brings to attention many of the bioethical values we have discussed. In particular non-malefesance and beneficence are called into question for the patients. Scientists want to do no harm while conducting clinical trials for the overall benefit of others (beneficience), but with the unknown long term effects, should we delve further into studies to find out? CBD may have the potential to treat difficult cases of epilepsy, but is that enough reason to venture into the unknown?

  https://www.ncbi.nlm.nih.gov/pubmed/30194563

Can a cup of coffee prevent type 2 diabetes?

I stumbled across an article that talks about type 2 diabetes prevention with a drink that many individuals in the US consume, coffee. Marilyn Cornelis, a nutritionist at Northwestern University Feinberg School of Medicine, is exploring the idea that black coffee has the most potential to prevent type two diabetes. Coffee drinkers have had a slightly reduced risk of cardiovascular disease, cancer, and Parkinson’s disease in addition to the decreased risk of type 2 diabetes. Epidemiological studies have begun supporting this statement and it is inferred that the chemical compounds released in the roasting process and high levels of antioxidants have a huge influence of how the body is interacting with them. However, at the end of the day Dr. Cornelis states that it is the metabolites, small building blocks, that are directly helping prevent type two diabetes. Dr. Cornelis is in the process of completing a study that takes into consideration 46 individuals that go from a four week coffee-free diet to a whopping eight cup coffee diet for a month. The FDA has acknowledged the coffee benefits and has suggested five cups as a healthy upper limit. However, with data supporting the prevention of type two diabetes we have to take into consideration individual’s tolerance to coffee. Some individuals genes influence the ability to metabolize caffeine and make it more efficient without feeling the immediate jitters or jolt of energy (ultimately allowing them to drink more coffee and having a greater prevention for type 2 diabetes). These are hopeful findings for the US population, since as a nation we struggle with diabetes and cardiovascular disease. Knowing that a simple adjustment to our everyday lifestyle can be beneficial to our health should be an easy transition.

http://www.diabetesforecast.org/2016/jul-aug/can-a-cup-of-coffee-prevent.html?loc=dorg_recentadv

Do opioids really help?

I just read a study published in March of this year comparing the effect of opioid and non-opioid treatments for patients with chronic back pain and hip/knee osteoarthritis pain. In the group treated with opioids, included treatments were immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. In the non-opioid group, treatments involved acetaminophen or NSAIDs. The study found that over a period of 12 months opioid therapy was no better than non-opioid therapy in improving pain-related function, but did lead to an increase in adverse side effects. Pain intensity was slightly lower in non opioid-treated patients.

            This article caught my interest because a lot of states have tightened their opioid laws recently in an attempt to combat the widespread opioid abuse the United States is currently in the midst of, which is responsible for thousands of deaths a year among other issues. As anyone who has worked in a clinical setting no doubt knows, the use of opioids in the treatment of chronic musculoskeletal pain is a relatively standard approach. Many of the doctors I’ve worked with through the changeover have struggled with how to continue treating patients with chronic pain. Many are poorly equipped to handle treating addiction and do not have much in the way of alternative options, at least in family practice settings. At some point there is uncertainty about how much of a patient’s pain is chronic and how much is coming from the opioid use itself. The most recent guidelines now discourage use of opioids for chronic pain because there is not sufficient evidence for benefits that outweigh the potential serious harm they can cause.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885909/