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To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It

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North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 15, How Stress Affects You and What You Can Do About It

According to an American Psychological Association survey, 75% of adults questioned reported moderate to high levels of stress in the past month and nearly half reported that their stress has increased in the past year. On this edition of “To Your Health,” Dr. Jim Morrow discusses different stress levels, stress triggers, and what you can do to reduce the effect of stress in your life. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Stress

  • Stress can be good for you.
    • It keeps you alert, motivated and primed to respond to danger.
    • As anyone who has faced a work deadline or competed in a sport knows, stress mobilizes the body to respond, improving performance.
    • Yet too much stress, or chronic stress may lead to major depressionin susceptible people.
  • Everyone knows that bad things in life are stressful
    • But the good things (marriage, new job or new house) are also very stressful.
  • The “good life” doesn’t happen in a vacuum, it takes a lot of mental and physical work.
  • Many of my patients are stressed because they are doing too much for too many people in too short a period of time and with too few resources.

There  Are Basically 3 Types of Stress

  • Acute stress
    • Acute stress is the most common form of stress.
    • It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future.
    • Acute stress is thrilling and exciting in small doses, but too much is exhausting.
      • A fast run down a challenging ski slope, for example, is exhilarating early in the day.
      • That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones.
    • By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach and other symptoms.
  • Examples of Acute Stress
    • the auto accident that crumpled the car fender,
    • the loss of an important contract,
    • a deadline they’re rushing to meet,
    • their child’s occasional problems at school
  • Emotional distress causes
    • Muscular problems including
      • tension headache,
      • back pain,
      • jaw pain and
      • the muscular tensions that lead to pulled muscles and tendon and ligament problems.
    • Stomach, gut and bowel problems such as
      • heartburn,
      • acid stomach,
      • flatulence,
      • diarrhea,
      • constipation and
      • irritable bowel syndrome.
    • Transient over-arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain.
  • Episodic acute stress
    • There are those who suffer acute stress frequently,
    • whose lives are so disordered that they are studies in chaos and crisis.
      • always in a rush, but always late.
      • If something can go wrong, it does.
      • They take on too much,
        • have too many irons in the fire, and
        • can’t organize the slew of self-inflicted demands and pressures clamoring for their attention.
        • They seem perpetually in the clutches of acute stress.
  • It is common for people with acute stress reactions to be
    • over aroused,
    • short-tempered,
    • irritable,
    • anxious
    • Often, they describe themselves as having “a lot of nervous energy.”
      • Always in a hurry,
      • they tend to be abrupt, and
      • sometimes their irritability comes across as hostility.
      • Interpersonal relationships deteriorate rapidly when others respond with real hostility.
      • The workplace becomes a very stressful place for them.
  • The cardiac prone, “Type A” personality is
    • similar to a constant extreme case of episodic acute stress.
    • Type A’s have an
      • excessive competitive drive,
      • aggressiveness,
      • impatience, and
      • a harrying sense of time urgency.
      • In addition there is a
        • free-floating, but well-rationalized form of hostility, and
        • almost always a deep-seated insecurity.
        • seem to create frequent episodes of acute stress for the Type A individual.
        • Type A’s are found to be much more likely to develop coronary heart disease than Type B’s, who show an opposite pattern of behavior.
  • The symptoms of episodic acute stress are
    • persistent tension headaches,
    • migraines,
    • hypertension,
    • chest pain and
    • heart disease.
    • Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months.
  • Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives.
    • They blame their woes on other people and external events.
    • Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.
  • Sufferers can be fiercely resistant to change.
    • Only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.
  • Chronic stress:
    • While acute stress can be thrilling and exciting, chronic stress is not.
    • This is the grinding stress that wears people away day after day, year after year.
    • Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition.
    • It’s the stress of poverty,
    • of dysfunctional families,
    • of being trapped in an unhappy marriage
    • or in a despised job or career.
    • It’s the stress that the never-ending “troubles” have brought
      • to the people of Northern Ireland,
      • the tensions of the Middle East
      • the endless rivalries that have been brought to the people of Eastern Europe and the former Soviet Union.
  • Chronic stress comes when a person never sees a way out of a miserable situation.
    • It’s the stress of unrelenting demands and pressures for seemingly interminable periods of time.
    • With no hope, the individual gives up searching for solutions.
  • Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present.
    • Some experiences profoundly affect personality.
    • A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times).
    • When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.
  • One of the worst aspects of chronic stress is that people get used to it.
    • They forget it’s there.
    • People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.
  • Chronic stress kills through suicide,
    • violence,
    • heart attack,
    • suicide,
    • stroke and,
    • perhaps, even cancer.
    • People wear down to a final, fatal breakdown.
      • Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.
  • Why is too much stress bad for you?
  • Too much stress can be detrimental.
    • Emotional stress that stays around for weeks or months can weaken the immune system and
    • cause high blood pressure,
    • fatigue,
    • depression,
    • anxiety and
    • even heart disease.
    • In particular, too much epinephrine can be harmful to your heart.
  • Sustained or chronic stress, in particular, leads to elevated levels of cortisol, the “stress hormone,”
    • As well as reduced levels of serotonin and other neurotransmitters in the brain, like dopamine
    • These hormone changes have been linked to depression.
    • When these chemical systems are working normally, they regulate biological processes like sleep, appetite, energy, and sex drive, and permit expression of normal moods and emotions.
    • When the stress response fails to shut off and reset after a difficult situation has passed, it can lead to depressionin susceptible people.
    • No one in life escapes event-related stress, such as
      • death of a loved one,
      • a job loss,
      • divorce,
      • a natural disaster such as an earthquake, or
      • even a dramatic dip in your 401(k).
    • A layoff — an acute stressor — may lead to chronic stress if a job search is prolonged.
  • Loss of any type is a major risk factor for depression.
    • Loss of a loved one is a huge stressor
      • Grieving is considered a normal, healthy, response to loss, but if it goes on for too long it can trigger a depression.
    • Loss of health –
      • A serious illness, including depression itself, is considered a chronic stressor.
    • Loss of independence –
      • When patients lose their ability to live alone, or to drive they are very stressed
    • Loss of financial stability –
      • Regardless of cause
    • What you can do?
      • Watch out for signs of stress overload.
        • Symptoms of too much stress can be
        • physical,
        • emotional,
        • mental and behavioral.
        • While everyone is different, some common signs are:
        • memory problems,
        • trouble concentrating,
        • racing thoughts,
        • irritability,
        • anger,
        • sadness,
        • headaches,
        • frequent colds and
        • changes in sleep or appetite.
  • Know your stress triggers.
    • Stress and its triggers are different for everyone.
      • Certain people, places or situations might produce high levels of stress for you.
      • Think about what causes you stress, and brainstorm solutions.
        • If public speaking or presentations make you stressed, start researching early and practice several times.
        • If there are friends or social situations that cause extreme stress, you may want to avoid them when you are already feeling tense or overwhelmed.
    • All forms of exercise
      • reduce stress hormones,
      • flood the body with feel-good endorphins,
      • improve mood,
      • boost energy and
      • provide a healthy distraction from your dilemmas.
      • Plus, exercise may make you less susceptible to stress in the long run.
      • Find physical activities that you enjoy and try to devote about 30 minutes to them each day.
    • While it’s impossible to eliminate all negative stress from your life, you can control the way you react to stress.
    • Your body’s natural fight-or-flight response can take its toll.
    • When you’re faced with a stressful situation that your mind perceives as a threat,
      • it sends various chemicals, like adrenaline and cortisol, throughout your body.
      • As a result, heart rate and breathing speeds up and your digestion slows down. This tires out the body.
      • Relaxation techniques are a huge help in calming you down, boosting mood and fighting illness.
        • Try a variety of techniques — like
          • yoga,
          • breathing exercises,
          • meditation and visualization — to see what works for you, and schedule a relaxation break every day.
  • Manage your time well.
    • Time can seem like a luxury, but there are various ways to manage it effectively.
      • First, focus on one task at a time.
        • Multitasking rarely works.
        • Jot down everything you need to do in a calendar or a task management app/program,
          • prioritize your list and break projects into single steps or actions.
  • Be realistic.
    • Pulling yourself in different directions will only stress you out, so try not to over-commit yourself or do extracurricular activities when you’re super busy with school.
    • Learn to say NO
  • Curb your caffeine.
    • Caffeine might help you study in the short term, but it interrupts sleep and makes you
      • more anxious,
      • tense and jittery
      • This obviously ups your stress level.
      • Try and drink no more than one caffeinated beverage a day.
    • Don’t self-medicate.
      • Some people
        • drink,
        • take drugs,
        • smoke and
        • use other unhealthy behaviors to cope with stress.
        • However, these behaviors can exacerbate stress by negatively affecting your mood and health.
  • Reach out.
    • If you’re stressed out,
      • talk to your friends and family.
      • If you feel like you can’t handle the stress on your own, schedule an appointment with a counselor or therapist.

To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer

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North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 14, Skin Cancer

One in six Americans develop skin cancer at some point in their life, and skin cancers account for one-third of all cancers in the country. On this edition of “To Your Health With Dr. Jim Morrow,” Dr. Jim Morrow addresses the prevention of and screening for skin cancer, as well as specific skin cancers to be aware of. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Skin Cancer

  • One in six Americans develops skin cancer at some point.
    • Skin cancer accounts for one third of all cancers in the United States.
    • Most patients with skin cancer develop non-melanoma skin cancer.
      • This group of cancers includes basal cell carcinoma, the most common neoplasm worldwide, and squamous cell carcinoma.
      • Fortunately, mortality associated with non-melanoma skin cancer is unusual.
    • However, malignant melanoma accounts for 75 percent of all deaths associated with skin cancer.
  • Melanoma, the eighth most common malignancy in the United States, is the cancer with the most rapidly increasing incidence.
    • 1 of 1,500 Americans born in 1935 were likely to develop melanoma, compared with 1 of 105 persons born in 1993.
    • Non-melanoma skin cancer typically affects older persons; the frequency of melanoma peaks between 20 and 45 years of age.
    • Mortality rates are higher in men than in women.
    • This higher rate may occur because lesions tend to develop in less easily observed areas, such as the back, in men.
    • Mortality is also increased in blacks for this reason, as is the propensity to develop more aggressive tumors and to be diagnosed at later stages.
    • The rising incidence of skin cancer over the past several decades may be primarily attributed to increased sun exposure associated with societal and lifestyle changes and to depletion of the protective ozone layer.

Prevention of Skin Cancer

  • Avoid the sun during peak hours.
    • Generally, this is between 10 a.m. and 4 p.m.
    • Water, snow, sand and concrete reflect light and increase the risk of sunburn.
  • Wear sun protective clothing.
    • This includes pants, shirts with long sleeves, sunglasses and hats.
  • Use sunscreen.
    • Look for water-resistant, broad-spectrum coverage with an SPF of at least 30, which blocks 97 percent of the sun’s UVB rays.
    • Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or sweating.
    • Higher-number SPFs block slightly more of the sun’s UVB rays, but no sunscreen can block 100 percent of the sun’s UVB rays.

Screening for Skin Cancer

  • While early detection and treatment of skin cancer can improve patient outcomes, convincing data regarding the benefit of mass screening programs are lacking.
    • In addition, the ability to identify potentially malignant lesions varies with physician training.
    • So, except for very high-risk persons with a history of skin cancer or atypical mole syndrome, for whom periodic screening is universally recommended, there is considerable debate about who should be screened, who should perform the screening and how often screening should be performed.
    • Part of the screening process should include an assessment of patient risk.
  • Basically,
    • Age 20 to 39 years: complete skin examination every three years
    • Age 40 years and older: annual complete skin examination
  • When screening is performed, the examiner must systematically inspect the entire skin surface.
    • The patient should completely disrobe and remove concealing cosmetics.
    • Daylight is the ideal light source
    • Photographs may improve the quality of documentation and detection of lesion changes over time.
  • ABCDE Rule:
    • Asymmetry (one half of the mole doesn’t match the other),
    • Border irregularity,
    • Color that is not uniform,
    • Diameter greater than 6 mm (about the size of a pencil eraser), and
    • Evolving size, shape or color.

Specific Skin Neoplasms

ACTINIC KERATOSES

  • Actinic keratoses, sometimes called solar keratoses, often arise on chronically sun-damaged body areas such as the face, ears, arms and hands.
    • They may provide an indication of a person’s cumulative ultraviolet light exposure and, therefore, that person’s risk for all types of skin cancer.
    • Actinic keratoses are often ill-defined and irregular, ranging from 1 mm to several centimeters in size.
    • They may be lesions that can be seen or felt, and generally have a scaly appearance.
    • Patients often have multiple lesions.
  • The lesions are usually pale brown or flesh-colored but may be yellow, reddish-brown or even dark brown or black following trauma.
  • The rate of malignant transformation of individual actinic keratoses to squamous cell carcinoma is less than one per 1,000 per year,
    • but treatment of lesions is indicated to decrease the chance of progression to squamous cell carcinoma.
  • Skin biopsy is occasionally required to rule out squamous cell carcinoma.
  • Cryotherapy with liquid nitrogen is the treatment of choice for most cases of actinic keratosis.
    • Curettage, or scraping away the lesion, may also be used and may be used in conjunction with cryosurgery or electrodessication (burning).
    • Surgical excision is rarely required but may be useful in excluding squamous cell carcinoma as a possible cause in lesions that are larger than 0.5 cm in diameter.
    • Chemical destruction of superficial lesions may be used when there are many lesions, particularly on the face and head.
      • 5-fluorouracil (5-FU), is most commonly used.
      • Areas other than the head and neck require the higher concentrations because of greater skin thickness.
      • In conventional regimens, 5-FU is applied twice daily for two to five weeks.
      • Adverse effects include true hypersensitivity, secondary bacterial and herpetic infection, and post-inflammatory pigmentation changes.
      • This therapy is often associated with significant discomfort related to an intense inflammatory response.
      • Pulsed dosing regimens aimed at reducing skin irritation have met with mixed success.
      • Topical corticosteroids may reduce inflammation but also make the treatment end point difficult to discern.
    • Other therapies used occasionally for treatment of actinic keratoses include laser, topical Retin-A, chemical peeling and facial dermabrasion.

BASAL CELL CARCINOMA

  • Basal cell carcinoma is the most common skin neoplasm.
    • Basal cell carcinomas
      • are usually located on the face or the backs of the hands.
      • They typically grow slowly and generally spread only locally.
      • Metastasis is quite rare.
    • While a preliminary diagnosis of basal cell carcinoma may be made on the basis of appearance, incisional or excisional biopsy is required for definitive diagnosis.
    • Cure rates of 95 to 99 percent can be achieved for low-risk lesions using simple excision with margins of 2 to 5 mm.
    • A lesion is considered low risk if it is less than 1.5 cm in diameter; has not previously been treated; is not in a difficult-to-treat area, like the H zone of the face; and is nodular or cystic.
    • Treatment of basal cell carcinomas with cryotherapy can also be successful, but healing may take weeks, and success depends on the skill of the cryotherapist.
      • Mohs’ micrographic surgery is the treatment of choice for most sclerosing basal cell carcinomas, as well as for large tumors and those located in areas that are difficult to treat.
      • Radiation therapy produces cure rates of 90 to 95 percent but has the same limitations as those outlined for squamous cell carcinoma treatment.
    • Other therapies used occasionally include topical Retin-A.

 SQUAMOUS CELL CARCINOMA

  • Squamous cell carcinoma is the second most common skin cancer, comprising 20 percent of all cases of non-melanoma skin cancer.
    • This is the most common tumor in elderly patients, and it is usually the result of a high lifetime cumulative dose of solar radiation.
      • A new study finds that some types of human papillomaviruses, or HPVs, may increase the risk of squamous cell skin cancers.
    • However, other irritants and exposures may lead to squamous cell carcinoma.
    • Up to 60 percent of squamous cell carcinomas occur at the site of a previous actinic keratosis.
    • Changes in an actinic keratosis that suggest evolution to squamous cell carcinoma include pain, erythema, ulceration, induration, hyperkeratosis and increasing size.
    • As many as 50 to 60 percent of squamous cell carcinomas occur on the head and neck.
    • Other common sites include the hands and forearms, upper trunk and lower legs.
    • Squamous cell carcinomas typically appear as small, palpable tumors that may grow moderately rapidly over a period of months and range from a few millimeters to centimeters in size.
    • They may appear nodular, and may be reddish-brown, pink or flesh-colored.
    • Larger squamous cell carcinomas may appear crusted, erythematous or eroded. In contrast to basal cell carcinoma, a definitive edge is difficult to demonstrate when a squamous cell carcinoma lesion is stretched.
  • Histologic confirmation by a full-thickness skin biopsy (incisional or excisional) is mandatory before definitive treatment.
    • Well-differentiated lesions less than 2 cm in diameter can be treated with surgical excision, with a cure rate approaching 99 percent.
  • Squamous cell carcinomas may grow aggressively and are associated with a 2 to 6 percent risk of metastasis.
    • Risk factors for metastasis include increasing lesion depth and location on the lip or ear.
    • The most common locations for metastatic spread are the regional lymph nodes, lungs and liver.
    • Once metastasis occurs, the five-year cure rate for squamous cell carcinoma is 34 percent.
    • Recurrence and metastasis typically occur within three years of initial treatment.
  • Mohs’ micrographic surgery involves gradual lesion excision using serial frozen section analysis and precise mapping of excised tissue until a tumor-free plane is reached.
    • Mohs’ micrographic surgery is used when tissue removal must be kept to a minimum for cosmetic reasons or to maximize function.
    • It is the treatment of choice for difficult and high-risk squamous cell carcinomas, including lesions that are:
      • larger than 2 cm in diameter;
      • located in areas where deep invasion is more likely or tumor extent is hard to assess, such as the nasolabial folds, eyelids and periauricular areas (facial “H zone”);
      • rapidly growing;
      • recurrent or incompletely excised;
      • ill-defined;
      • located in an area of previous irradiation; or
      • Cure rates of 99 percent have been reported.
    • Cryotherapy and the combination of curettage and desiccation are reserved for treatment of superficial tumors, lesions less than 2 cm in diameter and lesions located on the trunk and extremities.
    • Radiation therapy may be employed when preservation of function and cosmesis are critical, when patients refuse surgery, when metastasis is present or when an adjunct to surgery is required for high-risk tumors.
    • Because of the long-term risk of radiation-induced carcinoma, radiation therapy is used only in patients older than 60 years.

MALIGNANT MELANOMA

  • There are four types of malignant melanoma.
  • The two most common ones are:
    • The superficial spreading type is the most common among whites and accounts for 70 percent of all melanomas.
      • It usually occurs in adults and may develop anywhere on the body but appears with increased frequency on the upper backs of both men and women and on the legs of women
  • Nodular melanoma (accounting for 15 to 30 percent of all melanomas) is a dome-shaped, pedunculated or nodular lesion that may occur anywhere on the body.
    • It is commonly dark brown or reddish brown but may occasionally be uncolored.
    • Nodular melanomas tend to rapidly invade the dermis from the onset with no apparent horizontal growth phase.
    • These tumors are frequently misdiagnosed, because they may resemble blood blisters, hemangiomas, dermal nevi or polyps

Bottom Line on Skin Cancer

  • The incidence of skin cancer is increasing by epidemic proportions.
    • The use of tanning beds the risk of basal cell carcinoma by 1.5 times and squamous cell carcinoma by 2.5 times.
    • Basal cell cancer remains the most common skin neoplasm, and simple excision is generally curative.
    • Squamous cell cancers may be preceded by actinic keratoses – premalignant lesions.
      • While squamous cell carcinoma is usually easily cured with local excision, it may invade deeper structures and metastasize.
  • Aggressive local growth and metastasis are common features of malignant melanoma, which accounts for 75 percent of all deaths associated with skin cancer.
    • Early detection greatly improves the prognosis of patients with malignant melanoma.
    • The differential diagnosis of pigmented lesions is challenging, although the ABCD (Asymmetry, Border, Color, Diameter) checklists are helpful in determining which pigmented lesions require excision.
    • Sun exposure remains the most important risk factor for all skin neoplasms.
    • Thus, patients should be taught basic “safe sun” measures: sun avoidance during peak ultraviolet-B hours; proper use of sunscreen and protective clothing; and avoidance of sun tanning.

[Thanks to the American Academy of Family Physicians for much of the information provided in this episode.]

To Your Health With Dr. Jim Morrow: Episode 12, The Case to Vaccinate

by

North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 12, The Case to Vaccinate
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 12, The Case to Vaccinate

On this edition of “To Your Health With Dr. Jim Morrow,” Dr. Jim Morrow makes the case to vaccinate, arguing that vaccines are safe, necessary, and they work. The fears “non-vaxxers” have on the side effects of vaccines are not based in any proven scientific evidence. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes

History of Vaccines

  • Edward Jenner used cowpox material to create a vaccine for smallpox in humans in 1796.
  • Louis Pasteur created a rabies vaccine for humans in 1885
  • And then, at the dawn of bacteriology, developments rapidly followed.
    • Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s.
  • The middle of the 20thcentury was an active time for vaccine research and development.
    • Methods for growing viruses in the laboratory led to rapid discoveries and innovations, including the creation of vaccines for polio.
    • Researchers targeted other common childhood diseases such as measles, mumps, and rubella, and vaccines for these diseases reduced the disease burden greatly.
  • Innovative techniques now drive vaccine research, with recombinant DNA technology and new delivery techniques leading scientists in new directions.

Measles Has Been All Over The News

  • Measles Cases in 2019
    • From January 1 to June 27, 2019, 1,095** individual cases of measles have been confirmed in 28 states. This is an increase of 18 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000.
  • Why The Spread of Measles?
    • The majority of people who got measles were unvaccinated.
    • Measles is still common in many parts of the world.
    • Travelers with measles continue to bring the disease into the U.S.
    • Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

Common Misconceptions About Vaccines

  • “Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation”.
    • Statements like this are very common with the anti-vaccine crowd, the intent apparently being to suggest that vaccines are not needed.
      • Improved socioeconomic conditions have undoubtedly had an indirect impact on disease.
      • Better nutrition, not to mention the development of antibiotics and other treatments, have increased survival rates among the sick; less crowded living conditions have reduced disease transmission; and lower birth rates have decreased the number of susceptible household contacts.
      • But looking at the actual incidence of disease over the years can leave little doubt of the significant direct impact vaccines have had, even in modern times.
  • For example, there have been periodic peaks and valleys throughout the years, but the real, permanent drop in measles coincided with the licensure and wide use of measles vaccine beginning in 1963.
  • Other vaccine-preventable diseases show a roughly similar pattern in incidence, with all except hepatitis B showing a significant drop in cases corresponding with the advent of vaccine use. (The incidence of hepatitis B has not dropped as much because infants vaccinated in routine programs will not be at high risk of disease until they are at least teenagers. Therefore a 15-year lag can be expected between the start of routine infant vaccination and a significant drop in disease incidence.)
  • Haemophilus influenzae type b (Hib) vaccine is another good example, because Hib disease was prevalent until the early- to mid- 1990s, when conjugate vaccines that can be used for infants were finally developed.
  • Are we expected to believe that better sanitation caused the incidence of each disease to drop just at the time a vaccine for that disease was introduced?
    • Since sanitation is not better now than it was in 1990, it is hard to attribute the virtual disappearance of Hib disease in children in recent years in countries with routine Hib vaccination (from an estimated 20,000 cases a year to 1,419 cases in 1993, and dropping in the United States of America) to anything other than the vaccine.
  • We can look at the experiences of several developed countries after they allowed their immunization levels to drop.
    • Three countries —Great Britain, Sweden and Japan — cut back the use of pertussis (whooping cough) vaccine because of fear about the vaccine.
    • The effect was dramatic and immediate.
      • In Great Britain, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978.
      • In Japan, around the same time, a drop in vaccination rates from 70% to 20%-40% led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1979.
      • In Sweden, the annual incidence rate of pertussis per 100,000 children of 0-6 years of age increased from 700 cases in 1981 to 3,200 in 1985.
  • It seems clear from these experiences that not only would diseases not be disappearing without vaccines, but if we were to stop vaccinating, they would come back.
    • Of immediate interest is the major epidemics of diphtheria that occurred in the former Soviet Union in the 1990s, where low primary immunization rates for children and the lack of booster vaccinations for adults resulted in an increase from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994.
    • There were at least 20 imported cases in Europe and two cases in U.S. citizens who had worked in the former Soviet Union.
  • Here’s another thing you should know about vaccines. Older adults need them too.
    • Here’s why:
      • As we age, our immune system weakens. Older adults are more likely to be infected and develop complications from vaccine-preventable diseases.
      • Immunity from some vaccines can decrease over time, which means booster doses are necessary to maintain protection. Also, some bacteria or viruses change over time; this makes some annual vaccinations necessary.
      • Older adults are more likely to have a chronic condition, which can increase the risk of diseases such as influenza. Skipping a vaccine can have serious health consequences.

 Vaccine Safety: The Facts

  • ​​Many people have expressed concerns about vaccine safety.
    • The fact is vaccines save lives and protect against the spread of disease.
    • If you decide not to immunize, you’re not only putting your child at risk to catch a disease that is dangerous or deadly but also putting others in contact with your child at risk. Getting vaccinated is much better than getting the disease.
    • Indeed, some of the most devastating diseases that affect children have been greatly reduced or eradicated completely thanks to vaccination.
    • Today, we protect children and teens from 16 diseases that can have a terrible effect on their young victims if left unvaccinated.
  • Your healthcare provider knows that you care about your child’s health and safety. That’s why you need to get all the scientific facts from a medical professional you can trust before making any decisions based on stories you may have seen or heard on TV, the Internet, or from other parents.
  • Vaccines work.
    • They have kept children healthy and have saved millions of lives for more than 50 years.
    • Most childhood vaccines are 90% to 99% effective in preventing disease.
    • And if a vaccinated child does get the disease, the symptoms are usually less serious than in a child who hasn’t been vaccinated.
    • There may be mild side effects, like swelling where the shot was given, but they do not last long. And it is rare for side effects to be serious.
  • Vaccines are safe.
    • Before a vaccine is licensed in the United States, the Food and Drug Administration (FDA) reviews all aspects of development, including where and how the vaccine is made and the studies that have been conducted in people who received the vaccine.
    • The FDA will not license a vaccine unless it meets standards for effectiveness (how well the vaccine works) and safety.
    • Results of studies get reviewed again by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians before a licensed vaccine is officially recommended to be given to children.
    • Every lot of vaccine is tested to ensure quality (including safety) before the vaccine reaches the public. In addition, FDA regularly inspects places where vaccines are made.
  • Vaccines are necessary.
    • Your doctor believes that your children should receive all recommended childhood vaccines.
    • In the United States vaccines have protected children and continue to protect children from many diseases.
    • However, in many parts of the world many vaccine-preventable diseases that are rarely seen in the United States are still common.
    • Since some vaccine-preventable diseases still occur in the United States and others may be brought into the United States by Americans who travel abroad or from people visiting areas with current disease outbreaks, it’s important that your children are vaccinated.
  • Vaccines are studied.
    • To monitor the safety of vaccines after licensure, the FDA and the CDC created the Vaccine Adverse Event Reporting System (VAERS).
    • All doctors must report certain side effects of vaccines to VAERS. Parents can also file reports with VAERS.
  • Some parents are requesting that we space out their infant’s vaccinations because they are concerned that receiving multiple vaccinations at a single office visit might overwhelm the infant’s immune system.
    • Vaccine recommendations are determined after extensive studies in large clinical trials. They include studies on how vaccine recipients respond to multiple vaccines given simultaneously.
    • The overall aim is to provide early protection for infants and children against vaccine-preventable diseases that could endanger their health and life.
    • No scientific evidence exists to support that delaying vaccinations or separating them into individual antigens is beneficial for children.
    • Rather, this practice prolongs susceptibility to disease, which could result in a greater likelihood of the child becoming sick with a serious or life-threatening disease.
    • There could also be added expense (e.g., multiple office visits), additional time off from work for parents, and increased likelihood that the child will fail to get all necessary vaccinations.
  • Many patients are reading The Vaccine Book, in which the author, Dr. Bob Sears, cites studies that he interprets as showing that the amount of aluminum found in certain vaccines might be unsafe.
    • He thinks it is better to separate aluminum-containing vaccines, rather than give them according to the recommended U.S. immunization schedule. There is no science behind this.
  • Does the thimerosal in some vaccines pose a risk?
    • Thimerosal, a very effective preservative, has been used to prevent bacterial contamination in vaccine vials for more than 50 years.
    • It contains a type of mercury known as ethylmercury, which is different from the type of mercury found in fish and seafood (methylmercury). At very high levels, methylmercury can be toxic to people, especially to the neurological development of infants.
    • In recent years, several large scientific studies have determined that thimerosal in vaccines does not lead to neurologic problems, such as autism.
    • Nonetheless, because we generally try to reduce people’s exposure to mercury if at all possible, vaccine manufacturers have voluntarily changed their production methods to produce vaccines that are now free of thimerosal or have only trace amounts. They have done this because it is possible to do, not because there was any evidence that the thimerosal was harmful.
  • Some have expressed concern that some vaccines have been produced in fetal tissue.
    • The production of a few vaccines, including those for varicella, rubella, and hepatitis A, involves growing the viruses in human cell culture.
    • Two human cell lines provide the cell cultures needed for producing vaccines; these lines were developed from two legally aborted fetuses in the 1960s.
    • These cell lines are maintained to have an indefinite life span.
    • No fetal tissue has been added since the cell lines were originally created.
    • Some parents are concerned about this issue because of misinformation they have encountered on the Internet. Two such untrue statements are that ongoing abortions are needed to manufacture vaccines and vaccines are contaminated with fetal tissue.
  • The Failed Threat of Autism
    • An article linking autism to the MMR vaccine was retracted for fraud, but this misinformation persists and has caused long-lasting public health consequences.
    • Multiple studies have found no causal link between vaccination and autism, but the falsified report continues to cause parental concern.

Why Vaccinate?

  • Vaccination’s immediate benefit is individual immunity:
    • It provides long-term, sometimes lifelong protection against a disease.
      • The vaccines recommended in the early childhood immunization schedule protect children from measles, chicken pox, pneumococcal disease, and other illnesses.
      • As children grow older, additional vaccines protect them from diseases that affect adolescents and adults, as well as for diseases they may encounter during travel to other regions.
      • Travelers to certain parts of South America and Africa, for example, are required to receive the yellow fever vaccine, as the disease is still prevalent there.
  • The secondary benefit of vaccination, however, is herd immunity, also known as community immunity.
    • Herd immunity refers to the protection offered to everyone in a community by high vaccination rates.
    • With enough people immunized against a given disease, it’s difficult for the disease to gain a foothold in the community.
    • This offers some protection to those who are unable to receive vaccinations—including newborns and individuals with chronic illnesses—by reducing the likelihood of an outbreak that could expose them to the disease.
    • It also protects vaccinated individuals wh may not have been fully immunized against a disease (no vaccine is 100% effective)
  • When community vaccination rates drop below the threshold of herd immunity, widespread disease outbreaks can occur.
    • The threshold of herd immunity for polio, for example, is estimated to be between 80% and 86%;[1]if the vaccination rate drops significantly below this level, the level of community protection may not be enough to prevent the disease from spreading—primarily to those who have no prior immunity because they haven’t been vaccinated (due to chronic illnesses or vaccine refusal) or because they were vaccinated, but it was not effective.
  • This is precisely what happened in England when MMR (measles, mumps, and rubella) vaccination rates dropped.
    • Measles is extremely infectious; therefore, it has a higher herd immunity threshold than most other diseases.
    • In the late 1990s, MMR vaccination rates began to drop from more than 90% to 80% or lower—well below the level required for herd immunity against measles.
    • In response, the number of cases began to rise: while only 56 cases were confirmed in Wales and England in 1998, 1,348 were confirmed by 2008.
    • A disease whose spread in the country had been halted more than a decade prior was once again endemic.
  • Vaccination does more than just protect an individual; it protects entire communities. Sufficient vaccination levels can provide protection against disease for members of the community who would otherwise be left vulnerable.

            The best reason to vaccinate yourself or your child is, well, SCIENCE!!

To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease

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To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 9, Lyme Disease

What causes Lyme Disease? What about chronic Lyme Disease? What is it about some treatments of chronic Lyme Disease that should be concerning?  On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more. Dr. Morrow also talks about why he maintains ownership of his practice and what that means for his patients.

Dr. Morrow’s Show Notes on Lyme Disease

  • Today, I am going to talk about Lyme Disease, and before I am finished, I suspect that some of you will be shaking your heads and changing the dial, metaphorically at least.
  • Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States.
    • Transmission occurs primarily through the bite of an infected deer tick.
    • Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC.
    • Georgia has had cases of documented Lyme disease but the numbers are very low.
    • Identification of an erythema migrans rash following a tick bite is the ONLY clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.
    • The Centers for Disease Control and Prevention recommends a two-tier approach using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal.
      • This is a tremendous point of conflict among patients. The test reports a series of positive or negative “bands” that correspond to possible infection.
        • In order for the test to be POSITIVE, you MUST have FIVE or more positive bands. This is due to cross-reaction or false positive results on any one band.
        • Very often, when we get these results back, 1-3 bands are positive. I have seen too many times when the patient, or even on occasion, the clinician, made the diagnosis of Lyme disease based on this.
  • This is just wrong and is completely unfair to the patient. And it can make the patient vulnerable to the mountain of information available that would make them believe that they could someday have what has been labeled as “chronic Lyme disease”
  • The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease.
  • Doxycycline is often the preferred agent for oral treatment because of its activity against other tick-borne illnesses.
  • Preventive measures include
    • avoiding areas with high tick burdens,
    • wearing protective clothing,
    • using tick repellants (e.g., DEET),
    • performing frequent body checks and
    • bathing following outdoor activities, and
    • instituting environmental landscape modifications (e.g., grass mowing, deer exclusion fencing) to reduce the tick burden.
  • Although there is controversy regarding treatment of post–Lyme disease syndrome and chronic Lyme disease, there is no biologic or clinical trial evidence indicating that prolonged antibiotic therapy is of benefit.
  • Symptoms of early Lyme disease usually begin one to two weeks after a tick bite (range of three to 30 days)
  • There are three well-recognized clinical stages of Lyme disease, and clinical manifestations are different at each stage.
  • As many as 80 percent of patients develop the characteristic erythema migrans rash, which may be confused with other similar conditions.
  • Erythema migrans is classically reported as a single lesion
    • most commonly appears as a uniform red oval rash with average size of about 7-8 inches. It can be as small as a couple of inches.
  • Approximately 19 percent of Lyme rashes are a “bull’s-eye” rash. So, if you are basing the diagnosis only on a bulls eye rash, you could easily miss this.
  • Multiple similar rashes may occur in up to 10 to 20 percent of patients.
  • Associated symptoms are similar to a nonspecific viral illness and often include fatigue, malaise, fever, chills, myalgia, and headache.
  • Following this initial stage, the bacteria disseminate systemically via the lymphatic system or blood.
  • With untreated disease, the most common sites of extra-cutaneous involvement are the joints, nervous system, and cardiovascular system.

Stages of Lyme Disease

  • Early localized
    • Erythema migrans – (typical rash)
    • Virus-like illness (e.g., fatigue, malaise, fever, chills, myalgia, headache)
  • Early disseminated:
    • Cardiac (e.g., atrioventricular block)
    • Dermatologic (e.g., multiple erythema migrans lesions)
    • Musculoskeletal (e.g., arthralgia, myalgia)
    • Neurologic (e.g., lymphocytic meningitis, facial nerve palsy, encephalitis)
  • Late
    • Arthritis (can be one or multiple joints)
    • Neurologic symptoms (e.g., encephalomyelitis, peripheral neuropathy)
  • These are associated with a positive test for Lyme disease

Chronic Lyme Disease

  • Symptoms attributed to Chronic Lyme Disease are chronic pain, fatigue, neurocognitive, and behavioral symptoms
    • Clinicians who subscribe to the idea that chronic Lyme is a real entity will misread, either intentionally or through ignorance, the lab tests for Lyme disease.
    • Too often, they will explain to the patient that the only treatment for their symptoms is long-term antibiotic treatment with or without some other very involved, complex and almost always wasteful treatment THAT ONLY THEY CAN PROVIDE.
    • Perhaps the most recognized and contentious facet of this debate is whether it is effective, appropriate, or even acceptable to treat patients with protracted antibiotic courses based on a clinical diagnosis of CLD.
    • Patients and their families spend an unbelievable amount of money every year on these treatments. Thousands and thousands of dollars are wasted and just handed over to unscrupulous physicians who prey on the hardship of others.
  • The dialogue over CLD provokes strong feelings, and has been more acrimonious than any other aspect of Lyme disease.
    • Many patients who have been diagnosed with CLD have experienced great personal suffering; this is true regardless of whether Lyme infection is responsible for their experience.
    • On top of this, many patients with a CLD diagnosis share the idea that the medical community has failed to effectively explain or treat their illnesses.
      • In support of this patient base is a community of physicians and alternative treatment providers as well as a politically active advocacy community.
      • This community promotes legislation that has attempted to shield CLD specialists from medical board discipline and medicolegal liability for unorthodox practices, to mandate insurance coverage of extended parenteral antibiotics, and most visibly to challenge legally a Lyme disease practice guideline.
      • The advocacy community commonly argues that Lyme disease is grossly underdiagnosed and is responsible for an enormous breadth of illness; they also argue that the general scientific and public health establishments ignore or even cover up evidence to this effect.
      • A large body of information about CLD has emerged on the Internet and other media, mostly in the forms of patient testimonials and promotional materials by CLD providers.
      • This volume of information can be confusing and difficult to navigate.
    • The concept of CLD has for the most part been rejected. Clinical practice guidelines discourage the diagnosis of CLD and recommend against treating patients with prolonged or repeated antibiotic courses.
      • National and state public health bodies agree with this rejection of CLD.
      • Within the medical community, only a small minority of physicians have accepted this diagnosis: 2.1%
    • Many patients referred for Lyme disease are ultimately found to have a rheumatologic or neurologic diagnosis.
      • Rheumatologic diagnoses commonly misdiagnosed as Lyme disease include osteoarthritis, rheumatoid arthritis, degenerative diseases of the spine.
      • Some patients are found to have neurologic diseases, including multiple sclerosis, demyelinating diseases, amyotrophic lateral sclerosis, neuropathies, and dementia.
      • Some CLD advocates have argued that these various conditions are simply manifestations of Lyme disease, but these hypotheses are unable to be proven.
      • There is no evidence that these conditions are related to Lyme infection at any time.
    • Bottom line on chronic Lyme disease is that there is just no science behind it. No study has ever shown a definitive link between these vague symptoms and Lyme disease.
      • The only information even found with the infamous Google search is found on non-medical sites. Websites of any scientific value (those reporting actual scientific studies) reveal NO DATA supporting chronic Lyme disease.
      • The symptoms of chronic Lyme can sometime be explained by other REAL disease processes, but more often than not, these symptoms are just the symptoms of life. They can happen to anyone and do happen to a huge percentage of people in the everyday living of life.

(Information included in these notes comes, in part, from the American Academy of Family Physicians website at www.aafp.org.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

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To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

Sleep apnea affects not only a partner who can’t sleep for the snoring, but it reduces quality of life for the person affected by this condition. So why does sleep apnea occur, and what are the best treatment options? On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more, and talks about his own experience with sleep apnea.

Also in this episode, Dr. Morrow welcomes two 8th grade students from Taylor Road Middle School in Johns Creek, Cion Kim and Ananya Shaeker. To complete a project assignment for their language arts class, Cion and Ananya used a previous episode of “To Your Health” to explore the dangers of vaping for their peers. Impressed by their work, Dr. Morrow was delighted to welcome Cion and Ananya to the show!

Ananya Shaeker and Cion Kim
Ananya Shaeker and Cion Kim

 

 

Dr. Morrow’s Show Notes on Sleep Apnea

Sleep Apnea

  • There are two kinds of sleep apnea: obstructive apnea and central apnea.
  • Obstructive sleep apnea is the most common type.
    • Nine out of 10 people who have sleep apnea have this type of apnea.
    • something is blocking the airway that brings air into your body (also called the trachea).
    • When you try to breathe, you can’t get enough air because of the blockage. Your airway might be blocked by your tongue, tonsils, or uvula (the little piece of flesh that hangs down in the back of your throat).
    • It might also be blocked by a large amount of fatty tissue in the throat or by relaxed throat muscles.
  • Central sleep apnea is less common. This type of sleep apnea is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don’t get the “go-ahead” signal from your brain. Either the brain doesn’t send the signal, or the signal gets interrupted.

Obstructive Sleep Apnea

  • Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep.
  • People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping.
    • These short stops in breathing can happen up to 400 times every night.
    • If you have sleep apnea, periods of not breathing can disturb your sleep (even if they don’t fully wake you up).
  • This results in fragmented, non-restful sleep that can lead to symptoms such as morning headache and daytime sleepiness.
  • Obstructive sleep apnea affects persons of all ages, especially:
    • Men,
    • people who are overweight, and
    • people who are older than 40 years of age are more likely to have sleep apnea.
  • However, it can affect anyone at any age.
  • There are many health conditions associated with obstructive sleep apnea, including
    • hypertension,
    • coronary artery disease,
    • cardiac arrhythmias, and
    • depression
  • Predictive clinical features are:
    • Loud snoring,
    • gasping during sleep,
    • obesity, and
    • enlarged neck circumference.
  • Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited.
  • The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory (a sleep study).
    • Home sleep apnea tests are available and in recent years have become more reliable.
    • Home portable monitoring can be used as a substitute for in-laboratory polysomnography for the diagnosis of OSA in patients with a high likelihood of SA.
    • Most patients prefer home monitoring, and clinical outcomes among patients diagnosed by either method are comparable regarding sleepiness, sleep-related quality of life, and compliance with continuous positive airway pressure (CPAP) therapy

What is the Result of Untreated Obstructive Sleep Apnea?

Relation to Hypertension

  • About one half of patients who have essential hypertension have obstructive sleep apnea, and
  • About one half of patients who have obstructive sleep apnea have essential hypertension.
  • A growing body of evidence suggests that obstructive sleep apnea is a major contributing factor in the development of essential hypertension.

Excessive Daytime Sleepiness

  • Excessive daytime sleepiness is one of the most common sleep-related patient symptoms
    • affects an estimated 20 percent of the population. Persons with excessive daytime sleepiness are at risk of motor vehicle and work-related incidents, and have poorer health than comparable adults.
    • The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications.
    • Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy.
    • Obstructive sleep apnea is a particularly significant cause of excessive daytime sleepiness.
      • An estimated 26 to 32 percent of adults are at risk of or have obstructive sleep apnea, and the prevalence is expected to increase.
      • The evaluation and management of excessive daytime sleepiness is based on the identification and treatment of underlying conditions (particularly obstructive sleep apnea), and the appropriate use of activating medications.

Connection to Heart Disease

  • The connection between sleep apnea and heart disease is evolving very rapidly.
  • People with cardiovascular problems such as high blood pressure, heart failure, and stroke have a high prevalence of sleep apnea.
  • Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly.
  • One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well.
  • If you treat people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence to think there is a cause-and-effect relationship between hypertension and sleep apnea.
  • Why does your blood pressure go up when your sleep is disrupted by sleep apnea?
    • Your blood pressure will go up because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and the brain, because they have priority.
    • The problem is that things that go on at night tend to carry over in the daytime, even when the sleep apnea patient is awake. The low oxygen levels at night seem to trigger multiple mechanisms that persist during the daytime, even when the patient is breathing normally.
  • How can CPAP (continuous positive airway pressure) reduce the cardiovascular consequences of sleep apnea?
    • The available evidence tells us that when you treat people with sleep apnea using CPAP, their blood pressure is not only lower at night—it’s also lower during the day. That’s a very good thing.
    • Moreover, people with atrial fibrillation (a common type of irregular heart beat) with sleep apnea that is appropriately treated have only a 40% chance of coming back for further treatment of their atrial fibrillation.
      • If their sleep apnea is untreated, the chance of a recurrence of atrial fibrillation goes up to 80%. The message to heart patients with sleep apnea is: With treatment of your sleep apnea, your chances of improvement are considerably better.

Can Sleep Apnea Be Prevented or Avoided?

  • There are things you can do to prevent sleep apnea. The following steps help many people:
    • Stop all use of alcohol or sleep medicines. These relax the muscles in the back of your throat, making it harder for you to breathe.
    • If you smoke, quit smoking.
    • If you are overweight, lose weight.
    • Sleep on your side instead of on your back.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 7, Allergies

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 7, Allergies
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Dr. Jim Morrow, Host of “To Your Health With Dr. Jim Morrow”

Episode 7, Allergies

Allergies affect almost 50 million people in the United States alone. On this episode of “To Your Heath,” Dr. Jim Morrow, an allergy sufferer himself, takes them all on:  food, plants, drug, environmental, and contact allergies. Dr. Morrow also talks about Forsyth BYOT, a non-profit established by Dr. Jim and Peggie Morrow to support technology initiatives in Forsyth County Schools.

Dr. Morrow’s Show Notes on Allergies

Allergies

  • When you hear someone talk about having allergies, usually they mean rhinitis or upper respiratory symptoms (runny nose, watery eyes, itching eyes and ears and nose, sneezing).
  • Allergies also can be due to food, medications, animal dander or plants.

Allergic Rhinitis

  • The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing.
  • Individuals with allergic rhinitis should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
  • Specific testing (blood or skin) should be performed for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed.
  • Sinus imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
  • Intranasal steroids should be prescribed for patients with allergic rhinitis whose symptoms affect quality of life.
  • Oral second-generation/less sedating antihistamines should be prescribed for patients with allergic rhinitis and primary complaints of sneezing and itching.
  • Intranasal antihistamines may be prescribed for patients with seasonal, perennial, or episodic AR.
  • Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
  • Combination pharmacologic therapy may be prescribed for patients with allergic rhinitis who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
  • Immunotherapy should be prescribed for patients with allergic rhinitis who have inadequate response to pharmacologic therapy
  • Avoidance of known allergens or environmental control may be considered in patients with allergic rhinitis who have identified allergens that correlate with their clinical symptoms.
  • Inferior turbinate reduction may be considered for patients with allergic rhinitis with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.

Allergy Testing

  • Many types of allergies: environmental, foods, drug, contact.
  • An estimated 10% to 30% of the global population has an allergic disease.
  • Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features.
  • Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell–mediated reactions are the main types of allergic responses.
  • The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing.
  • For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred.
  • In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment.
  • If this is ineffective, IgE-specific antibody or skin testing can exclude allergens.
  • An oral food challenge should be performed to confirm the diagnosis. Results of laboratory testing for food-specific IgE are generally poor, even less helpful than those for percutaneous skin testing.
  • Patients with an anaphylactic reaction to an insect sting should undergo specific antibody or skin testing.
  • Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis.
  • Patch testing can help identify the allergen responsible for contact dermatitis.

Food Allergies

  • Patients with suspected food allergies are commonly seen in clinical practice.
  • Although up to 15 percent of parents believe their children have food allergies, these allergies have been confirmed in only 1 to 3 percent of all Americans.
  • Family physicians must be able to separate true food allergies from food intolerance, food dislikes, and other conditions that mimic food allergy.
  • The most common foods that produce allergic symptoms are milk, eggs, seafood, peanuts, and tree nuts.
  • Although skin testing and in vitro serum immunoglobulin E assays may help in the evaluation of suspected food allergies, they should not be performed unless the clinical history suggests a specific food allergen to which testing can be targeted.
  • Furthermore, these tests do not confirm food allergy. Confirmation requires a positive food challenge or a clear history of an allergic reaction to a food and resolution of symptoms after eliminating that food from the diet.
  • More than 70 percent of children will outgrow milk and egg allergies by early adolescence, whereas peanut allergies usually remain throughout life.
  • The most serious allergic response to food allergy is anaphylaxis. It requires emergency care that should be initiated by the patient or family using an epinephrine auto-injector, which should be carried by anyone with a diagnosed food allergy.
  • There are no recommended medications to prevent IgE- or non–IgE-mediated allergic reactions to food. Allergen-specific immunotherapy or immunotherapy with cross-reacting allergens is not recommended to treat food allergy.
  • Some environmental allergens cross-react with foods, such as:
    • Birch pollen:  Carrots, celery, fresh fruit (e.g., apples, cherries, nectarines, peaches, pears), hazelnuts, parsnips, potatoes
    • Grass pollen:  Kiwi, tomatoes
    • Ragweed pollen:  Bananas, melons (e.g., cantaloupe, honeydew, watermelon)

Nonallergic Rhinitis

  • Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies.
  • Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available.
  • Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes.
  • There are several subtypes with overlapping presentations, including:
    • nonallergic rhinopathy,
    • nonallergic rhinitis with nasal eosinophilia syndrome,
    • atrophic rhinitis,
    • senile or geriatric rhinitis,
    • gustatory rhinitis,
    • drug-induced rhinitis,
    • hormonal rhinitis, and
    • occupational rhinitis.
  • Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible.
  • First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium.
  • Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms.
  • Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.

Hives (Urticaria)

  • Hives are typically large, raised areas on the skin that can itch and spread and coalesce into huge areas of swelling
  • They can be caused by many things, including:
    • Colds
    • Bladder infections or other types of infection
    • Allergies to food, particles in the air, or things that touch your skin
    • Insect stings or bites
    • Medicines
    • Heat, cold, or pressure
    • Exercise
    • A serious disease, but this is uncommon In many cases, no specific cause is found.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Forsyth BYOT

In 2013, Dr. Jim and Peggie Morrow found that hundreds of students in Forsyth County did not have the technology necessary to succeed in the highly technical environment that school is today. The county relies on online work a great deal and so many students were having to go to the library or a Starbucks to access assignments because they did not have internet in their homes.  Additionally, many did not and do not have internet capable devices that make this work possible either.

So, the Morrows made it their mission to bridge this gap and help these students try to break the cycle of generational poverty that so many of them are born to.

In the last five years, over $300,000 has been raised and donated by Forsyth BYOT to the Forsyth County Schools for this purpose. Forsyth BYOT seeks to raise awareness of the problem and find sponsors to donate or raise money outright through two yearly fundraisers, the BYOT Golf Tournament in May and the iRUN for BYOT 5K & FunRun in October.  Donated funds are given to the school district, which has staff in place to first determine which students are in need and then to purchase and distribute internet hotspots or devices to that family.

To Your Health With Dr. Jim Morrow: Episode 6, The Keto Diet

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 6, The Keto Diet
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Dr. Jim Morrow, Host of “To Your Health With Dr. Jim Morrow”

Episode 6, The Keto Diet

The Keto Diet has grown significantly in popularity over the last couple of years. Is it effective? More important, is it safe? Dr. Jim Morrow calls it “the worse diet ever devised by man.” He offers reasons for this opinion, talks about his own struggles with weight, and offers recommendations.

Dr. Morrow’s Show Notes on the Keto Diet

What is a Diet?

  • The word “diet” can mean two things.
    • That food plan you follow for a period of time, to your weight
    • Whatever you eat on a daily basis.
  • The first one is what most people think about when they talk about a diet.
    • It has an artificial beginning and an artificial end, e.g. “Man, I can’t wait to lose this 20 pounds so I can get off of this diet!”
  • The problem is, that losing weight is the easy part. Keeping weight off is the hard part.

Diet Plans

  • There are as many diet plans available for you to follow as there are people in the world. And many of them will work. But, are they healthy?
  • The whole idea is to “eat less food.” That’s it, that’s what you have to do. As long as you eat less food than you have been eating, you will lose weight.
  • The hard part is that you have to eat less food FOREVER!
  • It’s the hardest thing you will EVER do. Harder than tobacco, harder than drugs, harder than anything because you have to eat.
  • So, as I tell patients, “If you want to change your weight, you have to change your life.”
  • And THAT is why it is so hard. We are who we are, we do what we do, and we like what we like. Lifestyle and genetics
  • Some of you will be like my brother-in-law, who admittedly eats to live. And some of you will be like me, live to eat. Well, the ones who eat to live will forever and for always be thinner than me. It’s a mindset, it is the way they are. It’s their nature.
  • And those like me will forever fight a battle, or have to adjust to being heavier.
  • If you follow a commercially available plan like Jenny Craig or Nutri-System, you’re very unlikely to do them for the long term. You’re just not likely to pay for that food for long.
    • I bought a month’s worth of Nutri-System’s food several years ago and in two weeks I was starving!
  • It has got to be a plan that you can stay on FOREVER. And that’s hard.
  • But what all of this boils down to is that you have to eat less food. So, to that end, I have written a book for those of you who really want to lose weight, or have a friend who wants to lose weight.

Keto Diet

  • A new twist on extreme weight loss is catching on in the United States. It’s called the “keto diet.”
  • The keto diet was originally formulated to treat seizures. In some patients, this does help reduce the number and severity of their seizures, although experts are not quite sure why it works.
  • It uses the body’s own fat burning system to help people lose significant weight in as little as 10 days.
  • Proponents say the diet can produce quick weight loss and provide a person with more energy.
  • The “keto” diet is any extremely low-carbohydrate diet that forces the body into a state of ketosis. This occurs when fat tissue is used for energy instead of sugar.
  • Low carbohydrate levels cause blood sugar levels to drop and the body begins breaking down fat to use as energy.
  • Keto diets vary in detail but are usually between 75 and 90 percent fat in the diet
  • Ketosis occurs when people eat a low- or no-carb diet and molecules called ketones build up in their bloodstream.
  • Ketosis is actually a mild form of ketoacidosis. Ketoacidosis mostly affects people with type 1 diabetes. In fact, it is the leading cause of death of people with diabetes who are under 24 years of age.
  • Many experts say ketosis itself is not necessarily harmful.
  • Some studies, in fact, suggest that a ketogenic diet is safe for significantly overweight or obese people.
  • However, other clinical reviews point out that patients on low-carbohydrate diets regain some of their lost weight within a year.
  • The keto diet that has been studied and that researchers say is a healthy diet is one consisting of:
    • 20 g to 30 g of carbohydrate in the form of green vegetables and salad, and
    • 80 g to 100 g of protein in the form of meat, fish, fowl, eggs, shellfish and cheese.
    • Polyunsaturated and monounsaturated fats are also included in the diet.
      • This is canola oil, olive oil, safflower oil, peanut oil, sunflower oil and corn oil.
      • Other foods high in polyunsaturated fats are walnuts, sunflower seeds, flax seeds or flax oil.
      • And fish, such as salmon, mackerel, herring, albacore tuna, and trout
    • Monounsaturated fat foods are avocados, almonds, cashews and peanuts
  • BUT this is NOT the Keto Diet that most people follow. The Keto Diet, as followed by most Americans, is not healthy.
  • Many people on keto include “High fat days” and on these days they might eat as much as a pound of bacon a day.
  • I have had patients who had well-controlled cholesterol, then started this version of the keto diet, and their cholesterol climbed 40 points or more.
  • On the true Keto diet, cholesterol has been shown to come down. But as it is practiced in most of America, cholesterol can go up. You’ll lose weight but won’t be healthy.
  • Weighing less is great, but having a normal cholesterol is extremely important also.

Long Term Weight Loss

  • The biggest issue I have with the Keto Diet is that in any form, it is not a plan that you are going to follow for very long.
  • The amount of fat that many people are taking in, by not following the original Keto Diet, is grossly unhealthy.
  • This diet, as too many people practice it every day, is the WORST DIET EVER DEVISED BY MAN.
  • There is not a fad diet, one that is intended to get a lot of weight off of you in a hurry, that you are likely to stay on, or certainly be healthy on, for a long time.
  • I do think that people need to do their very best to eat well, to be healthy.
  • But you also need to be realistic. If you go to a family reunion and everyone there is grossly overweight, you are probably not going to be a size 4. You can almost certainly lose some weight, but be realistic.
  • Be more concerned about not gaining weight. Too many people gain 5 pounds a year, look up in 5 years and have gained a lot of weight.
  • Women, you are especially unlucky when it comes to weight loss. Everyone who loses weight will lose and plateau for a while, lose then plateau again.
  • Women plateau at the beginning. Might be three months.
  • The best diet for long-term weight maintenance is one that you can and will follow for a very long time.
  • Because of that, Weight Watchers is, in my opinion, the best commercially available plan around.
    • You don’t buy your food from them,
    • You can eat anything in the world,
    • It helps you understand portion control, a novel idea for anyone dieting
    • It can be done long term, but again it is a way of life.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

 

 

 

To Your Health With Dr. Jim Morrow: Episode 4, Vaping

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To Your Health With Dr. Jim Morrow: Episode 4, Vaping
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Dr. Jim Morrow, Morrow Family Medicine

Dr. Morrow’s Show Notes on Vaping

  • If we are going to talk about vaping, we have to talk about: NICOTINE.
  • Why nicotine? What does it do to your brain?
  • Nicotine activates the circuitry that regulates feelings of pleasure, the so-called reward pathways. Research has shown that nicotine increases the levels of dopamine (a key brain chemical involved in mediating the desire to consume drugs) in the reward circuits of the brain.
  • Cigarettes also cause a marked decrease in the levels of monoamineoxidase (MAO), an enzyme responsible for breaking down dopamine, so…. more dopamine in the circulation.
  • The need to sustain the high dopamine levels results in the desire for repeated drug use.
  • Outward Signs of Nicotine Addiction
    • an inability to stop using tobacco products
    • withdrawal symptoms when nicotine use stops
    • a desire to keep smoking even when health complications arise
    • continued use of tobacco products even if it negatively impacts your life
  • Treatment for Nicotine Addiction
    • Wellbutrin
    • Chantix
    • Support groups

What We Learned

  • In 1950, the tobacco companies came out with a huge ad, a statement to America, that they did not believe that cigarettes were any health threat at all. Their “Frank Statement to Cigarette Smokers” essentially stated that they felt tobacco was completely safe and caused no harm, stating that “for more than 300 years, tobacco has given solace, relaxation and enjoyment to mankind.”
  • In 1964, the Surgeon General, Luther Terry, submitted his report on the direct link between smoking and cancer. It concluded that smoking is a cause of lung cancer and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.
  • In 1965, labeling changes occurred and today labels show graphic evidence of what cigarettes can do.
  • In 1967, advertisements for cigarettes had to start giving significant time to the dangers of smoking.
  • What is NOT a Treatment for Nicotine Addiction: VAPING!
  • If you’re puffing on something electronic – it’s vaping.
  • Might call it e-cig, vape, Juul (a brand name)
  • Bottom line is that it is an ENDS (electronic nicotine delivery system)
  • Vaping appears to increase young people’s risk of starting smoking
  • Young people who reported having used e-cigarettes were more than eight times as likely to start using conventional cigarettes
  • Problem may be exacerbated by the many flavors used to enhance the enjoyment of e-cigarette use
  • Adolescents and young adults are known to be very susceptible to flavorings
  • Vaping is exposing them to one of the most addictive chemicals known — nicotine
  • Studies show teens tend to underestimate their risk for getting addicted and overestimate their ability to quit once addicted

Types of e-Cigs

  • 1st Gen: closely resembles a cigarette and is disposable
  • 2nd Gen: larger, pen shaped, rechargeable
  • 3rd Gen: do not look like combustible cigs at all, have large batteries, replaceable parts, these are called “mods”
  • Latest: Sleek, modular design like Juul (looks like a USB drive) and some others. These often have a much higher nicotine content than traditional cigs or earlier devices.

Nicotine Concentrations

  • Levels vary – some are nearly the same as traditional cigarettes
  • Mislabeling is a common problem
  • Nicotine delivery is affected by how the device is used by the consumer.
  • Juul delivers nicotine almost THREE TIMES FASTER than a typical cigarette.
    • This increases the likelihood of addiction
    • Often, (some say 37 % of the time) youth and young adult users are not even aware that the device has nicotine in it at all.

As Harmful as Typical Cigarettes?

  • While e-cigarettes contain some fewer toxins than combustible cigarettes, they are not free of toxins and still deliver harmful chemicals
  • There is an enormous variability within the product category and there is no typical e-cigarette
    • different ingredients and different hardware, and deliver highly variable amounts of nicotine and potentially toxic chemicals

What People Think

  • Among adults,
    • 31% think they are the same as cigs
    • 4% think they are more harmful
    • 29% don’t know
    • 36% think they are less harmful

Usage Rates

  • In 2011, 1.5 percent of high school age students used e-cigs
  • In 2017 that number was up to 12 percent
  • In 2011, 0.6 percent of middle schoolers used them, and
  • In 2017, 3.5 percent used them
  • Among adults, in 2015, more than HALF of users also smoked cigarettes.
  • Among young adults, 40% also smoked cigarettes.

Patterns of Use

  • In 2017, studies showed that 12% of high school and 3.5% of middle school students has used e-cigs in the previous 30 days
  • 2018 NASEM report concluded that, “there is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults”
  • 60 percent of teens incorrectly reported e-cigarettes as being comprised of mostly flavoring.

Juul

  • Since 2016, Juul has surged in popularity – now with 68% of the e-cig share.
  • Many are unaware that the product always contains the addictive chemical nicotine
  • A single JUUL cartridge is roughly equal to a pack of cigarettes

Health Effects

  • Much is still unknown
  • E-cigs can deliver levels of nicotine similar to combustible cigarettes and this is causing concern about the potential risk for addiction
  • Exposure to nicotine among youth is particularly dangerous since it has been shown to have an effect on key brain receptors, making young people more susceptible to nicotine addiction
  • Effect of nicotine on developing brains may result in nicotine addiction and greater vulnerability to addiction to other drugs as well
  • Pregnant women who use nicotine are at a greater risk of stillbirth and preterm delivery.
  • At least 60 chemical compounds have been found in e-liquids, and more are present in the aerosol produced by e-cigarettes.
  • We don’t know what exposure to these flavors will do. Marketing has gotten out of hand with some being labeled “Thin Mint” or “Redi-Whip”, etc.
  • E-liquids can cause unknown problems
  • Explosions of devices can and do occur, although unlikely this is very dangerous.
  • Vaping is in its infancy. It is tobacco fifty years before the discovery that it caused lung cancer. What good could you possibly hope to derive from vaping?

Thinking about vaping? Think before you start! (Before you buy even that first device.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Jim Morrow, Morrow Family Medicine

To Your Health With Dr. Jim Morrow: Episode 2, Erectile Dysfunction

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To Your Health With Dr. Jim Morrow: Episode 2, Erectile Dysfunction
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Dr. Jim Morrow, Morrow Family Medicine

Dr. Morrow’s Show Notes on Erectile Dysfunction

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance It is a common problem, affecting at least 12 million U.S. men, about 1 in 3 after age 50. Probability increases with age.

Causes include vascular, neurologic, psychological, and hormonal factors. Contributing factors may be diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment; probability of undiagnosed diabetes mellitus (DM) is 1 in 50 in men without ED and 1 in 10 in men with ED. ED typically occurs two to five years before coronary artery disease (CAD), providing a potential window during which men diagnosed with ED can make lifestyle changes to prevent CAD.

Performance anxiety and relationship issues are common psychological causes.

Medications and substance use can cause or exacerbate ED; antidepressants (SSRI and SNRI), tobacco and alcohol use are the most common. Marijuana might cause ED but little data on that so far.

ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome (2.5 times more likely). Workup: A1C or fasting glucose level can be used to assess for diabetes. A lipid panel can assess for hyperlipidemia. A thyroid-stimulating hormone level is recommended for men with signs or symptoms of hypothyroidism.

Lifestyle interventions: Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions.

Oral phosphodiesterase-5 inhibitors are the first-line treatments for ED. Headache, flushing, and dyspepsia are common adverse effects, NOT when taking nitrates at all. Second-line treatments include vacuum devices and alprostadil. This comes as a suppository or an injectable. Surgically implanted penile prostheses are an option when other treatments have been ineffective.

Counseling is recommended for men with psychogenic ED.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

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