1-25-2019: The Virus
The virus has been around since antiquity, but we lack fossil proof - less advanced than bacteria and basically genetic material surrounded by a protein shell. It needs the host DNA to replicate and thus cannot survive long outside the intracellular milieu. Bacteria are a complete self-functioning cell. In fact, the virus "bacteriophages" prey on bacteria. Ancient Egypt documented perhaps the first flu epidemic. The herpes virus has been proven to be around even longer.
Domestication of animals allowed the virus to jump species, i.e. measles, rabies, small pox were some that devastated ancient Europe. Yet today newer ones emerged like hanta, Ebola, SARS, Zika and HIV.
The pandemic of 1918/19 was so devastating (perhaps wiped out over 25% population, mostly healthy folks) that research was mandated. The first vaccine was made available in 1938. But for many years the effects were minimal. The vaccine targets the sugar proteins used to attach (which change seasonally) to stimulate an immune response. Many advances in the past 5-10 years show new promise i.e. adding more antigens, growing the virus in animal media, adding components to hyper stimulate the immunity. 1999 saw the use of antiviral agents i.e. "Tamiflu", oseltamivir.
Virus attach, inject into a cell, merge with host DNA, hijacking it to make multiple copies of the virus and then burst to infect other cells. Oseltamivir binds the virus and prevents its escape - if taken within 48 hours. VACCINATE
11-10-2018: New Medical Specialties
The 1970's saw the advent of doctors developing new specialties.
For example, three years of formal and intense Emergency Room (ER) training began around this time leading to the ER specialization. Once started, this specialty grew rapidly. Previously local doctors would run over and see their patients, now patients could go to an ER clinic as fewer doctors made house calls.
New techniques like CPR became systematized with strict and nationalized standards/protocols; the use of defibrillators to shock out life threatening arrythmias became standardized; rapid intubation for respiratory arrest or distress became common. At this time, intensive care units improved and became standard in all hospitals not just teaching universities.
Another example is heart surgery. In the late 60's coronary bypass surgeries came into vogue, as pioneers such as Michael Debakey helped invent the heart lung bypass machine to allow surgeons to work on the heart so that gushing blood would not interfere with their operations. By the 1970's heart surgeons were getting proficient and some were doing five or more medical procedures per day. They took veins from the legs/chest and bypassed the clogged heart arteries to prevent future infarctions (tissue death due to inadequate blood supply to the affected area). The cardiologists also needed Intensive Care Units (ICU's) with highly skilled nurses and technicians to monitor pre- and post-operative critically ill patients.
Flu Vaccination Message from Dr. Tushla
11-1-2018: Time for a Flu Vaccination
Flu Vaccinations Helps Prevent the Flu!
Diabetes - Adult Onset
10-6-18: Diabetes - Adult Onset
Diabetes Mellitus as a diagnosis has been around for hundreds of years - way before family practice medicine came into being. The literal translation means sweet urine, and how that came be to named can be clarified by a quick chat with your physician. Type one diabetes is often called childhood diabetes. It occurs most often early In life and can often be related to an illness, i.e., viral where the pancreas is injured and quits making insulin. Thereafter the victim requires injections of insulin to survive. I like to use the metaphor of the large portion insulin acting as an airplane to deliver sugar(passengers) to the various living cells (airports). With no insulin, the sugar will go up quickly and the body will go in a coma.
Type 2 diabetics (or adult onset) make insulin, but the receptor sites on the cells (landing strips of the airports) are shut down. Family practice and internal medicine doctors must be adept at treating this as it is more and more common. The cause for the receptor problem is directly related to weight. Although not everyone is obese with type 2 diabetes, most people are. This type of diabetes is genetically passed on. Even pediatricians are starting to find this. Physicians are now astute at recognizing pre diabetes. Recently, it has been shown that the damage of diabetes, for example, neuropathy, visual problems, cardiac problems, etc., start at the pre-diabetes level. That is, this damage to end organs happens even before a blood test shows random sugar over 200 or fasting sugar over 140. In my 23 years of family practice I have seen several new classes of diabetic medicines introduced; some old ones, like Metformin re-introduced after it was made safer. The old days of putting everyone on insulin are much better with newer medications. Patients seem to be doing a better job and diabetics are living longer; however, with the increasing epidemic of obesity with cheaper and more affordable junk food, diabetes is still rising. The best and ultimate treatment remains the same - get the weight off.
should i get a flu shot?
9-29-18: The Flu Shot
Why do we get the flu shot?
This winter, will be the centennial anniversary of one of the most well recorded pandemics in the history of the world, "the Spanish Flu."
The flu season usually arrives during the winter months. Nearly everyone has experienced the flu: runny nose, muscle aches, body aches, chills, cough and perhaps, nausea. Some years are worse, while some are hardly noticeable.
The flu is often confused with the common cold, i.e., the "Rhino Virus." Many patients claim the shot causes these symptoms and so, decline the shot. Saying it's not effective, they ask for antibiotics, thinking that will fix the problem.
The virus is often named after protein antigens which coat their envelope and allow it to land on human cells, i.e., H1N1. Think of a team like the Yankees that have their own unique logo. The virus is mostly made of nucleic material that enters our bodies and hijacks human DNA. It duplicates and multiplies rapidly and cannot be killed by antibiotics. That said, there are some fairly new antiviral meds that will interfere with the duplication process if taken within the first 24-48 hours of contracting the disease. It is true the shot is not 100% in its effective-ness. Each year, the effectiveness depends on the vaccine makers picking the correct H and N proteins to target. They base their decision on the previous year and also on what is happening in the Southern Hemisphere as their winter precedes ours.
Unfortunately, the virus can evolve and change its proteins. Often the virus is seen in animals first, specifically birds and poultry. That's why it can be called the "bird flu" or "rooster," or whatever animal it invades.
The virus doesn't always cross the animal species barrier. The 1918 epidemic is an example. That flu killed about 5% of the world's population, and it was possibly made worse by the crowding from post war soldier camps. Many, back then died due to post viral bacterial infections as antibiotics were not yet invented. Nor were Intensive Care Units, ICUs or ventilators available.
The strain, however, would still be devastating today, and severe epidemics come around every 10-20 years. it is still estimated that a flu shot reduces the severity of the illness and reduces the chances of getting the flu by up to 50%.
So, to quote Ben Franklin: "An ounce of prevention is worth pound of cure."
9-24-18: Medicare, Up Close
The notion of Medicare has been kicked around since the early 1900's. Presidents Teddy Roosevelt and Woodrow Wilson tinkered with the idea, but it wasn't until 1965 that it was enacted. In the beginning, there were few takers. I remember my father, a Family Practice doctor, who started his practice that same year saying that "No doctors want to mess with the eight- dollar visit." So, each year Medicare upped the customary charge to twenty or so dollars per visit. Thus, began what I like to call "the Boondoggle," with super-inflationary costs.
The two ensuing decades satirically have been named "the Golden Age of Medicine." Owing to the largesse of Medicare, specialties bloomed. Dialysis became more accessible, emergency rooms had cat scans, hospitals had Intensive Care Units, ICUs. Heart catherization, angioplasty and coronary bypasses came on line along with joint replacements, On the positive side, antibiotics improved, chemotherapy drugs became more effective, and generally speaking, people started living longer.
Over time, the system became overloaded, as the baby boomer generation grew elderly. As the boomers who had been paying into Medicare became recipients of Medicare, it fell to younger generations to start funding the system. With diminished-in-number next generation, came a lessened number to pay into the now-massive structure called Medicare.
Neither I, nor anyone, seems to have a quick easy answer to this American medical predicament. One might ask if things are better in Canada. However, stories of delayed or insufficient care there may indicate the Canadian system also to be in trouble.
I started practice in 1995, at the tail end of this golden age. I have seen first-hand the ups and downs of Medicare and the many attempts to address and repair cost issues. I know my family practice field well, and I know how to navigate the system on behalf of my patients as much as anyone around.
In times good or bad, as we all grapple with providing quality medical treatment regardless of the current system of payment, I shall continue striving to provide the high quality medical care that I saw my dad offer when it was the eight dollar visit. Scott Tushla , MD
