Family Medicine Helping Puerto Rico

The plight of Puerto Rico has been broadcast daily since Category 4 Hurricane Maria slammed into the island less than 2 weeks ago. The Family Medicine community has been proactive in the relief effort, even before Maria hit Puerto Rico.

Our friend and colleague Dr. Kim Yu has been in contact with the Puerto Rico Academy of Family (PRAFP)  Physicians and has helped organize an effort and a campaign to raise money for electric generators for the people there, especially since it's been reported that 95% of people in Puerto Rico are still without power. The goal is 60 generators, since this year marks the 60th anniversary of the PRAFP. As of this posting, we have already reached 20 generators!

On Saturday, September 30, 2017, we broadcast a Facebook Live with Kim Yu, Alex McDonald, and myself to raise awareness for this fundraising campaign, and for Kim to share some of the stories that are happening in Puerto Rico right now. Please contribute to this link right now, and thanks to our colleagues at the Indiana Academy of Family Physicians for setting this up: https://www.in-afp.org/give

Included in the video segments below include a statement from Dr. Carlos Cestero who is the President of the Puerto Rico Academy of Family Physicians read by Kim Yu. How did Kim get started in this effort? She answers that question in a video below. In addition to raising funds for generators, Kim talks about other things that you can do to help Puerto Rico, including volunteering your physician skills on site in Puerto Rico. If you'd like more information on any of this, please reach out to Kim Yu on twitter at @DrKKYu

Also in the program, we talked about National Primary Care Week which is taking place now from October 1-7, 2017. In addition, we talked about lighter topics like the origins of Alex McDonald's twitter name, and how much fun we had at the recent AAFP Family Medicine Experience conference. Below, I broke down last night's video into shorter segments for your review and enjoyment. Please share this post with friends and colleagues to continue to raise awareness and to continue to raise funds for the people of Puerto Rico!

Raising Breast Cancer Awareness

Just this week, actress Julia Louis-Dreyfus, best known for her roles in the TV shows "Veep" and "Seinfeld," announced that she was diagnosed with breast cancer. She wrote on twitter, "1 in 8 women get breast cancer. Today, I am the one."

The month of October is also National Breast Cancer Awareness month, and I'll be doing my part to remind my patients and to remind my community about the importance of talking about this illness. Here are some facts about breast cancer and here are some risk factors to keep in mind from the American Cancer Society and the National Breast Cancer Foundation.

Breast Cancer Facts

• 1 in 8 lifetime risk of getting breast cancer
• Breast cancer is the 2nd leading cause of cancer death in women
• Over 250,000 new cases of breast cancer in women in 2017
• About 40,000 women will die from breast cancer in 2017
• More than 3.1 million breast cancer survivors in USA

Breast Cancer Risk Factors

• About 60-70% patients have no risk factors
• Genetic Risk
• Lack of Physical Activity
• Poor Diet
• Overweight/obesity
• Drinking Alcohol

There are so many other topics to mention, especially about testing, diagnosis, and treatment. But, the most important things at this point are to know the facts, and to know your risks. In addition to reviewing the information above, I encourage you to visit your Family Physician and/or your personal medical provider.

Addendum: Thanks to WKBN-TV for posting the article on the interview: "Importance of Recognition during Breast Cancer Awareness Month" 

One Hurricane Irma Story

As I write this, Hurricane Irma has not quite made landfall yet. However, the winds in Southern Florida and the Florida keys have already started to ramp up in speed and intensity. I wanted to try to get a sense of how it was going down there, so I reached out to a Family Physician friend of mine.

Dr. Ajoy Kumar practices Family Medicine in the Tampa, Florida area. And, as we recorded this interview at around 10:45am Eastern time on Saturday, September 9, 2017 - Hurricane Irma has not made landfall yet, and was forecast to arrive in the Tampa area in around 24-48 hours.

In our conversation, Dr. Kumar talked about the emotion that he is going through, and the sense of emotion going on both in the hospital and in the community. He also talked about how his experience working in developing countries have prepared him for this urgent situation. Finally, he speaks on how Family Medicine and Family Physicians are uniquely qualified to perform in these leadership positions.

There is an audio podcast above that you can both listen to and also download. For those who have access to iTunes podcasts, I encourage you to download the podcast from iTunes at this link. Finally, check out our youtube conversation both below and at this link. Stay safe, Dr. Kumar and all of our friends in Florida!

One Hurricane Harvey Story

Not only is Dr. Troy Fiesinger a Family Physician, but he is also a long time resident of the Houston, Texas area. Something interesting I saw on my Facebook feed was Dr. Troy posting news and updates from the Houston area. So, I reached out to him to see if he would be interested and available to share his story. I was honored that he shared his story exclusively with me, and we conducted a Facebook Live interview less than a week following landfall of the storm.

In the links below, I have made available an audio file for you to listen to you from my The Dr. Mike Sevilla Podcast. In addition, I tried to edit our 60 minute interview into smaller portions which make things easier to you to digest. 

Finally, I encourage you to donate to whatever charity you choose. For me, I recommend the American Academy of Family Physicians (AAFP) Foundation. I look forward to talking with Dr. Troy more at the upcoming AAFP Family Medicine Experience conference (#AAFPFMX on twitter).

New Rules For Acute Pain Prescribing in Ohio

A few hours ago, the State Medical Board of Ohio announced new prescribing rules for opioid pain medications in the treatment of acute pain. These rules will take effect beginning on August 31, 2017. These new rules do not apply to the treatment of chronic pain.

Rules for prescribing for acute pain:

• No more than seven days of opioids can be prescribed to adults
• No more than five days of opioids can be prescribed to minors, unless written permission from parent/guardian
• Can prescribe beyond day supply limits only if documented in medical record
• Total morphine equivalent dose (MED) cannot exceed 30 MED per day
• New rules do not apply to opioids prescribed for cancer care, palliative care, and hospice care

The State of Ohio Board of Pharmacy has a table of MED doses at this link. I also encourage you to check out the State Medical Board of Ohio links to Acute Pain Rules: Definitions, General Provisions, Prescribing of opioid analgesics for acute pain.

What does this mean? I know our "friends in Columbus" want physicians to write less opioid medication, but this is not the way to do it. Family Physicians like me will be more scared to write for opioid medications for my patients who will need it. Will I have to bring back my patients every seven days? According to the State Medical Board, when does acute pain transition to chronic pain?

In my opinion, these new rules will not help the opioid problem in Ohio. The unintended consequence will be that it will worsen the problem. Back in the 1990s, physicians were forced to address "Pain As The Fifth Vital Sign," which forced physicians to prescribe more opioid medication. Now, with the current opioid crisis, we are being legislated to write less. Will this drive patients to obtaining illegal opioids? The answer is yes, because you see it in the news everyday, especially here in Ohio.

What's the answer to the opioid problem in Ohio and across the country? I know it's complicated, but blaming doctors and putting more restrictions on physicians may get you some political points and help get/keep you elected. Meanwhile, according to the Columbus Dispatch, 4149 Ohioans died from unintentional drug overdoses in 2016, which is a 36 percent leap from the previous year. Plus, 2017 is on track to outpace last year's numbers. When are Ohioans themselves going to stand up and say that enough is enough?

Concussions & CTE

This week, many schools around the state will be getting back to school, and this ultimately means the beginning of high school football season. Through the summer, I've been performing a lot of sports physicals and back to school physicals, and an important topic that I bring up is concussions.

According to our friends at FamilyDoctor.org, a concussion is a type of Traumatic Brain Injury which is defined as a sudden damage to your head. Many associate football with concussions, but other sports including soccer, can also result in concussions. And, the Ohio High School Athletic Association has rules for athletes determined to have concussions.

Signs and Symptoms of Concussion:

• Loss Of Consciousness
• Headache
• Confusion or Memory Problems
• Dizziness or Balance Problems

OHSAA Rules For Athletes With Concussions:

• Unable to return to play the same day, under no circumstances
• For return to play, required to have written authorization from a physician (MD or DO) or certified athletic trainer

There has been a lot in the press about CTE, or Chronic Traumatic Encephalopathy. Symptoms generally appear 8-10 years after an athlete experiences repeated concussions. It is generally believed that CTE occurs in four stages.

Stages of CTE: Chronic Traumatic Encephalopathy

• Stage 1: Disorientation, dizziness, headaches
• Stage 2: Memory loss, erratic behavior, poor judgement
• Stage 3/4: Dementia, movement disorders, tremors, suicidality

Back to school is always an exciting time. But, as school sports progresses, make sure your review the signs and symptoms of concussion. And, as always, if any questions, please reach out to your Family Physician.

Ohio Issue 2: Drug Price Relief Act

I've been getting a lot of questions from my patients on Ohio Issue 2, the Drug Price Relief Act. Many believe this November 7th ballot issue will be the most expensive in Ohio history. All Ohioans have been seeing the television ads for the past few months. And, each side is accusing the other of deceptive advertising. 

What does Issue 2 say? Issue 2 would require the state of Ohio to pay the same, or lower prices for prescription drugs as the VA (meaning the US Department of Veterans Affairs).

Why is Issue 2 controversial? It's controversial because the voters in Ohio are confused about what actually will happen if Issue 2 passes. Will it actually lower drug prices? This is a key point that cannot ultimately be answered. In the research I have done, experts state that "there are too many variables" in play to predict whether drug prices will actually decrease.

My Bottom Line: I encourage you to check out the websites and videos below and make your own determination. For me, I still have many questions about Issue 2, and I'm not convinced that Issue 2 will lower the price of drugs for my patients. I am going to be voting No on Issue 2. 

Resources for you to read and to view on Ohio Issue 2:

• Vote No On Issue 2 Website: No On 2 Deceptive Rx Issue
• Vote Yes On Issue 2 Website: Ohio Taxpayers For Lower Drug Prices
• Ballotpedia: Ohio Issue 2: Drug Standards Price Initiative (2017)
• Dayton Daily News: Ohio's Drug Price Ballot Issue: What's Really Going On
• Cleveland 19 News: What Is Issue 2 in Ohio?

Disclaimer: This essay is my personal and individual opinion, and does not necessarily represent the places I work or the organizations of which I am a member.

Back To School Immunizations

As summer is quickly coming to a close for kids, it's that time of year again to think about Back-To-School. In addition to thinking about school supplies and school clothes, something else to ask yourself is this, "Is my child up to date on immunizations?"

There are certain immunizations that are required to attend school in the states of Ohio and Pennsylvania, and the Ohio Department of Health and Pennsylvania Department of Health have great links to let you know which immunizations are required to attend school. The full immunization schedule can be found at the site for the Centers for Disease Control and Prevention. 

But, in general, the immunizations that my patients and their parents are asking about are the following Back-To-School Immunizations:

• Before Kindergarten: MMR, Chicken Pox, Polio, Tetanus
• Before 7th Grade: Tetanus Booster, First Meningitis Shot
• Before 12th Grade: Second Meningitis Shot

The vaccine against Human Papillomavirus (HPV) is not required to attend school (yet), but I still try to have a discussion with parents about the benefits of this vaccine. And, of course, I do recommend the Flu Shot yearly. 

I also get questions about vaccine exemptions. In the states of Ohio and Pennsylvania (and other states), a child who attends public school can be exempted from taking vaccines in school for medical, religious, and philosophical reasons as long as the parent/guardian provides the school with a written statement along with a waiver form.

This exemption also comes with one caveat: If this school has an outbreak, the school may prevent the child from attending, to protect the health of all students and the faculty.

Of course, I advocate for vaccination, because we have seen the complications of not vaccinating. Remember the 2014 mumps outbreak at Ohio State University? This affected almost 500 people. How about the 2014 measles outbreak at Disneyland in California? I believe these came about because the people affected, for whatever reason, were unvaccinated.

Bottom Line: Vaccines work. Get your children vaccinated. Stay up to date on your (adult) vaccinations. And, finally, visit your Family Doctor to see which vaccines are appropriate for you and your child.

Summer Safety Tips

With the first day of summer a few days ago, summer is now in full swing! I've been getting a lot of questions from parents on the topics of pool safety and fireworks safety. And, I'll focus on those topics in this blog post.

Pool Safety: According to the Centers for Disease Control and Prevention, from 2005-14, there were an average of 3500 fatal unintentional drownings annually, which is about 10 deaths per day. And, approximately one in five of these fatalities were children 14 years old and younger.

Here are three Pool Safety Tips to keep in mind this summer:

• Never leave a child unattended near water
• Keep a Life-Saving ring and CPR instructions at poolside
• Keep a phone at poolside so you can call for help if needed

Fireworks Safety: With July 4th right around the corner, here are a couple of alarming statistics to keep in mind. In a 2014 report by the Consumer Product Safety Commission, 35 percent of people seen in the ER around the time of July 4th were younger than 15 years old. In addition, 28% percent of ER visits were due to sparklers. In case you didn't know, sparklers can reach 1200 degrees F.

Here are three Fireworks Safety Tips to keep in mind:

• A responsible adult should supervise all firework activities. Never give fireworks to children
• Always have a bucket of water nearby
• Never, ever relight a "Dud" firework

I also encourage you to check out the story on the WKBN site called "Tips To Say Safe Around Water, Fireworks as Summer Season Begins." 

'13 Reasons Why' Raises Discussion On Teen Suicide

The Netflix drama "13 Reasons Why" is causing a lot of discussion and controversy on the topic of teen suicide. The show, based on a 2007 young adult novel, tells the story, through the tapes she made, of a high school sophomore who committed suicide. Each tape addresses one of the 13 people the student claims contributed to her death.

Before I go further, I wanted to post the link to the National Suicide Prevention Lifeline and their phone number is 800-273-8255. For those who would rather text, contact the Crisis Text Line by sending "Hello" to 741-741. From a medical standpoint, Family Doctor.org has some useful information to increase awareness about teen depression, cyberbullying, and teen suicide. I also share an NPR audio podcast from May 18, 2017 below, and a video podcast from a Suicide Prevention Social Media community.

Even though that it is powerful storytelling, I would NOT recommend that teenagers watch this show alone. However, I realize a lot of kids watching this on their phones on the bus. So, kids who watch this show need to talk with their parents, or guardians, or school counselors, or other adults where they process what they're seeing and what they're feeling.

No, I do not think this show will cause teens to consider suicide. However, I think that this show is high risk to trigger those teens struggling with mental illness, or those who are/have been affected by bullying/cyberbullying and sexual assault in the past. It is unfortunate that the program did not originally share information about the National Suicide Prevention Hotline or the Crisis Text Line as above. More information was added at the beginning of this month.

To help raise awareness, and to help you, here are my "13 Reasons" to look out for in teens (and adults) as Warning Signs For Suicide:

• Talking about death and/or suicide in a casual way
• Saying they wish they hadn't been born
• Asking about death or how to commit violent acts
• Talking about leaving or going away
• Saying they won't need things soon
• Not wanting to be around people anymore
• Seeming sad and remote, instead of happy and social
• Becoming more angry or edgy
• Losing interest in hobbies or events
• Having trouble focusing
• Showing changes in normal routine, such as sleeping, eating, or grooming
• Acting out in harmful ways like drinking, using drugs, or hurting themselves
• Getting in trouble with the law

Addendum: I also invite you to check out the WKBN-TV article, "Local doctor discusses Netflix teenage-suicide show '13 Reasons Why'"