3 TYPES OF HEADACHES

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Most common is Tension headache, associated usually with stress and causing scalp or neck muscle spasm. It can occur daily. Migraines are usually 1 sided and can be associated with visual or other sensations just before the headache comes on. Cluster headaches are usually on the side of the head and hits frequently over a period of weeks and then stops. The treatment of each is different.

BEING YOUNG IN THE US IS LETHAL!
The largest cause of deaths was car crashes followed by firearms. 61% of these deaths were preventable. Our country has triple the rate of vehicle deaths of 12 other developed countries. And the rate of firearm deaths here was 36 times higher and of these, over half were homicides, over a third were suicides and a small number was from careless discharge. This group prefers to not use the term “accident” since that implies nothing could have been done to prevent it.

WHICH EXAMS ARE NECESSARY
The American Academy of Family Physicians recommends AGAINST routine testicular exams in young men since testicular cancer is rare and easily curable. Help yourself to check your testicles for any suspicious lumps. The top can have a spongy spaghetti mass—you are feeling normal tubules. They also recommend against routine prostate exams since they are wrong many times and result in too many tests and against routine pelvic exams in non-pregnant women

TOP 10 DRUGS KILLING US not in order:
Drugs of abuse: Oxycodone (Percocet®), heroin, fentanyl, cocaine, hydrocodone (Norco®), Xanax®, Ativan®, methadone, morphine, methamphetamine.

BENZOS ARE ABUSED.
Benzodiazepines (BZDs) like Xanax®, Valium®, and Ativan®, are being abused. 5 million reported abuse last year. Very few of these were prescribed, so they are purchased on the street. They cause addiction and stopping them can cause seizures and withdrawal. They are good for anxiety and cause a euphoria in some, but if used more than a week or two, dependency sets in. Older people are some of the abusers and they are at risk for falls and breaking a bone. When taken with opiates, like pain pills or heroin, then death can more readily occur–especially since cheap fentanyl is being mixed in to street opiates. If prescribed in California, the prescriber must regularly check the national database to see if the patient has multiple prescribers and send alerts for possible abuse.

HOW DOES SCREEN TIME AFFECT YOUR BRAIN?
A study of MRI scans of the brains of young people found that certain areas were larger or smaller depending on the activity they spent many hours on: social media vs. games. The larger areas were the ones that were involved in the activity. So more screen time may make some areas larger and others smaller. There is no strong recommendation to pull that phone away from you, the chronic user other than the reasons to get exercise, be more face-to-face social, clean your room and take a shower!

GUNS
Healthcare providers are now speaking out about the multiple shootings, accidental or otherwise, that hurt their patients, including many children. Nearly every day we have a school shooting or mass shooting in the US. The National Rifle Association is not happy with any criticism of guns so they issued complaints asking physicians to “stay in their lane.” The physicians answered that their lane is promoting health and that watching their patients die from gunshot wounds requires action. The problem is that the NRA has a lot of money to give to lawmakers to keep them from passing reasonable measures to limit firearm sales to the wrong people. Automatic weapons are not needed for hunting.

LATENT TB TREATMENT SHORTER (IMMIGRANT ALERT)
Most of the patients who get TB are immigrants. If you have a positive tuberculosis blood or skin test, then we perform a chest Xray to determine if the TB is sleeping (latent) vs. active and possibly infectious. A latent TB prescription was 6 months of isoniazid. Now they recommend 3 months of 2 meds: rifapentine and isoniazid. This makes the treatment easier and shorter.

CHOLESTEROL MEDS ARE GREAT!
The American Heart Association put out their opinion, looking at all the studies listing the risks and benefits: the risk of side effects is tiny and the benefits great, i.e. prevention of heart attacks and strokes. These are the statins, e.g. atorvastatin, pravastatin. All diabetics and people who have had a stroke or heart attack should be on one of them. Some others should too.

PRIMARY CARE PHYSICIAN SHORTAGE COMING SOON.
By 2025 we will need 52,000 more PCPs and it takes 7 years to train one. The US government has not expanded the money for training PCPs and the salaries are still lower for them than some of the specialties; there are few training spots and less money after the training. I’ll be old by 2025 and will be in line with others waiting for my PCP! Except for this paragraph I use the term PCP to mean Primary Care Provider, covering all who may treat patients, write prescriptions, do procedures, i.e. nurse practitioners and physician assistants who will fill some of this need.

Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto)
Member, Coachella Valley Clinical Research Initiative

REFERENCES: Medscape®

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