Dr. Howard Smith Oncall

Vidcast:  https://youtu.be/R6j4W6aPTgc Kids with teeth that protrude are at significant risk for a lifetime of dental problems.  An Australian study of more than 50,000 children and adolescents was just published in the journal Dental Traumatology. The data reveals that children under the age of six with teeth that protrude more than 3 millimeters are more than 3 times more likely to sustain serious dental trauma.  Children and adolescents older than 6 years with dental protrusions of more than 5 millimeters have double the  risk of injury.  When injuries do occur, they may negatively impact continued dental development, complicate future orthodontia efforts, or necessitate later dental implants. Children with protruding teeth should be fitted with protective mouth guards for use during sports and other vigorous play.  They should be considered prime candidates for aggressive and proactive orthodontia in order to normalize their dental profile and reduce risk of injury. George P Arraj, Giampiero Rossi‐Fedele,

Vidcast:  https://youtu.be/G3--3Vsow-c The ready availability of marijuana had both positive and negative impacts on the use of hospital services in the state of Colorado.  Cardiologists and epidemiologists at UC-San Francisco studied some hospital records from Colorado comparing utilization before and after pot legalization.  On the positive side, there were fewer hospitalizations for chronic pain.  This statistic is a tribute to the effectiveness of cannabis and its components THC and CBD as agents for pain management.  On the negative side, hospital admissions rose due to marijuana-driven motor vehicle accidents, alcohol abuse, and cannabis overdosing.  The net effect on hospital utilization was zero. The lesson learned is that mind-altering drugs can have health benefits.  Their ready availability dictates the need for public education about responsible, moderate use.   This is particularly true in the context of heavy machinery operation. Francesca N Delling, Eric Vittinghoff, Thomas A Dewland, etal. Doe

Vidcast:  https://youtu.be/RQhzQKE1s0M Inflammatory bowel disease is best treated by simultaneously applying therapies that focus both on the gut and the brain.  A study from Sweden’s University of Gothenberg just published in journal Gastroenterology emphasizes the need a comprehensive, holistic approach to the disease. The researchers studied 400 patients with IBD and matched controls using quantitative measures of intestinal sensitivity and motility as well as a questionnaire to explore the subjects neurological and psychological issues.  Their studies were particularly focused on the so call gut-brain axis which is the link between these components of IBD. The study concludes that the most severe forms of IBD were accompanied by multiple problems in the gastrointestinal tract and in the psyche.  Effective treatment was only possible when each component of the disease was recognized and managed holistically with not only pharmaceuticals such as anti-depressants but also cognitive behavioral therapy and hyp

Vidcast:  https://youtu.be/UoXTh9OtlzA Electronically monitoring a child’s day-to-day breathing patterns and their responses to medicine improves asthma management.  Pediatricians at the University of Utah developed a smartphone app they call eAsthmaTracker and tested it with more than 300 children receiving care at 11 clinics statewide. The app tracks a child’s respiratory symptoms and peak flow rates and their impact on everyday activities permitting parents and clinicians to detect impending acute asthma attacks and use proactive medication adjustments to prevent or at least moderate such episodes.  Use of the app improved asthma control, reduced ED visits by 60%, diminished the need for rescue steroids by 35%, led to 60% fewer missed school days, and drove an improved quality of life. The Utah app is not yet ready for prime time, but the good news is that there are several free asthma tracking apps already available on the iOS and Android App stores.  These apps appear to provide some of the same tracking

Vidcast:  https://youtu.be/RVam3gGQvYI Broccoli and its cruciferous vegetable cousins can inactivate a gene that cancers use to overwhelm our immune systems and our bodies.  This latest finding comes from Boston’s Beth Israel Deaconness Medical Center’s Cancer Research Institute. We know that eating broccoli, cauliflower, cabbage, collard greens, Brussel sprouts, and kale seems to reduce the risk of cancer.  The Harvard researchers report that a tiny molecule in these vegetables, indole 3 carbinol or I3C, blocks one gene, WWP1, and releases a second gene, PTEN that is a potent human cancer cell suppressor.  By this round about mechanism, these veggies metabolically disable tumor cells. So all we have so do is eat some broccoli, cauliflower, or cabbage to cure cancer.  No so fast.  Only tiny amounts of the magic I3C are in the usual servings of these vegetables, so you’d have to consume whopping quantities to consistently have an effect.   Nonetheless, eating them regularly is beneficial while researchers find

Vidcast:  https://youtu.be/frbow4n-VoM This is a wake up call for the US, Britain, Ireland, Italy, and Australia that comes from Italy’s Bocconi University and Bruno Kessler Foundation.  Researchers there crunched the numbers using a computer model and simulated the characteristics of measles immunity between 2018 and 2050 in these countries as well as in South Korea and Singapore. The study projections show that by 2050, only South Korea and Singapore would have the required 7.5% of their populations immune to measles and thereby escape a string of measles epidemics.  At the current rates of vaccination in the other countries, none of them would reach the 7.5% target. The CDC is webcasting a seminar this week for clinicians to help them cope with this year’s measles outbreak.  Although 95% of Americans have immunity to measles either by having had the disease or by vaccination, 1 in every 12 children in the US fail to receive their first dose of MMR vaccine on time.  Most of the cases of measles that enter t

Vidcast:  https://youtu.be/V6FqGGLJLo8 While the incidence of bowel cancer dropped in middle-aged adults 50+ over the decade ending in 2014, colon and rectal cancer is on the rise for younger adults.  This result is now reported in the journal The Lancet Gastroenterology & Hepatology, and it is derived from a tabulation of cancer registry data from the westernized countries Australia, New Zealand, Canada, Britain, Ireland, Denmark, and Norway. The numbers are small but significant.  While the bowel cancer incidence was dropping by 2% on average in older persons, it was rising 2.5% in the younger adults.  The rise is particularly significant for rectal cancer. The study authors speculate that better screening for young adults should be considered, since most surveillance doesn’t begin before the ages of 45-50 except in those with a strong family history of bowel disease.  With the advent of cheap at-home fecal immune test or FIT kits, it may be prudent to begin that type of screening on a periodic basis in

Vidcast:  https://youtu.be/wvab4Bj4SIc We’ve known for years that coffee can be good for your digestion as it helps keep you regular,  reduces risk of gallstones, and keeps your liver humming along.  A new study from the University of Texas at Galveston explores that reasons for this conclusion.  Their studies were carried out in a rat model. These investigators found that, when exposed to coffee for three successive days, the small and large intestines of the tests animals showed more forceful muscular activity than seen in animals on a coffee-free diet..  In addition, the bacteria within the guts of the experimental animals showed slower growth in the coffee-fed animals.  Most interesting was the observation that gut contractions increased and bacterial proliferation decreased whether or not the coffee was caffeinated or decaf. Healthline.com summarizes the known benefits of coffee: Boost energy. Burns fat. Improves physical performance. Contains essential B vitamins and minerals. May lower diabetes risk.

Vidcast:  https://youtu.be/n-VPKjhnrRU If a child swallows a button battery that has passed into the stomach, a study to be presented to the Digestive Disease Week annual meeting concludes that the ingested object must be removed quickly to prevent damage to the gastrointestinal tract linings.  Current recommendations suggest wait and see to allow the battery to pass through the gastrointestinal system.  These tiny coin-shaped batteries are found in small electronic devices including toys, key fobs, talking greeting cards, watches, and hearing aids. A study by the Children’s Hospital Colorado that presents data from 68 kids treated at children’s hospitals in that state, Florida, and Ohio.  The findings indicate that acid released by these ingested batteries leads to corrosive stomach lining injuries 60% of the time. Because of this damage, the authors’ recommendation for immediate removal of the coin battery is far more aggressive and proactive than the current wait and see guidelines issued by the North Amer

Vidcast:  https://youtu.be/ZIK07yBWRcA A study just published online by the New England Journal of Medicine is challenging the way we manage asthma.   For decades, inhalation of the short-acting bronchodilator albuterol, sold as Proventil and Ventolin, has been the recommended treatment for attacks with the addition of an inhaled steroid for maintenance of easy breathing. A collaborative group from New Zealand, Australia, and Britain now demonstrates that the inhaled steroid+long acting bronchodilator combo budesonide-formoterol, marketed as Symbicort, and only used when needed not only works effectively to stop asthma attacks but also prevents them with less steroid exposure for the patient. The study included 688 adult asthma patients in 3 treatment groups who randomly received either as-needed albuterol, as-needed budesonide-formoterol, or daily budesonide with the addition of albuterol as needed.  The results showed that as-needed steroid+long-acting bronchodilator reduced the incidence of severe asthma a

Vidcast: https://youtu.be/MtNakRwjYu0 Health News You Should Use, the latest medical discoveries and commonsense advice that you can use in a practical way to keep yourself and your family healthy.   Here are this weeks stories and a selections of news from the past several weeks: Prophylactic Antibiotic Dose Improves Instrumented Vaginal Deliveries  How Much Coffee Is Too Much Sunscreens Won’t Lower Your Vitamin D But May Be Toxic Meditation Could Backfire Losing Your Appendix May Bump Up Your Parkinson’s Risk Recreational Sports Improve Grades Avocado Kills Hunger Skin-sparing Mastectomy A Safe Alternative Cialis Helps Heart Failure Nuts to High Blood Pressure An Early Diagnosis of Autism Is Possible Morning Workouts Drive Better Thinking E-Cigarettes Are Contaminated With Bacteria and Fungi A Simple Test Predicts Lasting Concussion Effects Late Pregnancy Ultrasound Benefits Mother, Baby, and Bottomline Children’s Author Roald Dahl Speaks About Measles For more information, you’ll find all the references fo

Vidcast:  https://youtu.be/9DzvBHZ9CzU The author of “Charlie and the Chocolate Factory” and “Matilda,” Roald Dahl, wrote in 1988 about his experience when his daughter developed measles.  "Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. 'Are you feeling all right?' I asked her. 'I feel all sleepy,' she said. In an hour, she was unconscious. In twelve hours she was dead.” Dahl went on: “The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was...in 1962, but even now, if a child wit

Vidcast:  https://youtu.be/CU2WZFt3CZ8 A planned ultrasound at 36 weeks will detect undiagnosed breech presentations in time to allow intervention and prevention of dangerous fetal distress and emergency c-sections.  This recommendation springs from a study by public health specialists at Britain’s University of Cambridge. The investigators screened nearly 3900 women during their first pregnancies with a 36 week ultrasound.  The screening detected a 4.6% incidence of breech presentation more than half of which were unsuspected.  The women were given the choice of attempting to turn the baby, so-called external cephalic version, or a an elective c-section. Those whose babies would not reposition underwent the elective c-section. In the UK, the 36 week ultrasound that costs about 13 pounds or US$17, would prevent about 15,000 undetected breech presentations, more than 4,000 emergency c-sections and 8 baby deaths a year.  The effects are even more dramatic when extrapolated to the US population. If you are pregn

Vidcast:  https://youtu.be/RvII1BZlmOU Pediatric sports medicine specialists at the University of Colorado report that a simple test, the Romberg test, can predict which children will suffer lasting effects from a concussion and would benefit from proactive therapy.  Their study was just published in the Journal of Neurosurgery;Pediatrics. The data from more than 350 children and adolescents with a mean age of nearly 15 years showed that an abnormal Romberg balance test was the best predictor of prolonged symptoms after the traumatic brain injury.  This test was more predictive than other variables including self-reported headache severity, headache frequency, confusion, forgetfulness,  inattention, memory lapses, fatigue, and dizziness failed to correlate with the duration of issues post-concussion. The Romberg test is simple to perform.  The subject stands with feet together and eyes closed.  The test is deemed positive if the individual cannot maintain balance with minimal movement. This finding is importa

Vidcast:  https://youtu.be/PqKyUnQe-Mc Need more reasons not to use e-cigarettes and to convince your children to avoid them?  Besides the fact that they spew addicting nicotine and toxic flavoring chemicals?   A study from the Harvard School of Public Health now finds bacterial endotoxins and fungal cell wall remnants in 75 popular e-cigarette products from 10 top-selling US brands. The investigators studied 37 e-cigarette cartridges and 38 e-liquid products that are used to refill cartridges.  They demonstrated that 23% of the products contained significant concentrations of gram-negative bacterial endotoxins and a whopping 81% of the products were contaminated with fungal by-products.   Other studies have confirmed that these bacterial endotoxins and fungal glucans trigger acute and chronic respiratory problems.  Asthmatics or those with pre-existing lung disease would be particularly vulnerable. This study joins so many others that underscore what is just common sense: don’t inhale poisons unless you have

Vidcast:  https://youtu.be/Xvpv230Tovc Starting the day with a moderate-intensity walking exercise session does help your mind function better.  The latest Australian study just published in the British Journal of Sports Medicine, looked at more than 65 subjects of all genders and 55 to 80 years of age. The morning workout was associated with improved attention, concentration, executive function, visual learning, and working memory.  The study also revealed that periodic 3 minute walking breaks during the day further improved test results when compared with those clocked by those who had no additional exercise after the morning session. This study is additional proof that the extra exercise-driven blood flow to your brain and the exercise-induced chemical agents such as endorphins that flow in that blood fine-tune your brain to perform optimally.  Although the study was completed in middle-aged and older persons, the exercise would likely also benefit anyone of any age. Michael J Wheeler1,2, Daniel J Green1,

Vidcast:  https://youtu.be/v1aLm03-Ujg Neuroscientists at the University of California-San Diego’s Autism Center of Excellence now report that autism may be reliably diagnosed in babies as young as 14 months thereby permitting effective, early intervention.  The researchers studied more than 1200 toddlers who were first evaluated between their first and third birthdays and were then followed with at least one additional thorough assessment later in childhood. The ability to reliably diagnose autism or autism spectrum diagnosis occurs by 14 months of age.  Diagnostic reliability is only 50% at 12 months, rises to 79% by 14 months, and is 83% by 16 months.  Only 2% of those first diagnosed with autism during infancy later had that diagnosis dropped. The mean age at diagnosis for autism is currently between 3 and 4 years.  Research studies suggest that autism in its many shades develops in utero during the first or second trimesters, and this new information confirms that a reliable, earlier diagnosis is definit

Vidcast:  https://youtu.be/KgQBWuFn7SM Eating walnuts instead of other sources of fat in a diet can lower your blood pressure.  This conclusion comes from a study of 45 overweight or obese subjects by nutritionists at Penn State just published in the Journal of the American Heart Association. The investigation found that eating walnuts to replace at least 5 percent of the typical 12 percent saturated fat that most Americans consume significantly lowered the body’s central diastolic or resting blood pressure. A normal diastolic pressure level is key for preventing heart disease and stroke.  The walnuts did not lower either systolic blood pressure or arterial stiffness. The next time you’re looking for a heart healthy snack, skip the potato chips and reach instead for the can of walnuts.  For an even greater effect, replace those french fries you know you always order with walnuts and green beans.  Your heart and circulation will be glad you did. Alyssa M. Tindall, Kristina S. Petersen, Ann C. Skulas‐Ray, Chesn

Vidcast:  https://youtu.be/axAxR1HvtK8 Tadalafil, marketed as Cialis, is one of the popular drugs used for erectile disfunction (ED).  Now a study at Britain’s University of Manchester shows that cialis slows or reverses the progression of congestive heart failure. The study, just published in the journal Scientific Reports, was carried out in sheep since their hearts are physiologically similar to the human heart.  Heart failure was induced in the sheep using pacemakers to overdrive and exhaust their hearts. When the sheep were given Cialis at a dose equivalent to that taken by humans for ED, their heart function improved and their hearts were again capable of responding to adrenaline, a key signaling agent in both sheep and humans.  Cialis and drugs like it including Viagra work in part by dilating blood vessels, and this effect may reduce the resistance against which the heart must pump, the so-called after load, permitting it to function better. More studies are needed to explain the exact mechanism of ac

Vidcast:  https://youtu.be/2ldqpbInV8s A new Mayo Clinic study shows that many breast cancers may be safely and completely removed without sacrificing the overlying skin and nipple.  This study is being presented to the American Society of Breast Surgeons annual meeting this month. The study looked at skin and nipple-sparing mastectomies in 769 women undergoing a total of 1300 surgeries.  At one year following surgery, the technique was considered a success in 97% of cases both in terms of cancer eradication and breast reconstruction. Longer-term followup data will be necessary to determine whether or not skin- and nipple- sparing will become the norm.  Even at this point, though, this information from Mayo suggests that such conservative surgery should be considered an option for many women. Mayo Clinic. "Less-invasive mastectomy safe for more breast cancer patients." ScienceDaily. ScienceDaily, 2 May 2019. . #mastectomy #skinsparing #nipplesparing