Samme Sez

I'm never wrong- and I can prove it!

FDA proposes rule to notify women with dense breasts about increased cancer risk and imprecise mammograms

The FDA is proposing a rule for breast cancer screenings that would require doctors to give women more information about the risks associated with dense breasts.  Read the full article here.

Caduceus Chief Medical Officer, Gregg DeNicola MD, shares his take for our patients.

“Informing women that their amount of breast density may affect results of the mammogram and their risks be outlined just makes common sense; it’s hard to imagine any body opposing this recommendation. Yes; it is more time necessary to advise patients as the physician, but it is essential women are educated on the details of their mammogram.  In California, such a requirement already exists and is enforced so it will have little impact for our patients, but to set this as a national standard is just smart medicine.”

April 2, 2019 Posted by | The latest in medicine, Uncategorized | , , | Leave a comment

Hormone replacement therapy for women- Is it right for you?

There have been many recent articles and online buzz about hormone replacement therapy for women and our Chief Medical Officer and Caduceus physician Gregg DeNicola MD wanted to weigh in on the discussion.

To provide some perspective, in 2002, an extensive study of over 16,000 women supported by the National Institutes of Health, was halted after discovering that the drugs, a combination of estrogen and progestin, caused small increases in breast cancer, heart attacks, strokes and blood clots. Those risks outweighed the drugs’ benefits -a small decrease in hip fractures and a decrease in colorectal cancer. A year later a comparable study was also stopped in the UK after comparable findings.

Chief Medical Officer Dr. DeNicola agrees, “The fact is a large, prospective study has never been executed proving hormone replacement therapy is indeed safe.  This is an emotional issue and the data is definitely conflicting. Both sides have ample data to support their position.  At Caduceus, we do not routinely recommend or dissuade the use of HRT. The decision is individualized after discussion between the patient and provider. Until the evidence is more definitive, it is the most prudent policy for our patients.”

More questions?  Schedule an in-office or virtual video chat with your Caduceus provider.


February 12, 2019 Posted by | The latest in medicine, Uncategorized | , | Leave a comment

Millions of Americans incorrectly think they have food allergies, study finds

You may have read the story recently that new research suggests Americans may be over-diagnosing themselves with food allergies. A study published in the medical journal JAMA Network Open estimates that nearly 19 percent of adults think they have food allergies, but less than 11 percent actually do.

Caduceus Chief Medical Officer Gregg Denicola MD adds, “I have felt this way for a long time and agree less than 10 percent of Americans have documented food allergies.  Most allergies are to fish and nuts.  They have become so popular that many people self-diagnose and claim one for any type with even minor reactions.  Most restaurants are perpetuating this and now are inquiring regularly with customers of any food allergies,  reinforcing that claim it is now almost expected.  Prior to assuming one has a food allergy, it is always best to be checked and diagnosed by an allergist.”

Allergist Sunil Saini MD sees patients at Caduceus Specialty in Yorba Linda.  Read his bio and/or reserve an appointment.

January 15, 2019 Posted by | The latest in medicine, Uncategorized | | Leave a comment

Are multivitamins a waste of money? Editorial in medical journal says yes.

More than half of all adults in the United States take some sort of multivitamin; many do so in hopes of preventing heart disease and cancer or even to aid with memory. But an editorial published in this week’s Annals of Internal Medicine says that using supplements and multivitamins to prevent chronic conditions is a waste of money. “The (vitamin and supplement) industry is based on anecdote, people saying ‘I take this, and it makes me feel better,’ said Dr. Edgar Miller, professor of medicine and epidemiology at Johns Hopkins University School of Medicine and co-author of the editorial. “It’s perpetuated. But when you put it to the test, there’s no evidence of benefit in the long term. It can’t prevent mortality, stroke or heart attack.”

The editorial, “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” is based on three studies looking at the effects of multivitamins on preventing heart attacks and cancer, as well as improving cognitive function in men older than 65. All three studies were also published in this week’s Annals of Internal Medicine.

The first study was a meta-analysis of 27 studies that covered more than 450,000 participants and found that multivitamins had no beneficial effect on preventing cardiovascular disease or cancer. In addition, taking vitamins didn’t prevent mortality in any way. However, the analysis did confirm that smokers who took only beta carotene supplements increased their risk of lung cancer.

When taking multivitamins to prevent a second heart attack, authors again found no beneficial evidence.
The second study looked at 1,700 patients who previously had heart attacks. They were assigned to take three multivitamins or placebos twice a day for five years. However, with more than 50% of patients stopping their medications, it was difficult for authors to come to any real conclusions about the vitamins’ effectiveness.
With such a high drop-out rate, “interpretation is very difficult,” said Miller.

The final study followed nearly 6,000 men older than 65, who took either a multivitamin or a placebo for 12 years. The men were administered cognitive functioning tests, and test results found no differences between the two groups. However, Gladys Block, a professor of nutrition and epidemiology at University of California Berkeley, pointed out that the group of men followed in the cognitive study were all physicians with no health problems.
“These are very well-nourished, very health-conscious people,” she said.

In fact, she says none of the studies accurately represents the American population.

Block has spent her life studying the role of Vitamin C, in particular, on disease risk factors and says that most Americans are undernourished. She says that most Americans don’t have a healthy diet, and therefore don’t get the vitamins and minerals they need. “You’re not getting any of these micronutrients from Coke and Twinkies,” said Block. “Two-thirds of us are overweight, a quarter over 50 have two or more chronic conditions, so there’s a substantial population that one would hesitate to call healthy.”

Block went on to say, “There’s always a nontrivial minority that’s actually getting a questionable level of some micronutrients. So multivitamins are a backstop against our poor diet.” Cara Welch, senior vice president of the Natural Products Association, agreed with Block. “It is pretty common that in this day and age with the lifestyle many of us lead that we don’t always take the time to have a balanced diet, and even if you do have a balanced diet, you can still have nutritional deficiencies.”

The Natural Products Association is the largest trade organization representing the manufacturers and retailers of the natural products industry, including vitamins. The vitamin and supplement industry rakes in nearly $12 billion annually, according to the researchers, with multivitamins its most popular product. “Multivitamins address the nutritional deficiencies in people,” Welch said. “We don’t believe they are the answer to all life’s ailments, as the editorial suggests.”

Miller, however, disagreed that the studies didn’t represent the general public. “They didn’t select people who eat good diets or bad diets,” he said. “You assume that these people selected are the typical American diet. Taking a supplement in place of a poor diet doesn’t work.”

Some groups, however, do need supplements, he said.

“For people with deficiencies, malabsorption issues, and to prevent neural tube defects in pregnancy — there are a small number of conditions where we prescribe them.” Miller also said the jury is still out on Vitamin D, which can help strengthen bones, and omega-3 fatty acids, including DHA and EPA. Miller said the studies were unlikely to change any clinical standards, and that focusing on diet and exercise remain key to maintaining a healthy lifestyle.

It’s something with which Block can agree. “Eat fruits and vegetables,” she said.

Source: CNN Health


December 24, 2013 Posted by | The latest in medicine, Uncategorized | , , | Leave a comment

Tea for Your Health? Skip the Milk.

Next to water, tea is the most widely consumed beverage in the world. Chock-full of antioxidants, vitamins and other compounds, tea has been linked in a variety of studies to stronger immune function and reduced cell damage. Some research suggests tea may prevent cavities, improve blood sugar levels and perhaps provide cardiovascular benefits.

In many parts of the world, the custom is to serve tea with milk. But lately researchers have been surprised to find that adding milk may strip tea of some of its beneficial effects.

In a study published in The European Heart Journal, researchers had 16 healthy adults drink cups of freshly brewed black tea, black tea mixed with a small amount of skim milk  or boiled water. Then the scientists measured the effects on vascular function.

Compared with water, black  tea “significantly improved” arterial function, the researchers found, “whereas addition of milk completely blunted the effects of tea.”

The scientists repeated similar tests in mice and found the same results, which they speculated may be a result of proteins in milk binding to and neutralizing antioxidants. “Milk,” the researchers wrote, “counteracts the favorable health effects of tea on vascular function.”

A study published this year looked at whether the effect was limited to dairy products. It was not: Proteins in soy milk had the same effect as regular milk on antioxidants in tea.

September 18, 2012 Posted by | The latest in medicine, Uncategorized | , , , | Leave a comment

Standing Up & Heart Failure: Orthostatic Hypotension

Orthostatic hypotension occurs when a person’s blood pressure drops when standing up from a reclining position. Sometimes the sudden dip causes a brief dizzy spell or head rush; in severe cases it may cause a person to faint. Recent research indicates that persons with orthostatic hypotension were nearly 50% more likely to later develop heart failure.

Results of a 20-year research project around the possible link between orthostatic hypotension and heart failure were published this year in the medical journal Hypertension. The 20-year study followed more than 12,000 middle-aged adults for nearly two decades. At the start of the study, researchers measured blood pressure while people were lying down and then several times over a two-minute period after they stood.  “If the top number, the systolic number, fell by 20 or more points, or the bottom number, the diastolic blood pressure, fell by 10 or more points, then it was defined as orthostatic hypotension,” says Christine D. Jones, MD, an internist at the University of North Carolina at Chapel Hill. “Sometimes people can have the condition and not feel a thing,” Jones says.

About 600 people had the telltale blood pressure shift at the start of the study;  some of that extra risk appeared to be explained by high blood pressure. It was noted that people with orthostatic hypotension were also more likely to have high blood pressure, which is known to contribute to heart failure.

However, when researchers excluded people with high blood pressure from their analysis, those whose blood pressure dropped when they stood were still 34% more likely to develop heart failure.  In heart failure, the heart loses its ability to pump blood effectively to the rest of the body. Medications and lifestyle changes can help control the condition if it’s spotted early.

The risk appeared to be highest for younger adults. Those who were younger than 55 when they were diagnosed with the positional change in blood pressure were nearly twice as likely as those with steady blood pressure to go on to develop heart failure.

Researchers caution that their study can only show associations. It doesn’t prove that falling blood pressures cause heart failure or even explain how the two problems may be linked.  The researchers believe that a common disease process, like atherosclerosis, which causes arteries to become hard and stiff, may be behind both.

When arteries harden, they can’t contract as easily to raise blood pressure. Stiff arteries around the heart muscle can weaken its ability to pump. “Maybe this is an [indicator] of early atherosclerotic disease,” Jones says.

August 16, 2012 Posted by | The latest in medicine, Uncategorized | , , | Leave a comment

New Services in 2012

New Services in 2012

February 14, 2012 Posted by | The latest in medicine, Uncategorized | , , | Leave a comment

Entering the Dangerous World of ….

I have to admit that I’m a fan of mystery and suspense stories. I get a little freaked out with clowns (“It”) and don’t go for the real slasher flicks, but a good mystery read or an old Hitchcock flick is a treat.

When I saw an article that called out the most “dangerous” room in the house, I took a peek. Published by the Centers for Disease Prevention and Control, the article stated that approximately 235,000 people report to the ER annually with injuries sustained in this particular room. I assumed this would be a story about the dangers in the kitchen: we see a lot of cuts and burns every day in our same-day visit program and at our after-hours locations. Many budding culinary wizards carry scars from their experiments in the kitchen.

However, the answer was “the bathroom.”

As a Hitchcock fan, I should have known this. No one showers alone without the quiet thought of “Mother” visiting you at your most vulnerable moment.

We docs know that the shower/tub is a primary location for slips and falls. And, let’s face it: there is nothing “soft” in that environment to cushion a fall. I often recommend that my patients install safety rails to protect against such an accident. But to think that the shower trumps the dangers of knives and fire in the kitchen?

Then, I saw the darker side of the bathroom: yes, the toilet.

No kidding:  “using” the toilet actually trumped “leaving the tub” in the stats. Although slips IN the tub and shower were responsible for one-third of the injuries, 14% were from “using the toilet.”

The increase of age did correlate with the number of injuries, but the degree to which women’s accidents outpaced those of men was shocking: 64% to 36%. 64% of all recorded injuries were women. How to explain the gender gap? Is it indicative of which sex has better hygiene? Is it indicative of men simply not reporting injuries? In this case, I agree with the author: along with the age factor it’s indicative of men’s general increased muscle mass (strength) and possibly women’s loss of bone density. Yet another reason to include walking, running and/or weight lifting in your daily schedule.

Another interesting fact: head injuries in the bathroom were highest among the 15-24 year old group. “Alcohol may be a factor,” says the author. “You bet,” says Samme.

So, aside from making sure that there is no can of Hershey’s syrup nearby, I plan to take greater care when entering “the most dangerous room in the house.”  Keeping myself active to stay strong, using rubber mats in the tub, and installing a safety rail or two seem to be reasonable ways to prevent becoming a statistic.

To read the full article, click here

November 10, 2011 Posted by | The latest in medicine, Uncategorized | , , , , , | Leave a comment

Caffeine or Naps?

The Workplace Coffee Effect

Lab studies show that remembering what you have heard or seen and how you physically perform decreases across the day.  Most US workers grab a cup o’ Joe during the afternoon for a “pick up” to finish the work day; indeed, Starbucks has made this an easy “office run” for most city workers.

Caffeine is the most popular stimulant in the world, used daily by 90%  of North Americans.  Our increased caffeine consumption mirrors and contributes to our society’s reduction in sleep.  Having coffee houses on every corner only adds to this concern.  While it appears caffeine can keep you awake when sleep deprived, complex cognitive processes do not fare well on this drug.

Should employers encourage napping during the day and toss out the espresso machines?

A study compared caffeine with napping and placebo conditions on three memory domains: visual, motor and verbal. On caffeine, verbal and motor skills decreased, whereas napping enhanced performance across all three tasks. Furthermore, a study of caffeine withdrawal showed that the immediate enhancements seen after caffeine abstinence completely disappear with regular use. It appears the perceived benefits of caffeine may be more related to release from withdrawal symptoms rather than actual performance enhancement.

Another recent study examined creative problem solving, a valuable asset in most work environments. Naps containing rapid eye movement (REM) sleep produced a 40 percent enhancement in creativity, compared with non-REM naps or quiet rest.

Who gets to break the news to Starbucks shareholders?

Courtesy: Sara C. Mednick, an assistant professor psychiatry at the University of California, San Diego

September 3, 2010 Posted by | The latest in medicine | , , , , | Leave a comment

Soy to Prevent Breast Cancer?

It makes sense that researchers would study soy in preventing breast cancer, given how common the occurrence of cancer is here in the US. A recent study in the Journal of Nutritional Sciences showed that in women who consumed at least 25 grams of soy per day, their risk for breast cancer was reduced by 25%. Additionally, this same intake of soy appeared to improve bone density in post menopausal women and decrease menopausal “hot flashes.”

The trouble is getting 25 grams per day of soy protein.  According to Samme, this would be the equivalent of 13 tablespoons per day of soy sauce. As an alternative, you could eat one cup per day of edamame (whole cooked soybeans). You could also eat two soy veggie burgers per day instead of the soy sauce. And, if you are a tofu fan, four thick slices will give you the 25 grams per day you need.

Samme Sez: Studies show that 25 grams per day of soy may reduce the risk of breast cancer as well as improve bone density in postmenopausal women and decrease “hot flashes.”

January 15, 2010 Posted by | The latest in medicine | , , | Leave a comment

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