Thursday, September 28, 2023

PTSD vs. PTSI — The Arguments for Changing the Name – It's PTSI

What's in a name?  Everything.

"Shell shocked". That is what PTSD was called after World War II and after the Korean War. 

We now realize PTSD occurs after any severe traumatic event, accident or emotional stress both acute and chronic.

The symptoms of PTSD are typically categorized into four main clusters:

1. Re-experiencing Symptoms: These symptoms involve reliving the traumatic event, often through distressing memories, nightmares, or flashbacks. Individuals with PTSD may experience intense emotional or physical reactions when reminded of the trauma.

2. Avoidance Symptoms: People with PTSD may try to avoid reminders of the traumatic event. This can include avoiding specific places, people, activities, or even thoughts and feelings associated with the trauma. They might also have a reduced interest in activities they once enjoyed.

3. Negative Changes in Mood and Thoughts: PTSD can lead to significant changes in a person's thoughts and feelings. They may experience persistent negative emotions, such as fear, guilt, or shame. They might have trouble recalling specific aspects of the traumatic event, feel detached from others, or have difficulty experiencing positive emotions.

4. Arousal and Reactivity Symptoms: These symptoms involve heightened arousal and reactivity, such as irritability, anger outbursts, difficulty sleeping, and being easily startled. Individuals with PTSD may also struggle with concentration and may become hypervigilant or overly alert to potential threats.
The American Psychiatric Association (APA) added PTSD —  coined in 1980 for severe, trauma-related symptoms among veterans of military engagement — to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM). 

While the recognition was monumentally important then, a strong case can be made to think and talk differently about the condition today. More than 40 years later,  it’s clear that a shift from “disorder” to “injury” is necessary, if not overdue.

Post-Traumatic Stress Disorder (PTSD) is a complex mental health condition that can have various biochemical effects on the body. While I can provide some insights, please keep in mind that our understanding of the precise biochemical mechanisms of PTSD is still evolving. Here are some key biochemical effects and factors associated with PTSD:

PTSD or PTSI has associated biochemical dysfunction as well with the following features.

The technology can now detect physical changes in the brain following post-traumatic stress (PTS), but it was NOT available in 1980. These changes may include alterations in neural connectivity, activation patterns, or even structural changes in specific brain regions.

While it is understood, and even accepted, that terminology and conceptual frameworks within medicine often require time to adapt and incorporate advancements, like the ones mentioned above, the time has come to change the current classification/diagnosis of PTSD to PTSI. The once “invisible“ wounds of brain injury following psychological trauma can now be

1. **Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation:** One of the most well-documented biochemical effects of PTSD is the dysregulation of the HPA axis. This system controls the body's stress response. In individuals with PTSD, there can be alterations in the levels of stress hormones such as cortisol. Some may have elevated cortisol levels, while others may have reduced sensitivity to cortisol.

2. **Neurotransmitter Imbalances:** PTSD has been associated with disruptions in neurotransmitters, which are chemical messengers in the brain. There can be alterations in serotonin, norepinephrine, and dopamine levels. These imbalances can contribute to mood disturbances, anxiety, and other symptoms of PTSD.

3. **Inflammatory Response:** Chronic stress, which is often a part of PTSD, can lead to chronic inflammation in the body. Inflammation is associated with various physical and mental health issues. Elevated levels of inflammatory markers, such as C-reactive protein (CRP), have been observed in some individuals with PTSD.

4. **Alterations in Brain Structure and Function:** Neuroimaging studies have shown that PTSD can lead to changes in the structure and function of the brain. The amygdala, which plays a crucial role in the processing of emotions, can become hyperactive, leading to heightened emotional responses. Conversely, the prefrontal cortex, involved in emotional regulation, may show decreased activity.

5. **Epigenetic Changes:** There is emerging research suggesting that trauma, including that which leads to PTSD, can induce epigenetic changes. These changes can affect gene expression and may be passed down through generations. Epigenetic modifications can play a role in the long-lasting nature of PTSD symptoms.

6. **Sleep Disturbances:** Many individuals with PTSD experience sleep disturbances, which can further exacerbate biochemical imbalances. Sleep disruption can impact neurotransmitter function, stress hormone levels, and overall well-being.

7. **Altered Immune Function:** Prolonged stress associated with PTSD can weaken the immune system, making individuals more susceptible to infections and other health issues.

It's important to note that not all individuals with PTSD will experience the same biochemical effects, and there is significant variability in how PTSD manifests. Additionally, the relationship between biochemical changes and the development or persistence of PTSD is complex and not fully understood.

Treatment for PTSD often involves a combination of psychotherapy, medication (such as antidepressants or anti-anxiety drugs), and lifestyle changes to address these biochemical imbalances and their associated symptoms. Early intervention and a comprehensive approach to treatment are key to helping individuals with PTSD manage their condition and improve their overall well-being. 

 observed in the brains of people diagnosed with post-traumatic stress and, thus, should be considered “injured.”

The efficacy of diagnostic imaging, and the importance of its role in determining treatment for the injured, should not be ignored when considering the effects — and the survivors — of severe trauma. The current model of a “disorder” does not consider the latest, widely accepted neuroscience developments and, thus, renders the “D” in PTSD to be clearly outdated, from a scientific perspective.

The use of brain scans to diagnose PTS has proved inconclusive, yet there is abundant evidence for changes in the structure and function of different areas of the brain involved in fear response and anxiety, regulation of emotions, cognitive processing, and memory. For example, Michael T. Alkire, M.D. — featured in a 60 Minutes segment about the use of SGB to treat PTSD — has demonstrated over-activation of the amygdala in patients with PTS as far back as 2015 in his work for VA Long Beach Healthcare System.

From a scientific perspective, the “D” in PTSD is outdated. Seeing is believing.

Stigma is a barrier to seeking help.

PTSD vs. PTSI — The Arguments for Changing the Name – It's PTSI

Wednesday, September 27, 2023

Costco announces new $29 perk for shoppers after membership - and customers call it 'awesome' | The US Sun

New scam ??

COSTCO announces new $29 perk for shoppers after membership

Costco enters the digital telehealth market by aligning with Sesame, a telehealth network.  Especially interesting is the telehealth mental health perk, for $72.00

You get what you pay for.  Costco has entered a slippery slope, one which will backfire for them and their intended Costco Members.  Costco has a reputation for quality products, such as tires, food, and other specialty items. and exceptional guarantees and this flies in the face of its credibility.  Will COSTCO offer a refund if your are dissatisfied?

This is nothing but a ploy to bring business into the COSTCO PHARMACY, which is an established and credible pharmacy.  Why not get your prescription at COSTCO PHARMACY. After all you are there already.

However, why pay $29 to get the prescription from an unknown person from Sesame who may not even be an M.D. doctor.  Many of Sesame's providers are unsupervised Physician assistants or Nurse practitionersIt's important to note that both PAs and NPs are mid-level medical professionals. They're basically at the same level. However, NPs can work independently in many states that PAs can't. So, it places nurse practitioners above physical assistants in terms of practice independence. 

In order to make an appointment on the Sesame Telehealth Platform, you must enter. your credit card information and add several personal identifying information data. Is Sesame telehealth HIPAA compliant?


Costco announces new $29 perk for shoppers after membership - and customers call it 'awesome' | says  The US Sun, an online newspaper.

Friday, September 22, 2023

Emergency Message System

Motor Vehicle Crashes: A Leading Cause of Death for Children. Of the children who were killed in a crash, 36% were not buckled up. Parents and caregivers can make a lifesaving difference by ensuring that their children are properly buckled on every trip.

Risk Factors for Child Passengers



Restraint use (like car seat, booster seat, or seat belt use) varies by age.

Restraint use typically decreases as children get older.

In a study from 2021 where researchers observed children riding in cars, they found:

<1% of children under age 1 were not buckled up,

6% of children 1–3 years old were not buckled up,

11% of children 4–7 years old were not buckled up, and

13% of children 8–12 years old were not buckled up.3


Being unrestrained in a vehicle increases the risk of being killed in a crash. In a study from 2023 using fatal crash data, researchers found:

30% of 0–3-year-olds killed in crashes were not buckled up and

36%§ of 8–12-year-olds killed in crashes were not buckled up.


Also, among children who are buckled up in child restraints, many graduate too soon to the next stage of child passenger safety. An example is when children stop using a booster seat before the seat belt fits them correctly. Age-appropriate restraint use typically decreases as children get older.

Race and ethnicity

American Indian and Alaska Native children and Black children are more likely to be killed in a crash than White children.

Child passenger death rates were highest among American Indian and Alaska Native children (2.67 per 100,000 population), followed by Black children (1.96), according to combined data from 2015–2019.

Several studies also indicate that it is more common for Black children, Hispanic children and American Indian and Alaska Native children to travel unrestrained or improperly restrained when compared with White children.

21% of Black children, 15% of Hispanic children, and 7% of White children ages 4–7 years were not buckled up, according to a study in 2021 where researchers observed children riding in cars.

There are likely many reasons for these differences, including access to affordable car seats and booster seats and differences in culture and perceptions related to car seat and booster seat use.

Rural versus urban location

Children in rural areas are typically at higher risk of being killed in a crash. According to combined data from 2015–2019:

Child passenger death rates were highest in the most rural counties (4.5 per 100,000 population) and lowest in the most urban counties (0.9).

Death rates among children who were not using age-appropriate restraints were highest in the most rural counties (2.9 per 100,000 population) and lowest in the most urban counties (0.5).

Studies also indicate that children in rural areas are more likely to be incorrectly restrained than children in urban areas.

A multistate study using data from car seat check events found that child restraint misuse was more common in rural locations (91%) than in urban locations (83%).Similar to racial and ethnic disparities, there are likely several factors for these differences.

Alcohol-impaired driving

Alcohol-impaired driving is a major threat to all road users, including child passengers.

In 2021, 25% of deaths among child passengers (ages 14 and younger) involved an alcohol-impaired driver.

Among all child passengers (ages 14 and younger) who were killed in crashes, a higher proportion of those riding with alcohol-impaired drivers were unrestrained (43%) compared with children riding with drivers who had no alcohol in their system (38%).


Driver seat belt use

Restraint use among children is associated with their driver’s seat belt use. In 2021, 69% of child passengers ages 14 and younger killed in crashes who rode with unbuckled drivers were also not buckled up, compared with 26% of children riding with buckled drivers.

Researchers who observed adults and children riding in cars in 2021 found that 95% of children ages 7 and younger who were driven by a buckled driver were restrained, compared with 77% of children driven by an unbuckled driver.

Many other studies assessing different child age groups or specific geographic locations have also found strong associations between unrestrained drivers and unrestrained child passengers.

Car seat and booster seat misuse

Car seats and booster seats are often used incorrectly, which can make them less effective.

Researchers who observed children riding in cars in a 2011 study estimated that 46% of car seats and booster seats are used incorrectly in a way that could reduce their effectiveness.22–24 Car seat misuse estimates are even higher at 59% when booster seats are excluded.



Thursday, September 21, 2023

The average doctor in the U.S. makes $350,000 a year. Why? - The Washington Post

The average doctor in the U.S. makes $350,000 a year. Why? - The Washington Post

Compensium of Unpublished Health Train Express Articles

 These are previously unpublished articles from September 2016 until current (September 22, 2023)

I unknowingly accumulated these drafts during the past years.  Sometimes I will look at them and don't even remember writing them...   Does anyone else have this experience?  Am I brain-damaged?

I will be posting additional memories.  Stay tuned

Giving up the knife: Saying goodbye to surgery

Words from a retiring surgeon.

This year, I stopped doing surgery — giving up the knife, so to speak. It wasn’t an easy decision to make. I’ve been a surgeon for 32 years since graduating from medical school. It’s been a distinct part of who I am for most of my life.

This doesn’t mean I’ve retired. I’m still practicing in a clinic-based setting and still do procedures in the office. I just no longer operate in hospitals or ambulatory surgery centers. And because of this, I no longer must take call for the hospitals and their emergency rooms (which are required to have surgical privileges at a hospital). In the past few years, seeing patients in the office occupied most of my work week anyway.

And yet now, the time spent in the office is less harried and more engaging. I’m more in the moment with the person in front of me, without that overhanging sense of dread that comes with the unknown — an unexpected complication in a post-op patient, a call from one of the ERs, the hospital or the transfer center.

Office encounters have been more rewarding. Besides a patient’s medical problems, I’m more inclined to see their intangible qualities, aspects of their nature that can be intensely interesting or downright humorous.

I do miss the OR. I miss the people in the OR. Though we’ve faced a torrent of scary, pee-in-the-pants situations as any surgical team is bound to face, much of the time was quite pleasant and fun. Yeah, surgery can be a real kick-in-the-pants. That’s the reason I became a surgeon.

I miss some of the more challenging surgeries when actively treating a patient with cancer was the ultimate high of my surgical profession. But I gradually gave up some of the more complicated and lengthy surgeries some years ago. Part of this was the stamina of my youth had dwindled– some of those cases took six to eight or more hours of continuous operating with no break. More importantly, more fellowship-trained surgeons nowadays are sub-specialized with more experience. It was best for the patient to be treated by these folks, even if it meant traveling three or more hours to get there. All the other ENTs in our area have done the same.

I was the sole “old-timer” still in private practice. All the other ENT doctors in our area are employed by a large hospital system with a huge referral base. My surgical volume was far lower than my hospital-employed colleagues, which didn’t bother me since I was getting older. Yet last year, I was the only ENT taking call for all three of our area hospitals. I could’ve been employed by a hospital, earning much more while relinquishing the business of running a practice, but the loss of autonomy wasn’t worth the trade-off.

I wasn’t unhappy about making less than my peers. There was no dire need for more money. What’s the endpoint with money anyway? How much annual income is really enough? My wife and I always budgeted our expenses and were able to save each year while regularly contributing to our kids’ college funds, even during the leanest years. We stuck by a strategic plan for savings and investing and nearly met our financial retirement goals before I decided to stop doing surgery. Our quality of life was not adversely affected. Additional money would not have changed our lifestyle.

Stopping surgery and no longer taking calls from the hospitals was the right thing to do at the right time. I eventually felt the stress evaporate, replaced by an enhanced peace of mind. I see this not as an end but as another stage in life’s journey. But I’m not ready to retire yet.

After giving a lecture earlier this month, a third-year medical student came up to me. He was interested in pursuing ENT, his reasons being a good blend of clinic and surgery — some of the same reasons I chose this calling. He said that aside from tonsillectomies, and nasal and ear procedures, he wasn’t aware we did surgeries such as thyroidectomies, parotidectomies, neck dissections, and the like, which fascinated him even more.

He asked how one gets to that point doing such intricate surgery. I had that same fascination back when I was a lost third-year med student, not knowing what field of medicine to choose. The epiphany came during a series of lectures from a few of the ENT attendings, one of whom was a head and neck surgeon who later became my mentor (Bruce Campbell, MD). Like a slobbering, tail-wagging dog, I approached him and asked the same questions. I chose ENT and never looked back. It has been — and continues to be — a most fascinating and rewarding career.

Saying goodbye to surgery is a pivotal and bittersweet milestone, but I look back at my surgical career with fondness and satisfaction. And despite no longer performing surgery in the OR, I still want to treat patients until I am unable to do so.

Following are a few lines from a speech to the graduating class of residents I was asked to give this year, which speaks to this very point:

At this stage in my career, I still want to keep going. I still think of medicine as an adventure. I still find joy in our profession. I still learn; I learn from all of you. It’s been 27 years since I finished my residency, and I reflect back with a sense of satisfaction and pride and no regrets. Though I look forward to one day retiring, I’m hesitant to do so since what we do is so meaningful, absorbing, and worthwhile that I don’t want my professional journey to end. That’s by choice. Being a doctor is a part of who I am, embedded in my DNA. And hopefully, it is with you.

#259 - Women's sexual health: Why it matters, what can go wrong, and how to fix it | Sharon Parish, M.D. - Peter Attia

Women’s sexual health: Why it matters, what can go wrong, and how to fix it | Sharon Parish, M.D.

We discuss:

Sharon’s interest in sexual medicine and the current state of the field [3:00];

How hormones change in women over time and how that impacts sexual function [8:15];

Changes after childbirth and its impact on sexual function [11:00];

The role of metabolic health and systemic vascular health in sexual health [20:15];

Conditions associated with decreased sexual function and the importance of sexual health for overall well-being [26:15];

Sexual dysfunction case study #1: A 41-year-old mother of two, the sexual response cycle, and the difference between arousal and desire [38:45];

Medications that may reduce sexual desire [49:45];

The effect of birth control pills on sexual desire [56:30];

The importance of testosterone in women for sexual function and desire, and why the FDA hasn’t approved exogenous testosterone as a therapeutic [1:01:15];

Challenges faced by physicians who are open to prescribing off-label testosterone for women, and Sharon’s approach in managing this aspect with her patients [1:14:30];

A hypothetical treatment plan for the patient in case study #1 [1:26:45];

The role of DHEA (a precursor to testosterone) in female sexual health [1:32:15];

Case study #2: A 30-year-old woman with anorgasmia (inability to orgasm) [1:38:30];

Resources for helping women and their partners to enhance the pleasure experienced during sex, overcome anxiety, and increase desire [1:51:30];

Two drugs for premenopausal women with low desire [1:59:30];

Why treatments are potentially underutilized for both desire and genitourinary syndrome of menopause [2:13:15];

Case study #3: A menopausal woman with symptoms [2:19:00];

Addressing the misguided fears around hormone replacement therapy and cancer [2:24:15];

Symptoms and treatment of genitourinary syndrome of menopause [2:32:45];

Age 65 and beyond, and resources for finding a provider [2:37:30]; and


Journal of Medical Internet Research - Virtual Reality Treatment for Chronic Low Back Pain

Virtual Reality treatment in hospitals and at home is gaining traction. Patients and providers agree this is an option for treating acute or chronic pain reducing the need for opioids.

Journal of Medical Internet Research - An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19

Josh Sackman, president, and co-founder of AppliedVR, discusses the new Healthcare Common Procedure Coding System (HCPSC) Level II code for the company's product RelieVRx.

CVS recieves stern warning from FDA


Established in 1927 as a reorganization of President Roosevelt’s pre-existing Pure Food and Drug Act of 1906 (also known as the “Wiley Act” in deference to its tireless advocate, chief chemist of the US Department of Agriculture, Harvey Washington Wiley), the US Food and Drug Administration (FDA) continues to regulate food and drugs made domestically in, or being imported into, the States.
In terms of ophthalmic medicines – by their very nature a drug class commonly administered in a way that bypasses some of the body’s natural defenses – the FDA acts as a crucial gatekeeper – “protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices.”
The FDA has now focused its attention on eight companies – CVS Health, Natural Ophthalmics, Similasan, TRP Company, DR Vitamin Solutions, OcluMed, Boiron, and Walgreens Boots Alliance – for “manufacturing or marketing unapproved ophthalmic drug products in violation of federal law.” The warning letters, sent out on September 11, 2023, relate to an assortment of eye-related, over-the-counter products for a variety of ophthalmic conditions, including cataracts (Cataract Eye Drops with Cineraria), glaucoma (Life Extension Brite Eyes III), dry eye disease (Optique 1 Eye Drops), and conjunctivitis (Pink Eye Relief Eye Drops). 

 Some of the products under the FDA spotlight, such as CVS Health Pink Eye Relief Drops, Similasan Dry Eye Relief, and Walgreens’ Stye Eye Drops, “are labeled to contain” silver as a preservative. The long-term use of silver can cause toxic levels of deposits to build up in the body, eventually leading to argyria – a condition where the skin and other body tissues – including the eye – permanently turn a gray or blue-gray metallic color. And though it’s considered a benign condition, the symptoms of argyria can often be irreversible.  
Some of the companies on the receiving end of the FDA’s warnings have reacted swiftly; for example, CVS stopped the sale of its conjunctivitis eye drops, offering full refunds for consumers who’ve already bought them – others have yet to respond. 

If these companies fail to respond within 15 days of receipt of the letters, the FDA may decide to take legal action, which includes potential product seizure, as well as getting court orders in place to stop the companies from manufacturing and distributing these medications. 

These are OTC medications, which the FDA does not regularly examine unless they have been shown to produce significant side effects. 

Although these products are 'eye products' Does this signal an awakening of the FDA to many products that are sold OTC with little to no regulation?