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Dr. Mashburn Interview on WSIC Radio

Mashburn

Dr Mashburn on WISC Radio Interview

 

Listen to Dr. Lindsey Mashburn interview on WSIC Radio about the business model of her practice, the challenges doctor’s face in the healthcare industry, and the medical and cosmetic services offered at Southlake Womens Healthcare.

She talks about what made her decide to become a doctor and why she chose to focus on womens health. She also talks about how having her own practice allows her to provide more personalized patient care.

Play audio below to listen to Dr. Mashburn on WISC radio interview.

Flu Widening Its Grip on the United States: CDC

FRIDAY, Jan. 4, 2019 (HealthDay News) — The flu is now spreading throughout the United States, health officials said Friday.

Since last week, when nine states and New York City were reporting high flu activity, 19 states and New York City are now seeing a lot of flu, and it’s widespread in 24 states, according to the U.S. Centers for Disease Control and Prevention.

“The season is really starting to pick up,” said Lynnette Brammer, the lead of CDC’s domestic influenza surveillance team.

The most common type of flu around is the influenza A strain H1N1. That strain has been circulating and was pandemic in 2009 and in 1918.

In 1918, H1N1 flu killed 50 million people around the world. But the current vaccine works exceedingly well against H1N1 — it is up to 65 percent effective, which is highly effective for a flu vaccine, according to the CDC.

“H1N1 is the most common [strain] in most of the country,” Brammer said. “But it’s odd that in the Southeast, the H3N2 virus is more common.”

The influenza A H3N2 strain is the one that made last year’s flu season so severe. When that strain predominated, nearly 1 million Americans were hospitalized and 80,000 died.

According to the CDC, flu activity is high in Alabama, Arizona, Colorado, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Mississippi, Nevada, New Jersey, New Mexico, Oklahoma, South Carolina, Texas, Utah and Virginia.

It’s too early to tell how severe this season will be or what the mix of viruses will be, Brammer said. Right now, the hospitalization rate is still relatively low compared with last year, and deaths are still below epidemic levels, she said.

“But as we see a jump in activity as we did this week, we would expect an increase in hospitalizations, and unfortunately, probably an increase in mortality,” Brammer said.

The CDC doesn’t track adult deaths from flu, but they do keep tabs on pediatric deaths. This week two more children have died from flu, bringing the total to 13.

“There’s still a lot more flu season to come,” she said. “I expect activity to continue for several more weeks.”

The best way to protect yourself and those around you is to get a flu shot, and there’s still plenty of time to get vaccinated, Brammer said.

“Anybody who hasn’t been vaccinated should go and get vaccinated,” she said. This year’s vaccine is well matched to the circulating strains of flu and a lot of vaccine is available, Brammer added.

The CDC recommends that everyone 6 months and older get vaccinated. Getting your kids their flu shot is the best way to protect them and prevent deaths from the complications of flu, she said.

Getting a flu shot should be at the top of the list for those at high risk for flu, including the elderly and people with heart disease or lung disease and pregnant women.

Getting vaccinated won’t guarantee that you won’t come down with flu, but if you do, your illness will be milder, health experts say.

If you get the flu, antiviral drugs such as Tamiflu and Relenza can make your illness less severe. But if you’re sick, the CDC recommends that you stay home so you won’t infect others.

Brammer can’t predict when the flu season will peak, but it most likely won’t be until the end of February or March. So there’s still a long way to go, she said.

More information

For more on the flu, visit the U.S. Centers for Disease Control and Prevention.

As You Age, Alcohol May Be Harder to Handle

FRIDAY, Jan. 4, 2019 (HealthDay News) — Seniors may be more vulnerable to alcoholism, a psychologist warns.

“As we age, it takes longer for the body to break down alcohol. It stays in the system longer. Tolerance also decreases. Excessive drinking can compromise your immune system and can lead to some forms of cancer,” said Brad Lander, an addiction medicine specialist at Ohio State University Wexner Medical Center.

As you age, your drinking habits may change. Social drinking when you’re young may turn to drinking to relieve boredom, loneliness and grief, which are common with aging. The risk of becoming an alcoholic is greater for women than men, Lander noted.

Also, according to the U.S. National Institute on Alcohol Abuse and Alcoholism, even after you stop drinking, alcohol continues to enter the bloodstream, resulting in impaired judgment and coordination for hours.

“It also can decrease the effectiveness of some medications and highly accelerate others, including over-the-counter medications such as aspirin, acetaminophen, sleeping pills and others,” Lander added in a center news release.

Alcohol abuse can also cause problems with balance and reaction times, increasing the chances of accidents and falls.

Moreover, alcohol can worsen health problems such as diabetes, high blood pressure, stroke, osteoporosis and liver disease.

Excessive drinking can also increase the odds of dementia, depression, suicide and impaired sexual functioning, Lander said.

However, the differences between safe, moderate and heavy drinking is different for everyone.

“But the general rule of thumb is to take a close look and honestly assess if drinking is causing any life problems. If it’s causing difficulties with your health, relationships, daily functioning or emotions, then it’s too much,” Lander said.

The average senior should drink no more than seven drinks in a week and no more than three drinks in one day.

Research has shown that only about 2 percent of people who drink within these limits develop an alcohol problem, Lander explained.

He recommends that seniors drink in moderation at social gatherings and eat to slow the absorption of alcohol and lower the peak level of alcohol in the body.

“A lot of drinking is ‘thoughtless,’ so simply ask yourself, ‘Do I really want a [or another] drink?’ Remember, you don’t have to drink,” Lander said.

More information

The U.S. National Institute on Alcohol Abuse and Alcoholism has more on alcohol abuse.

Study Eases Concern That Common Diabetes Med Might Harm Bones

THURSDAY, Jan. 3, 2019 (HealthDay News) — If you have type 2 diabetes and you’re taking canagliflozin to help control your blood sugar, a new study has some good news for you: The drug doesn’t appear to raise the risk of bone fractures.

Previously, research had suggested this might be the case.

“We were interested in doing this study because there was one randomized trial that said there was an increased risk of bone fractures and another that said there wasn’t. So, we conducted a real-world study with almost 200,000 people with type 2 diabetes,” said study author Dr. Michael Fralick.

“I hope these findings are reassuring to patients and physicians because these are blockbuster medications for type 2 diabetes. This class of medicines can improve blood sugar levels and help reduce heart disease risk,” he said. Fralick is from the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital in Boston, and a general internist at the University of Toronto.

Canagliflozin (Invokana, Invokamet) is one drug in a class of medications called SGLT-2 inhibitors. Other drugs in this class include dapagliflozin (Farxiga) and empagliflozin (Jardiance).

These drugs cause the kidneys to remove excess sugar from the blood and excrete it through urine, which lowers blood sugar levels, according to the U.S. Food and Drug Administration. This class of drugs has been linked to a number of complications, including kidney injury and serious genital infections.

Fralick said one way these drugs could potentially increase fracture risk is by lowering bone mineral density.

Dr. William Leslie, author of an editorial accompanying the study, suggested that dehydration may be another way these drugs might be linked to fracture risk. Leslie is a professor of medicine and radiology at the University of Manitoba in Canada.

For the new report, Fralick and his team reviewed data from two U.S. commercial health care databases. They found information on about 200,000 people with type 2 diabetes who were just starting to take one of two different type 2 diabetes medications — canagliflozin or a medication in a class of drugs called GLP-1 agonists, which includes Victoza, Trulicity and Byetta. These drugs haven’t been linked to an increased risk of fractures.

The researchers looked for fractures in the upper and lower arms, as well as the hips and pelvis.

In the end, the study team compared approximately 80,000 people on canagliflozin to about 80,000 treated with GLP-1 agonists. The patients’ average age was 55, and about 48 percent were female.

The study showed a similar risk of fractures in these low-risk, middle-aged populations.

Both Fralick and Leslie said the jury is still out for people who are at a higher risk of fractures, such as elderly people.

This study is “a relatively low-risk population. But, it begs the question, what about higher-risk populations? We need additional safety data,” Leslie said.

The U.S. Food and Drug Administration currently requires canagliflozin labels to carry a warning about the potential fracture risk, and Fralick said it may be too soon to change the labeling, particularly for people at high risk. Both experts said more research is needed.

In the meantime, if you’re concerned about taking canagliflozin, Fralick recommended having a conversation with your health care provider. But, he added, “For people without a high baseline risk, the risk of fracture is very small and the clear benefits to SGLT-2s outweigh that potential risk.”

The findings were published online Jan. 1 in the Annals of Internal Medicine.

More information

Learn more about oral diabetes medications from the American Diabetes Association.

AHA: Lifestyle Changes Helped New Dad Shed Nearly 50 Pounds

THURSDAY, Jan. 3, 2019 (American Heart Association) — It happens every January. Gyms fill with people who’ve committed to New Year’s resolutions involving health and fitness. While making a resolution is an important first step, developing new habits is the key to long-term success, said Erik Minaya, who has maintained significant weight loss for several years.

Minaya started to put on the pounds during his freshman year in college. His body mass index continued to creep up throughout his college years and beyond, as he began working at a stressful job with a one-hour commute each way. By age 24, he tipped the scale at nearly 265 pounds.

“The bad habits compounded over the years,” said the 30-year-old from Michigan.

Sugary drinks and fast food were his biggest vices. Drive-in dinners were easier and cheaper than healthy options, and the jolt of sugar and fat temporarily alleviated some of the stress after working at a job he didn’t enjoy. By 2 p.m. nearly every afternoon, Minaya would crash.

“I wasn’t motivated to do much,” he said. “And good luck getting me to go out and do anything physical.”

Minaya’s family has a history of elevated blood pressure and cholesterol, and diabetes. Worried that he was headed down the same path, Minaya made drastic lifestyle changes in 2013.

He cut out fast food, replacing it with lower-carb offerings that he prepared himself. He swapped regular soda for diet; a few months later, he switched to water.

“It wasn’t a crash diet,” Minaya said. “I was trying to make actual life changes.”

People should limit their intake of added sugars to no more than half of their daily “discretionary calories,” suggests the American Heart Association. For most men, that figure is 150 calories per day; for most women, it’s 100 calories. But one 12-ounce can of most sugary sodas will typically contain about 150 calories, and some have even more.

The changes Minaya made had an almost immediate impact.

He lost 15 pounds during the first year. And after accepting a new job with a shorter commute and an onsite gym, he lost 15 more pounds. Since then, he has continued to lose weight more slowly – nearly 50 pounds total so far. He has more energy and focus.

“I have an almost heightened sense of awareness,” he said.

Minaya recently finished a 5K run (3.1 miles) in less than 30 minutes “which is slow for me,” he said. He also lifts weights and plays golf, tennis and soccer. He persuaded his company, Delta Dental of Michigan, to put up a basketball hoop in the parking lot.

“It’s good to have a goal and go for it,” Minaya said. “I like being driven to achieve something.”

Minaya is not shy about sharing his experience. He recently encouraged a friend to adopt the same diet, which led the friend to lose 30 pounds. He also told his story at an event hosted by Delta Dental, the AHA and the Grand Rapids Children’s Museum as a part of the Rethink Your Drink campaign.

With a newborn at home, Minaya said he has succumbed to old temptations and put on a few pounds, but he is determined to get back on track, not only for his sake but also for the sake of his daughter, Elsie.

“My wife, Jamie, and I want to make better choices for her sake,” he said. “I’ll never have six-pack abs, but what I care about is good health.”

Snacking for Diet Success

THURSDAY, Jan. 3, 2019 (HealthDay News) — Restrictive diets are hard to stick with, especially when you must eliminate most of your favorite foods.

Research has also found that cutting out a particular food can cause cravings and may lead to overindulgence — and weight regain — when you allow yourself to enjoy it again.

Since permanent weight loss really involves a forever approach, learning how to work in your favorites, especially sweets, is a must even during the weight-loss phase.

Penn State University researchers set out to test whether purposefully including a favorite snack in a diet could help people stick with their eating plan and achieve weight loss success. They conducted a small study in which all the participants followed a low-calorie, high-nutrient diet of whole grains, vegetables, fruits, non-fat milk and lean protein with a small number of daily calories going to a sweet treat.

For one group of participants the treat was one small square of chocolate twice a day plus a sugar-free cocoa drink. For the other group, the treat was red licorice, plus the cocoa drink.

After 18 weeks, both groups lost inches and pounds, with the chocolate group achieving slightly better results. The researchers also found that participants didn’t overindulge in their treats — they kept within the overall calorie-range of their diet — and that the snacks kept cravings under control.

To try this approach on your own, you must practice portion control. Make sure most of your intake is from nutrient-rich foods. And allot no more than 150 calories a day to your preferred snack — that’s about one ounce of dark chocolate.

More information

You can search for the calorie counts of more than 1,000 types of chocolate on the website of the U.S. Department of Agriculture.

New Cholesterol Drug's High Price May Not Be Worth It: Study

WEDNESDAY, Jan. 2, 2019 (HealthDay News) — Despite being slashed by half in recent months, the price tag for advanced cholesterol-fighting drugs is still too high to make them cost-effective, a new analysis has concluded.

In March, the manufacturer of alirocumab (Praluent) announced that it would cut the cost of the medication from $14,000 a year to $7,000.

But the price would have to fall even more, to around $900 to $2,000 a year, to make it as cost-effective as cholesterol-lowering drugs that have been around far longer, researchers reported.

“We do think these drugs are useful to patients, and cost is a major barrier to access at this point,” said lead researcher Dr. Dhruv Kazi. He is associate director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center in Boston.

“Perhaps the right thing here is to acknowledge the efforts the manufacturers have made to respond to these pricing pressures,” Kazi said. “But I don’t think we’re there yet.”

The pricing dilemma stems from the fact that there already are very cheap and very effective cholesterol-lowering drugs on the market, Kazi said. Statins and ezetimibe both are available in generic form, and have years of safety and effectiveness data behind them.

“Your additional drugs have to work harder to be cost-effective,” Kazi said.

Praluent belongs to a new class of drugs called PCSK9 inhibitors. They work by boosting the liver’s ability to remove cholesterol from the bloodstream. The U.S. Food and Drug Administration approved Praluent in July 2015; a second drug in this class, evolocumab (Repatha), received approval in December 2017.

Regeneron Pharmaceuticals, maker of Praluent, said in a statement that it disagrees with the new cost analysis.

The company argues that researchers did not take into account clinical trial results showing the drug’s ability to ward off deaths and reduce cholesterol levels in hard-to-treat heart patients.

The American Heart Association acknowledged the usefulness of PCSK9 inhibitors in new cholesterol guidelines it released in November. The new guidelines recommend that the drugs be used alongside statins for certain high-risk heart patients who are having trouble lowering their levels.

But doctors and patients are still struggling to access these new drugs, and cost is the barrier, said Dr. Suzanne Steinbaum, director of Women’s Cardiovascular Prevention, Health and Wellness at Mount Sinai Hospital in New York City.

“I can’t get these medications covered by insurance. There are these amazing tools out there to help us, but unless we figure out insurance coverage and cost, it’s irrelevant,” Steinbaum said.

Kazi’s team did a cost-effectiveness analysis on Praluent based on results from the latest clinical trial of the drug, known as the ODYSSEY Outcomes trial.

The researchers said that its price would have to be reduced by 86 percent to be considered cost-effective for treating “bad” LDL cholesterol.

That amounts to an annual price tag of $874 to $2,311, depending on the drug regimen against which Praluent is being compared, the study authors concluded.

Such a cost cut would be “unprecedented” for biologic therapies in the U.S. market, they noted.

Results of this analysis were announced in March with release of the ODYSSEY trial results, prompting the subsequent price cut by Regeneron.

“We’re excited that having done this analysis in a timely manner might have contributed to this price reduction,” Kazi said.

Regeneron said its own analysis concluded that Praluent is cost-effective at a yearly price range of $6,319 to $9,346 for people with serious heart problems, and at $13,357 to $19,805 a year for heart patients whose cholesterol resists treatment by other medications.

“These results are well within the current price range paid for Praluent in the U.S., and aligned to our March announcement to lower the Praluent U.S. net price to between $4,500 and $8,000 to payers who would allow for more straightforward, affordable patient access,” the company’s statement said.

Ultimately, the market will decide whether the price is low enough, Kazi said.

“It’s important to measure how patients and doctors respond to these pricing changes,” Kazi added. “Are patients actually able to get the drug? Are they able to take the drug in the long run? Because it’s not helpful if people start the drug and then stop it because it’s expensive or out-of-pocket costs are too high.”

The analysis was published online Jan. 1 in the Annals of Internal Medicine.

More information

The American Heart Association has more about cholesterol.

AHA: The Pros and Cons of Weighing Yourself Every Day

WEDNESDAY, Jan. 2, 2019 (American Heart Association) — This is the year
you’ve vowed to lose weight. You step on the scale to mark the starting point
toward your goal.

Now how often should you hop back on to check your progress?

The answer isn’t always so simple. Perhaps every day, perhaps every week,
with the qualifier that the scale isn’t the only way to gauge whether you’re
headed in the right direction.

“Our philosophy here is that no one size fits all,” said Meridan Zerner, a
dietitian, nutritionist and wellness coach at Cooper Clinic in Dallas. “The
majority of research would say weigh daily. But if there’s any negative fallout from weighing every day in terms of outlook, self-esteem or your positive momentum, I would say we can check in once or twice a week.”

A study presented at the American Heart Association’s recent Scientific
Sessions conference concluded that daily weigh-ins might be beneficial. Researchers tracked 1,042 adults over a year and found that people who weighed themselves once a week or less did not lose weight, while people who weighed themselves six or seven times a week averaged a 1.7 percent weight loss.

“That’s an action we call self-monitoring, which is an evidence-based
strategy that we use with all kinds of behavior change,” said Amy Walters, a
psychologist and director of behavioral services at St. Luke’s Health System
Humphreys Diabetes Center in Boise, Idaho. “Tracking your behavior gives people some accountability, it can create some natural feedback, and it can serve as a source of motivation. They see, ‘Gosh, if I really follow my plan, I start to see some changes.'”

But there can be drawbacks to spending too much time on that scale.

“You can get obsessive about it,” Walters said. “We want to focus on trends and not get hung up on today’s number. Weighing daily may be distressing if you don’t see the scale change, or have a negative impact on motivation.”

Dr. Pamela Peeke, a Maryland-based physician who has written four books on
healthy living and weight loss, concurred.

“Keeping tabs on your progress is important to help achieve your weight loss goals,” said Peeke, who chairs the Science Advisory Board for the Jenny Craig weight loss centers. However, she added, “If daily weighing causes you more anxiety than motivation, then it’s not right for you.”

Several factors can affect anxiety and motivation. Different scales can yield different results at different times of day, which is why experts recommend using the same scale at the same time. “First thing in the morning is the best,” Zerner said.

Even on the same scale, Walters said, “your weight can fluctuate because of different things: your fluid intake, your hormone levels, your activity level. We don’t want to get too hung up on the number.”

That number, Zerner said, isn’t always a true indication of progress. “If somebody loses a pound of fat and gains a pound of muscle, that’s two full pounds of change and that’s meaningful,” she said.

Nor is the scale the only measure of success.

“How’s your energy level?” Walters said. “How are you feeling physically? Are your clothes fitting better? Are you sleeping well? There are other biometrics like blood pressure or blood glucose levels, besides just your weight.”

Zerner advises her clients to also monitor their body fat percentage and
waist measurement. Men are advised to have a waist circumference the distance around the natural waist of less than 40 inches, while women should aim for a waist that measures less than 35 inches.

“(The scale is) just one of many tools,” Zerner said. “But it’s giving you feedback, awareness, accountability and just being mindful of how your body is doing.”

What's the Best Diet for 2019? Experts Weigh In

WEDNESDAY, Jan. 2, 2019 (HealthDay News) — For many, the start of the new year signals the start of a new diet. But what’s the best way to eat if you want to lose weight?

For overall healthy eating, the best diet plan is the Mediterranean diet, according to U.S. News & World Report’s annual diet review. The DASH (Dietary Approaches to Stop Hypertension) diet was ranked second on the magazine’s overall Best Diets 2019 list, followed by the Flexitarian plan. All three plans focus on eating a mostly plant-based diet (veggies, fruits and whole grains), healthy fats and lean protein sources.

“I hope these rankings steer people in the direction of doing something healthful,” said nutritionist Samantha Heller of NYU Langone Health in New York City.

“I wish though, that we weren’t so obsessed with weight loss and diets, per se. I wish the focus was on adopting a healthy lifestyle, like eating a more plant-based diet, getting regular exercise, getting enough sleep and managing stress, all of which help us live a better quality of life,” Heller said.

To that end, she said the top three diets are all similar in their food content, and all can be healthy eating regimens.

The Mediterranean diet has been linked to increased longevity and a decreased risk of chronic illnesses, the report said. The Mediterranean diet was also ranked high in multiple categories including: Easiest Diets to Follow, Best Diets for Healthy Eating, Best Diets for Diabetes, and Best Diets for Hearth Health.

If weight loss is part of your plans, here are plans that topped the rankings for the best weight-loss plans:

  • WW (Weight Watchers)
  • Volumetrics
  • Flexitarian diet (tie)
  • Jenny Craig (tie)
  • Vegan diet (tie)

Feel the need to knock off some pounds quickly? Here are the best fast weight-loss plans:

  • HMR program
  • Atkins (tie)
  • Keto diet (tie)
  • Optavia (tie)
  • WW (Weight Watchers) (tie)

Heller said that many people feel that they need to “kickstart” their weight loss for motivation. The problem with plans that focus on fast weight loss, however, is that they don’t teach you how to eat well every day.

“On these types of diets, you often don’t learn how to manage holidays, stressful days or special occasions. You don’t develop strategies for life,” she said.

The easiest diets to follow include the Mediterranean diet, the Flexitarian diet and WW (Weight Watchers).

The magazine asked a panel of nutrition experts to review 41 diet plans. Like Heller, the expert panelists emphasized the importance of well-balanced, sustainable diets that aren’t overly restrictive. These types of diets can help teach lifelong positive eating habits.

Lifestyle diets, such as the Mayo Clinic diet and MIND diet, are healthier and more sustainable than weight-loss plans such as the Ketogenic or Atkins diet are, the panelists concluded.

Although the popular Keto diet ranked high for fast weight loss, it landed way down on the Best Diets list — tying for number 38. Other diets at the bottom of the list included the Dukan diet, the Body Reset Diet and the Whole30 diet.

“I think that diets that don’t differentiate between healthy and unhealthy fats, over time are ultimately an unhealthy approach to losing weight,” Heller said.

But the diet topping any list isn’t necessarily the best diet for you. Choosing a diet is a “very individual thing,” Heller noted, adding that you have to find a diet plan that works well for you. And, hopefully one that teaches you to eat healthy for life.

More information

Learn more about the U.S. News & World Report’s best diet rankings.

Alcohol May Be Sabotaging Your Diet

MONDAY, Dec. 31, 2018 (HealthDay News) — Alcohol.

It’s a fixture at New Year’s parties, but it’s also is a calorie guzzler — one drink can eat up 10 percent or more of a dieter’s daily allotment, depending on how fanciful the beverage is.

And there are other ways booze can undermine your wellness efforts. The calories in every gram of alcohol have no nutritional value, so you’re also missing out on the vitamins and minerals you get from food calories.

What’s more, heavy drinking can affect your metabolism and lead your body to store fat, hampering muscle development, the American Council on Exercise reports.

Despite its initial feel-good effect, alcohol is actually a depressant, negatively affecting brain function, balance and hand-eye coordination. It can leave you feeling sluggish while ramping up your appetite, causing you to eat hundreds of unwanted calories, often unhealthful “bar food.”

But the news isn’t all bad. As with most consumption, it comes down to moderation — that’s a max of one drink a day for women and two for men.

To avoid overdoing it on booze:

  • Know the standard drink sizes so you can account for the correct number of calories.
  • Never drink on an empty stomach — food helps to slow down alcohol’s effects.
  • Have a sip of water between sips of alcohol to make the drink last longer.
  • Set daily and weekly goals for consumption, and record drinks just as you do meals in a food journal.

More information

Are you in the safe “sweet spot” when it comes to booze? For a reality check, use the alcohol calculator at the U.S. National Institutes of Health website to see how many calories you’re drinking every week.