Medical Assistant

Concussions Clarified


There are currently 40 definitions of concussion. No wonder it is difficult to diagnose and manage head injuries in clinical and research settings.

The Congress of Neurological Surgeons has published evidence-based concussion guidelines. There are four “prevalence indicators” of concussion:

  1. observed and documented disorientation or confusion immediately after the event
  2. impaired balance within one day after injury
  3. slower reaction time within two days after injury
  4. impaired verbal learning and memory within two days after injury


Stress: Don’t let it make you sick


New research reveals the links between stress and disease.

1. Common cold: in a study, those experiencing chronic stress exposed to a cold virus were cortisol resistant and more likely to get sick.

2. Weight gain: stress hormones stimulate a preference for foods that are full of sugar, starch and fat. New studies show that the link between stress and weight gain is more complex. In addition to triggering changes in metabolism, the stress response produces a rise in insulin levels and a fall in fat oxidation, a dual process that promotes fat storage. Other research has revealed a correlation between excess cortisol and abdominal fat.

3. Slower healing: excess cortisol slows wound healing and lowers vaccines’ effectiveness in older people who are caring for sick family members. This study showed that for those caring for relatives with dementia took about 10 days longer to heal than a non caregiver; the longer the stress goes on, the longer the immune system is disrupted.

4. Sleep dysfunction: older adults already experience a natural decrease in the amount of deep sleep and an increase in nighttime wakefulness. Stress  may aggravate these sleep deficits, making it especially hard for older people to get back to sleep when they wake up at night. To compound the problem, people with troubled sleep may find it harder to handle the stress in their lives.

5. Heart disease: blood samples taken from those enduring high levels of stress contained a surplus of disease-fightin white blood cells. Previous research suggesting that cortisol actually changes the texture of WBCs, encouraging the cells to attach themselves to blood vessel walls was confirmed. The result is plaque which is a key marker of this disease.

6. Depression: stress throws several brain neurotransmitters systems like serotonin, dopamine and norepinephrine out of balance, negatively affecting mood, appetite, sleep and libido. Some severely depressed people have permanently elevated cortisol levels which can alter the hippocampus and permanently damage brain cells.

7. Ulcers and stomach problems: stress can be a critical factor in irritable bowel syndrome, indigestion, heartburn, ulcerative colitis and Crohn’s disease which is characterized by chronic inflammation.

8. Back, neck and shoulder pain: stress can intensify both the severity and duration of the pain

November 2013



In August, the FDA approved the first DNA test used to screen individuals who are at an average risk for colon cancer.

Cologuard reportedly finds 92% of all colon cancers, is noninvasive, requires no change in diet or medication and can be done in the privacy of your own home.

Cologuard is a test from Exact Sciences who partnered with the Mayo Clinic for the clinical trials. This test is the first to be approved by the FDA and by CMS (Centers for Medicare and Medicaid Services) simultaneously. CMS plans to cover the new test once every three years for people ages 50 to 85 who have a normal risk of developing colon cancer. The coverage proposal is not yet final. At this time, no other insurance plans cover this test.

colon cancer screening tests

Entira Family Clinics November 2014November 2014 Volume 2 Issue 3        , Issue 3

Study: Eye color may affect pain tolerance


Pain is the main motivator for a visit to the hospital. New research has shown women with dark (brown and hazel) eyes respond differently to pain than those with light (blue and green) eyes. The study consisted of 58 healthy pregnant women. 24 were placed in the dark group and 34 were placed in the light group.  Responses to pain before and after birth were measured through a variety of quantitative standard testing, questionnaires and surveys. The results indicated women in the dark group experienced more dramatic response to pain with increases in anxiety and sleep disturbances than those in the light group. Identifying eye color as a genetic biomarker for pain thresholds may be advantageous for the medical community.

The goal is to use the study data to help identify those patients who need to be treated for pain post op and those that are in need of chronic pain control.

Multiple studies have correlated red hair to resistance to pain blockers and requirements for higher doses of anesthesia. Further research is planned to expand this study to men and children.

by Campbell North Pittsburgh Post-Gazette 8/10/14

A half-dozen reasons why you can’t beat eggs


1. Did you know that eggs have 6 grams of high quality protein? And did you a protein packed breakfast helps sustain mental and physical energy throughout the day?

2. Eggs are rich in choline which promotes normal cell activity, liver function and the transportation of nutrients throughout the body.

3. Eggs contain zero carbs and no sugar.

4. Eggs have 9 amino acids and these are essential (luceine, lysine, methionine, tryptophan, phenylalanine, histidine, valine, threonine and isoleucine).

5. Eggs contain one ingredient and at 15¢ a serving eggs are the least expensive source of high quality protein.

6. Eggs are naturally gluten-free

New formula for baby formula


The FDA announced the finalization of a rule that sets standards for infant formula manufacturers that will go into effect on September 8, 2014.

Pathogens testing is required for harmful pathogens Salmonella and Cronobacter.

Physician growth support- manufacturers must demonstrate that the formula supports this.

Nutrient check- infant formulas must be tested for nutrient content in the final product stage.

CMA Today Sept-Oct 2014

Red wine caught red-handed

red wine

Heartbreaking news: The time has come to redefine our relationship with dark chocolate and red wine. The antioxidant, resveratrol, which is found in these products as well as red grapes, has no measurable impact on health according to  Hopkins University School of Medicine and NIH. Previously the antioxidant was thought to help safeguard against inflammation, cardiovascular disease and cancer but there is not enough creditable evidence to support this.

CMA Today Sep-Oct 2014

Medicare revises hospice drug rules

45% of Americans age 5 and older are covered by Medicare.

Medicare has backed away from a new rule that required hospice patients to seek prior approval for all their prescription drugs. The rule was intended to clarify whether each medication should be covered under either the hospice benefit or Medicare’s Part D drug program. But the policy places undue burden on hospice patients as they need to navigate payer disputes. Under current Medicare aw, hospice patients voluntarily stop taking drugs meant to treat their terminal illness. If they want drugs to alleviate symptoms of that illness (pain) the hospice organization is supposed to pay for them out of funds provided by Medicare. Drugs for other conditions unrelated to the terminal illness are covered by the patient’s Part D drug plan. Under the new rule, patients would have been denied coverage for each prescription until they or their doctors had contacted their Part D plan to confirm the drug’s purpose.

In modifying its policy, Medicare now requires prior approval for only four groups of drugs: analgesics, antiemetics, laxatives and anti anxiety drugs. These are typically covered as palliative care under the hospice benefit.

AARP Bulletin/Real Possibilities September 2014

The supersized problem of malnutrition in the US


People who are overweight or obese can suffer from a lack of essential nutrients just as a thin person might. Eating disorders represent another facet of  malnutrition. The foods we eat or do not eat directly affect health. Malnutrition may be a hidden cause underlying medical conditions.

USDA indicates 10 states with rates of food insecurity above the national average of 14.7% including a swath of southern states. Rates of food insecurity are significantly higher in low income households, households with children headed by a single parent, back, non-Hispanic households and households with children headed by a single man.

Many of the same regions and populations that have higher rates of food insecurity and hunger also face the threat of overweight and obesity. People can be overnourished in calories but undernourished in vitamins and minerals. Poor vitamin D status, calcium. folate, iron and B12 and lack of Iodine are other concerns.

To ensure proper nutrition and balance of both macro- and micronutrients, the USDA recommends increased intake of vegetables, fruits, whole grains, fat free or low fat milk and milk products, seafood and healthful oils.

There are a number of signs that may indicate malnutrition. Children need to be continually assessed for linear growth. Unintentional weight loss is a concern particularly if 5% weight loss over a month occurs. Protein-energy malnutrition can be assessed with a recent diet intake history. Blood tests can check for micronutrient deficiencies and anemia. Hair, nails and skin should be assessed for signs of dehydration.

Lifestyle changes such as divorce, death of a spouse, or children leaving home can precipitate unhealthy dietary changes that could lead to malnutrition.  Elderly adults who are living alone may not be cooking for themselves or have a loss of appetite.

In many ways, malnutrition is an issue that goes beyond the provider-patient relationship.The condition has risen to the level of a societal concern. Regardless of body sizes, nutrients that are needed should be taken in. The challenge is to make healthy food convenient and affordable and really tasty while helping people make healthy choices.

CMA Today Sept-Oct 2014


Is your lamp keeping you awake?


Exposure to too much indoor light in the evening can keep you up at night. For ceiling lights and bedside tables, use yellowish-white lights that are 40 watts or less. These bulbs produce the least amount of blue light which can delay your sleep. When using the bathroom before bed, keep the vanity bulbs above the mirror off. These extremely bright lights suppresses the hormone (melatonin) that helps you nod off at night.

September 2014