Increase in #Heart Attack and #Stroke from a Non-sugar #Sweetener

An article in Nature Medicine (2023) reported on studies showing that a group of non-sugar sweeteners, “… polyol sweeteners, especially erythritol were associated with incident (3 year) risk for major adverse cardiovascular events.” Such events include heart attacks and strokes.

Erythritol is used as a sweetener, sometimes with another non-sugar sweetener and some keto-reduced sugar products. Checking contents of non-sugar sweeteners is a prudent measure, especially if you are a higher than average risk of cardiovascular events. An example would be having diabetes.

Research showed that ingesting erythritol can result in elevated levels that can “increase platelet reactivity and thrombosis potential.” Such platelets can result in blood clotting, which can block blood flow to the heart (may cause heart attack) or the brain (may cause a stroke).

For details in the research paper by Witkowski M, Nemer I, Alamri H et al Nat Med (2023), you can access it via this online address: https://doi.org/10.1038/54159-023-02223-9

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Brain Fog from COVID-19

COVID-19 has been shown to cause “brain fog” in people who have long-COVID (see my prior blog on this topic) after the acute infection has resolved. An article in AMA Morning News in February 2023 noted that patients with this condition describe it by using words such as “sluggishness, difficulty thinking or concentrating, ‘not as sharp,’ and having word finding problems.”

The authors of the article point out that these patients are often stigmatized because others cannot see anything wrong with them and believe that it is “not real.” Such unhelpful responses to someone struggling with this common complication of long-COVID just makes the situation worse.

The authors, who have treated many patients with brain fog, point out that brain fog is more likely in patients who had a more severe infection. Usually, these physicians order neuro-cognitive testing to document the type and degree of cognitive dysfunction. This can provide guidance for treatment approaches.

On a more positive note, the authors point out that vaccination against COVID reduces the risk of developing brain fog in a patient who gets COVID after vaccination. Vaccination does not totally prevent COVID illness, but it significantly reduces the severity of infection. In turn, this reduces the risk of brain fog.

Another helpful preventive measure is to take paxlovid shortly after acquiring COVID. Physicians and some pharmacists can determine if the medication is indicated and provide a prescription if it is appropriate.

It is also valuable to prevent future COVID infections as that can make brain fog worse. So, it is important to obtain COVID vaccination boosters when recommended. Wearing a mask and limiting exposure indoors with lots of people is helpful.

Once a patient has brain fog from COVID and has had a careful evaluation, there are treatment strategies that can help. One approach is to find ways to compensate for symptoms. For example, a patient with difficulty maintaining focus or attention, can schedule shorter times for activities that require maintaining attention.

The authors recommend that patients write down an action plan so they don’t have to remember each item. Also, taking notes is beneficial when meeting with someone, such as a doctor, accountant, or others, when recall of what was said is important.

They also suggest asking a spouse or close friend to let you know if they observe “something different about you.”

Engaging in good health habits is extra important for these patients. This includes getting adequate sleep, eating a healthy diet, and remaining hydrated. Avoid drinking alcohol and taking medications that can slow cognitive function (check with your doctor).

Develop a good physical exercise program with an emphasis on aerobics (work up to 30 minutes 5 days a week). Mental exercise is also helpful; examples include read books, do puzzles, learn a new skill, etc.

Anxiety is common in these patients. Learning how to use mindfulness to manage the anxiety is often helpful. The authors also recommend minimizing stress as much as possible.

Some patients also struggle with other psychiatric conditions such as PTSD or depression. The authors recommend prioritizing mental health.

Some people with brain fog have a severe case and/or have other problems from long-COVID. In that event, your doctor may recommend that you be seen in a specialized treatment center for the management of long COVID.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Vaping and Severe Lung Disease

The dangers of smoking tobacco cigarettes is generally well-known. However, people are generally less familiar with the dangers of vaping/smoking E-cigarettes. One serious illness from vaping is a form of lung injury.

It is named E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). A study reported in Pediatric Pulmonology (December 2023) compared EVALI in teens (age 13-18) before and during the COVID-19 pandemic.

The usual symptoms of this form of lung damage were the same for the cases before and during the pandemic. During the pandemic, only one patient was positive for COVID-19; all other cases at a large teaching hospital were tested and were negative.

This suggests that the lung injury in the vast majority was due to vaping and not COVID-19. Also, during the pandemic, the affected teens were less likely to require a ventilator or to go home on oxygen upon discharge. This further supports the role of vaping as the essential cause of this new disease.

The primary symptoms of EVALI are pulmonary (cough, shortness of breath, and chest pain), gastrointestinal (nausea, vomiting, diarrhea, and abdominal pain), and whole body symptoms (fever, chills, and weight loss). Any teen who vapes and has at least some of these symptoms and appears ill, should be evaluated for EVALI.

Because these same symptoms can be due to COVID-19, the patients should also be tested for it. As noted, one teen had both EVALI and COVID-19.

In the summer of 2019 the CDC “began to investigate a steep rise in hospitalizations linked to the use of vaping products.” By February of 2020 the CDC recorded over 2800 hospitalizations and 68 deaths due to EVALI.

Awareness of this serious consequence of vaping will hopefully lead to earlier diagnosis and treatment. In the study mentioned above, treatment with steroids led to improvement in 79% of cases. The benefit included improved lung function.

Please make this information known to any young people in your life. It may prevent serious illness.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Killing Your Own Child

A recent news report tells about a mother who killed her 3 young children. She then attempted suicide and ended up in a hospital. She is charged with 3 counts of premeditated murder.

Why would any mother kill her own children? In the case mentioned, the mother suffered from post-partum psychosis and was treated with multiple medications over a number of months in an attempt to manage her psychosis.

As is too often the case, the legal system is treating this as a murder case rather than a mental health emergency.

So, why do mothers (and fathers) ever kill their children? Filicide is the technical name for a parent killing their own child. A famous forensic psychiatrist, Phillip Resnick, MD did a study years ago and found that there were 6 reasons why this happens.

1. Altruism: The child is killed to relieve suffering that the parent believes the child has.

2. Acute psychosis: Often, the psychosis includes hallucinations telling the parent to kill the child. This is often accompanied by a delusion that the child is possessed by an evil spirit and will go to hell for eternity unless the parent releases the child’s soul by killing the child. That is, the parent is trying to save the child.

3. Accidental (unintended) due to child abuse or neglect: Examples include a child who dies as a result of a beating given as punishment for some reason, and the child dies, but that was not what was intended. Or a child may die of dehydration due to a parent’s neglect by not giving the child enough fluids.

4. Child is unwanted: The parent resents the child for some reason and kills the child. An example might be a child, resulting from a rape and who has a mental disorder, and constantly disrupts the household.

5. Get revenge on a spouse: A parent who is enraged at their spouse kills their child to get revenge by taking away what the spouse most loves, the child.

6. Resulting from the killing of the whole family: In this case the parent kills everyone in the family including the children. Killing one’s own family is called, familicide.

Attempting suicide after killing one’s own child is common. Even if the killing was for an altruistic reason or due to a psychotic delusion, the parent often no longer wants to live. This is especially true when the parent has significant depression as part of an underlying mental disorder.

One cause of psychosis that results in filicide is post-partum psychosis. On the face of it, this is the most likely reason for the case mentioned at the start of this blog. If so, the correct response is psychiatric care, not legal proceedings.

While post-partum depression is common, post-partum psychosis is uncommon. There are underlying psychiatric illnesses that are the cause of the psychosis. The most common one is bipolar disorder with depression; it may not have been identified before the baby’s birth. A second cause is a major depressive disorder with psychosis. Other diagnoses are less common.

Filicide is uncommon. When it does occur, many people are outraged and baffled. They find it unfathomable that a parent would kill their own child. It is important to identify the specific reason in each case before passing judgment.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Pathological #Lying

Lying Can be Obvious

Congressmen George Santos is in the news for what he calls “embellishments” of his resume. Others refer to them as lies. As a psychiatrist, I cannot render an opinion about whether Santos has a diagnosis since I have not personally examined him. However, the news has raised interest in the topic of lying.

Drew Curtis, PhD is a psychology professor at Angelo State University; he has a longstanding interest in deception and pathological lying in particular. He has defined pathological lying as “the category of people who tell excessive amounts of lies that impairs their functioning, causes distress, and poses some risk to themselves or others.”

Another description of pathological lying is “telling numerous lies each day for longer than 3 months.” Dr. Curtis notes that some research subjects, that he has studied, describe themselves as meeting criteria for pathological lying. They report “greater distress, impaired functioning, and more danger than people not considered pathological liars.”

Based on his research, Dr. Curtis believes that “pathological lying seems to be compulsive, with lies growing from an initial lie, and done for no apparent reason.” When behaviors are compulsive, the person has restraints on their ability to stop their compulsive behaviors.

What about people who lie but don’t have pathological lying? The “ordinary, everyday” lies that most people tell are referred to as “common lies.” They may be told to avoid embarrassment, to avoid hurting someone’s feelings, or to avoid a negative event such as getting fired. There is a clear reason for lying.

However, there are people with a personality disorder who frequently tell lies. Those disorders are primarily three related ones. The first is the person with an antisocial personality disorder who frequently lies, usually for some personal gain. They do not have a normal conscience so they may not experience guilt when they lie.

The next two diagnoses are borderline and narcissistic personality disorders. They have a tendency to lie more than the average person, and they typically lie to “alter reality” to match their emotional state. They may also lie for personal gain just like most people.

Pathological lying is accepted by mental health professionals as a real thing, but, by itself, it is not an official diagnosis. Dr. Curtis is trying to change that.

So, telling “small lies” is very common; frequent lying is much less common and may result from a personality disorder; and pathological lying is uncommon and may be due to a compulsion.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

# Eye Infection Due to Artificial Tears

The CDC has reported an outbreak of Eye Infections associated with using artificial tears. There have been 55 patients from 12 states identified from May 2022 to January 2023.

These infections are dangerous; one person has died and vision loss was present in 5 others. While these infections have been found in people using a variety of over-the-counter artificial tears, EzriCare Artificial Tears have been the most common eye drops identified.

The CDC “recommends clinicians and patients stop using EzriCare Artificial Tear products pending additional guidance from the CDC and FDA.

They also recommend seeing your doctor right away if signs or symptoms of an eye infection is experienced. These include eye pain, redness, thick discharge, and/vision loss.

These dangerous eye infections are due to a strain of a bacteria named Pseudomonas aeruginosa. This strain has never been seen in the U.S. before. This type of bacteria is found in the environment including soil and water. It causes infections in a variety of body parts and not just the eye. Of added concern is that this strain is resisted to a number of antibiotics, which is the usual treatment.

Peter M. Hartmann, MD

Family Medicine & Psychiatry