The answer is a resounding “No” according to Dr. Jacob Hunter, ear specialist at Jefferson University Hospital. For one thing, Q-tips only remove a small amount of ear wax that is near the opening but pushes most of the wax down the canal against the ear drum. In the end, the canal gets blocked with wax, which impairs hearing.
An additional concern with using a Q-tip in the ear is the risk of damaging the thin skin lining the canal. Infection may occur.
When I was a medical student I was told by an ear specialist that you should not put anything in your ear smaller than your elbow. It was his humorous way of warning against using Q-tips.
Generally, ear canals “clean themselves as long as they get water in there” (quote from Dr. Hunter). If you need to clean your ears, he recommends using peroxide. However, he says not to use it if your canal is dry and itchy because peroxide dries the canal.
Sometimes, peroxide is ineffective, and you may need to see your doctor. They can remove the dense wax by irrigation and/or scooping it out with a special tool.
Most of this information was published by Sara Berg for the AMA on October 20, 2023 in a publication for the general public entitled What Doctors Wish Patients Knew.
The diagnosis of “excited delirium” has been used for many decades but has now been discredited by several medical organizations.
They include the American Psychiatric Association, the AMA, and the National Association of Medical Examiners.
It is a diagnosis sometimes used to explain a suspect’s cause of death during an arrest by police when the suspect is showing extreme agitation.
Recently, California passed a law “prohibiting coroners, medical examiners, physicians, and PAs from using this diagnosis on death certificates or autopsy reports.”
Also, law enforcement are not “allowed to describe a person’s behavior in any incident report …” using this “diagnosis.”
This information comes from an article by Samatha Young in the KFF Health News on October 13, 2023.
While this “diagnosis” should not be used, it is my view that police are not necessarily at fault when a suspect dies during an arrest. For example, a suspect may die from a heart attack during an arrest.
As an illustration, people under the influence of cocaine can have a heart attack when agitated or even when they are not. A medical examiner needs to determine the cause of death when someone dies during an arrest. No assumptions should be made beforehand.
Ultra-processed foods have been found to be addicting, according to a review of 281 studies from 36 countries in 2023 (see reference below). These studies found that 14% of adults and 12% of children are addicted to these foods.
The studies demonstrating food addiction utilized the same methodology used to evaluate Substance Use Disorders. However, at this time, food addiction is not listed in the official manual for psychiatric disorders.
Ultra-processed foods are “… industrially produced foods containing ingredients not available in home kitchens …” They contain a high percentage of refined carbohydrates and added fats.
Also, they often have additives that “may contribute to the addiction potential…”. Salty foods may also be addicting.
While the percentage of adults and children with an addiction to ultra-processed foods is worrisome, the percentage “reaches 32% in people with obesity having bariatric surgery, and over 50% in those with Binge Eating Disorder.”
The information provided is from an article on this topic by Gearhardt and colleagues in the British Medical Journal 2023; 383.
Binge drinking of alcohol is most common among young adults. It is defined as a female having more than 4 drinks or a male having more than 5 drinks in a single session.
Binge drinking can be unhealthy by itself but can also lead to an Alcohol Use Disorder.
If you or someone you know is wondering if they have any type of Alcohol Use Disorder or are at risk of developing one, there is a free on-line anonymous screening test available.
It gives immediate feedback, including suggestions on what action to take.
The test can be accessed on-line at auditscreen.org. It takes a couple of minutes to complete.
The test has been been carefully studied via a multinational research project by the World Health Organization beginning in 1989. It is designed to screen for unhealthy alcohol use.
For more information about unhealthy alcohol use, see my WordPress blog from August 26, 2023.
What’s something most people don’t know about you?
Getting Ready to Fly
Of course, my family and close friends know that I was a family doctor and psychiatrist (now retired) and that I am a licensed sport pilot. However, most people don’t know that I have a pilot’s license and was co-owner of an airplane.
I no longer fly sport airplanes for several reasons. They include the fact that I am at an age when piloting may not be safe. Sometimes, I miss it, but I recognize that it is for the best.
I think having a hobby interest that gives you a chance to learn something new, that is exhilarating, and that keeps your mind off of your job is great for your mental health. We all need regular mental breaks.
I hope that anyone who reads this either has or will find a joyous hobby as I was fortunate enough to do.
Many people are concerned about their weight and take weight loss medications. A popular choice are medicines that were developed to treat diabetes, and were found to also help with weight loss.
It is known that certain adverse intestinal disorders are more common in diabetics. Researchers wanted to know if these adverse events were also increased in non-diabetic people taking these medications for weight loss.
The medications are semaglutide (Ozempic, Rybelsus, Wegovy) and liraglutide (Victoza, Saxenda). In this research, non-diabetic people taking one of these medications for weight loss were reviewed for these adverse intestinal events.
The frequency of intestinal adverse events in people on semaglutide or liraglutide were compared with the frequency in people on a different weight loss medication, bupropion-naltrexone (Contrave). It works differently from semaglutide and liraglutide.
The intestinal adverse events are: pancreatitis (inflammation of the pancreas), bowel obstruction (blockage in intestine), gastroparesis (stomach empties much more slowly than normal), and biliary diseases such as gallstones.
All of these adverse disorders were seen in patients taking any of these weight loss medications, but only three were more common with semaglutide or liraglutide than with bupropion-naltrexone.
They were: pancreatitis, bowel obstruction, and gastroparesis. Although these were more common compared to people on bupropion-naltrexone, all of these adverse events are rare.
The researchers concluded that, even though these adverse events are rare, people taking these medications should be aware of the increased risk.
The research was published by Sodhi and colleagues in JAMA online, October 5, 2023. For anyone wishing to read the article, it can be accessed online at: doi:10.1001/jama.2023.19574
Bipolar Disorder is characterized by significant mood shifts alternating among a normal, a depressed, and a manic mood (a manic mood presents with a significantly elevated or irritable mood along with markedly increased physical activity).
In order to be diagnosed with a Bipolar Disorder, the individual must have had at least one episode of mania or hypomania (mild version of full-blown mania).
If someone has had at least one episode of mania, they are said to have Bipolar I Disorder. If they have only ever had hypomania, their diagnosis is Bipolar II Disorder.
Bipolar II Disorder is a less severe form of Bipolar Disorder and less problems usually result from the disorder.
About 4.4% of Americans have a Bipolar Disorder. It usually begins during adolescence or young adulthood. Most commonly, the first mood episode is depression so Bipolar Disorder cannot be diagnosed in them until they have a manic or hypomanic episode.
It takes an average of 9 years after onset before a diagnosis is made. Unfortunately, a patient’s life may have been disrupted prior to the correct diagnosis being made. Also, Bipolar Disorder is easier to treat during earlier episodes.
In addition to disrupted relationships, problems in school or at work, and legal problems, patients with Bipolar Disorder have a serious risk of suicide (about 30 to 60 times higher than the general population).
Other co-occurring psychiatric disorders are common in these patients (about 65%). These psychiatric disorders include anxiety disorders, substance use disorders, personality disorders, and ADHD.
A number of general medical disorders are also more common. They include heart disease, diabetes, dementia, high blood pressure, and elevated cholesterol. The reasons for the increased incidence of these illness is likely due to multiple causes.
One important cause is the fact that a greater percentage of these patients smoke tobacco (45%) than the general population. Additional factors include medication side-effects, poor diet, obesity, and inadequate physical activity. Lifestyle interventions have been shown to reduce the risk of cardiac disease.
Fortunately, there are a number of medications that have been shown to treat Bipolar Disorder. It may take some trial and error to find the optimal medication or medications to treat an individual patient.
In addition to medications, severe cases may require ECT, which can often resolve a depressive or manic episode that does not respond adequately to medications.
Psychotherapy has also been shown to benefit patients with Bipolar Disorder. Among other factors, patients in therapy tend to be more consistent in taking their medications.
The data reported in this blog are taken from an excellent review paper on this topic by Nierenberg and colleagues published in JAMA Volume 330, Number 14, on October 10, 2023.
What’s something you would attempt if you were guaranteed not to fail.
Anxiety
If I knew I couldn’t fail, I would perform brain research and discover a treatment that would cure all known mental illnesses. The cure would be free of adverse side-effects, would be inexpensive, and would work within 24 hours.
Mental illness is very common and causes a lot of suffering. Yet, many people with a mental illness receive little or no treatment.
I would want to find a charitable way to provide the treatment throughout the world in such a way that everyone who wanted it would receive it.
Autism Spectrum Disorder (ASD) is often missed in teenagers. A study of 16-year-olds in New Jersey showed that “one in four study-confirmed individuals with ASD did not have an ASD diagnosis.”
The incidence of ASD was one in 55 males and one in 172 females. ASD was more common in Whites than Hispanics and in teens from higher socio-economic groups than lower ones.
Interestingly, 58% of the teens with ASD had co-occurring neuropsychiatric disorders. Examples of such disorders include ADHD, seizure disorders, cognitive deficits, bipolar disorder, migraine headaches, and many more.
The data and quote in this blog are from an article in the Journal of Autism and Developmental Disorders by Zahorodny and colleagues on August 29, 2023.
What would you do if you lost all your possessions?
Losing Everything You Have
I don’t know for sure how I would respond because I have never lost everything that I had. However, I have lost a number of things that I cared about.
The Buddhists say that suffering comes from attachment. In the case of the things we have, how attached we are to them determines how upset we are if we lose them.
Knowing this, I have consciously tried to limit how attached I am to my things. When I do lose something I am able to let it go with equanimity.
That doesn’t mean that I don’t care. It means that I do not allow it to make me overly distressed.
So, I suspect that I would be upset if I lost everything but not overwhelmed.
My goal would be to prioritize what I need to replace in the order of their importance.
Access to water, food and shelter would be my first priority. Next would be to replace my medications and my cPAP machine.
Getting copies of important documents would probably be next (insurance documents, driver’s license, etc.).
Health and Culture 