NBA Coach Steve Kerr: Bad Advice on Back Pain

http://www.acsh.org/news/2017/05/16/nba-coach-steve-kerr-bad-advice-back-pain-11287

Tuesday night marks the seventh straight NBA playoff game that Steve Kerr will miss due to debilitating back pain. It’s been more than three weeks since the head coach of the Golden State Warriors said he had to leave the team because of the intense discomfort, and to seek additional treatment.

Despite this being the most important time for his team, Kerr is not expected to return to the Warriors bench this season, even if his juggernaut advances to the NBA Finals in June, as expected. That’s how uncertain his situation is.

The lean and trim 51-year-old, whose undergone two failed back surgeries, cannot even manage sitting or standing – or a combination of both – in order to coach and travel to games, which is why Kerr stepped aside.

But during his announcement last month about his specific physical condition, he included some ill-advised medical advice for those in situations similar to his own.

“I’m not going to go into details on the symptoms. It’s just discomfort and pain and it’s no fun,” Kerr said on April 23. “And I can tell you if you’re listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anybody get in there.”

Considering the amount of pain he’s experienced since first going under the knife in 2015 to repair a ruptured disk – also called a herniated or slipped disk – it’s understandable why Kerr said what he did. However, given his celebrity status and high visibility, he should have never offered medical advice of any kind, especially because every back problem is different, and no one approach is appropriate for every patient.

“We really don’t understand the spine very well, particularly the mechanics of the back. We apply a mechanical solution to what’s not necessary a mechanical problem, given that there are nerves and muscles involved,” says Charles Dinerstein, M.D., a Senior Medical Fellow at the American Council and retired vascular surgeon. “That said, while Kerr may have felt let down after two operations with no sustained relief, he should not have directed others with chronic back pain to stay away from surgery.”

The Wall Street Journal reported this week that “[r]esearch has shown the procedure is more successful than nonsurgical treatment for patients whose pain has persisted for several months,” and according to “Hyun Bae, a professor of orthopedic surgery at Cedars-Sinai Medical Center in Los Angeles, ‘When you look at the data, it clearly shows the patients who had surgery had a faster and more reliable recovery.’ “

Yet as many a back specialist will tell you, locating the source of back pain can be a very difficult thing to do. And even if it’s located, coming up with a plan to treat it – and overcoming it – can be just as difficult, if not impossible. Unless it’s under rare circumstances, even back surgeons won’t recommend back surgery from the start, since it’s often not the best approach – and the last option. 

“While sufferers are often desperate, and they are experiencing neuropathic pain,” adds Dr. Dinerstein, “in general it is almost never the first choice.”

For those who have experienced a herniated disk and the pain “has not resolved within a few weeks, your doctor may suggest physical therapy. Physical therapists can show you positions and exercises designed to minimize the pain,” according to the Mayo Clinic. Medications – including muscle relaxers and cortisone injections – WHICH THE FDA DOESN’T RECOMMEND… can also be prescribed. 

For Kerr, with enough time passed after recuperating from his first surgery, he began working out daily and incorporating yoga into his regimen to battle headaches, to help keep the pain at bay – which worked for awhile. But then he was afflicted by a rare complication from the original surgery: leaking spinal fluid, also called a cerebrospinal fluid leak, from a dural tear. That condition was addressed in his second operation in October 2015, but his awful pain has returned.

It’s this complication that makes Kerr’s situation even more unique, given that the cerebrospinal fluid leak occurs in roughly 1 in 20 disk operations. Just more reason for Kerr to have avoided telling the public to run from back surgeons. 

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FDA Adds Boxed Warning to Canagliflozin for Amputation Risk

http://www.medscape.com/viewarticle/880059

The US Food and Drug Administration (FDA) has issued a new boxed warning to the label of canagliflozin (Invokana, Invokamet, Janssen) to describe the risk for leg and foot amputations.

This heightened warning follows a May 2016 safety alert based on interim data from one of two ongoing trials in which the risk had been seen in one but not the other. Now, final results from both trials ― CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus) ― indicate an approximate doubling of the risk for both leg and foot amputations in canagliflozin-treated patients compared to those randomly assigned to receive placebo.

The amputations were most commonly of the toe and middle of the foot, but some also involved the leg, below and above the knee. Some patients underwent more than one amputation, and some of those involved both limbs.

The European Medicines Agency has been investigating this phenomenon since April 2016, and in February 2017 issued a requirement that the labels of all drugs of the sodium glucose cotransporter 2 (SGLT2) inhibitor class carry the amputation warning.

Before prescribing canagliflozin, the FDA advises healthcare professionals to consider factors that may predispose patients to amputations, including a history of prior amputation, peripheral vascular disease, neuropathy, and diabetic foot ulcers.

Patients taking canagliflozin should be monitored for signs and symptoms of those conditions. The drug should be discontinued if these complications occur.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

Complete and submit the report online: www.fda.gov/MedWatch/report.

Download the reporting form or call 1-800-332-1088 to request a form.

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As the nation’s heroin epidemic continues to claim lives at a rapid rate, the search for the heroin high is creating a dangerous situation for pharmacies. Police have responded to more than 500 pharmacy robberies in Illinois and Indiana since 2012, according to statistics compiled by the Drug Enforcement Administration. Chris Coffey investigates.

(Published Monday, May 15, 2017)

http://www.nbcchicago.com/investigations/Pharmacy-Robberies-a-Nasty-Side-Effect-of-Nations-Opioid-Crisis-422408144.html

As the nation’s heroin epidemic continues to claim lives at a rapid rate, the search for the heroin high is creating a dangerous situation for pharmacies. Police have responded to more than 500 pharmacy robberies in Illinois and Indiana since 2012, according to statistics compiled by the Drug Enforcement Administration.

In many security camera videos, pharmacists and their staff members can be seen being threatened, pushed or held at gunpoint by robbers who are demanding opioids and anti-anxiety medications. Opioid painkillers are known to ease heroin withdrawal while anti-anxiety pills can be used to mellow a high.

Glenn Kosirog was working at his family-owned pharmacy in Chicago in February when an alleged robber displayed a gun and forced him to hand-over thousands of prescription pills. Most of the incident was captured by Kosirog’s security cameras.

“He had ripped the narcotic cabinet off the wall,” Kosirog said. “He didn’t take everything. He just took the Xanax and hydrocodone.”

Chicago police said no offenders are in custody and the investigation is still ongoing.

Prescriptions for hydrocodone dropped by 350,000 in Illinois, as tighter controls on painkillers are putting fewer pills in the hands of users. The resulting street value of the drugs increases because they are in more demand.

“If you can’t get your painkiller any more, you’re either going to move to heroin or in some cases you’re going to rob a pharmacy to get those drugs that’s harder to get from your medical provider,” said DEA Chicago Special Agent in Charge Dennis Wichern.

According to Mt. Prospect-based National Association of Boards of Pharmacy (NABP), violent pharmacy robberies may end up having the harshest effect on the real patients who need prescription painkillers.

“One of the unintended consequences of all of this is they will simply quit carrying these products and when they do, these patients don’t have access to the medication they need,” said NABP executive director Carmen Catizone.

The number of opioid overdose deaths in the U.S. skyrocketed to more than 33,000 in 2015, according to the Centers for Disease Control and Prevention.

The February robbery wasn’t the first targeting Kosirog’s pharmacy.

“You’re always taken by surprise,” Kosirog said. “You try to hope and pray that they leave quickly.”

Police continue to investigate a violent robbery at a Wauwatosa, Wisconsin pharmacy that occurred in December. Security video of the incident, which was reported by NBC 5, showed robbers knocking down pharmacy staff members and threatening them at gunpoint. A spokesperson for the Wauwatosa Police Department said suspects in the case have been identified, but criminal charges have not yet been issued in the case.

Wichern said in some cases children under 17 are given “shopping lists” by an older person to rob pharmacies of prescription pills. He said children are used to conduct the robberies because it makes it more difficult to prosecute the cases.

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Coroner says teen died from too much caffeine

http://www.cbsnews.com/videos/coroner-says-teen-died-from-too-much-caffeine/

May 16, 2017, 7:17 AM|A South Carolina coroner says too much caffeine caused the death of a healthy teenager. Davis Cripe, 16, collapsed last month at his high school and died at the hospital. He had consumed a large soft drink, a latte and an energy drink over a short period. Tony Dokoupil reports.

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Former IU Health doctor found not guilty of reckless homicide by over prescribing painkillers

http://www.theindychannel.com/news/crime/former-iu-health-doctor-found-not-guilty-of-reckless-homicide-by-overprescribing-painkillers

INDIANAPOLIS — A former IU Health doctor accused of over-prescribing opioids was found not guilty by a Marion County jury Monday.

Dr. John K. Sturman was originally charged in August 2015 with three counts of reckless homicide and 16 counts of issuing invalid prescription drugs for allegedly overprescribing pain medication to patients – some of whom later overdosed and died.

Sturman operated a clinic at Indiana University Hospital until 2012, when he lost his admitting privileges for failing to properly document patient visits.

Investigators alleged that from 2008-2012, Sturman had displayed a pattern of prescribing large amounts of pain medication “outside the usual course of medical care.”

A Marion County jury dismissed the charges against Sturman in December 2015, but Prosecutor Terry Curry appealed that decision. His appeal was granted in July 2016 and charges were again filed against Sturman.

On Monday, following a six-day trial, Sturman was found not guilty on all counts against him.

After his tenure at IU Health, Sturman worked as the chief of pain management for the VA Illiana Health Care System. The health network’s website does not currently list him on staff.

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The 80’s called and they want their WAR ON DRUGS BACK

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Trump’s Budget Director Hints at Mandatory Drug Rebates in Medicare

How can so many people in so many important positions be so CLUELESS ?

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The myth that prescriptions caused the opioid crisis

http://www.newsobserver.com/opinion/op-ed/article145348794.html

As the North Carolina legislature and the DHHS look for solutions to the opioid problem, consideration of new options is imperative. As doctors, we need to be sure we are doing no harm, as Hippocrates taught us some 3,000 years ago. “Job One” in the medical profession is to relieve pain. Prescription controls always sound good but don’t work and harm those who are seriously in pain.

Opioids (narcotics) are the only class of medicine to control real pain. Out of 100 people taking pain medicine, only a very few, perhaps three or four, will develop an addiction. Restricting pain medicine in the other 97 is not good medical practice.

When I treated soldiers returning from Vietnam in the 1970’s hooked on high-dose heroin, only a very few became addicted after withdrawal was over. The vast majority of people exposed to the same amount of narcotic will not end up as addicts; they don’t have the disease.

Well-meaning people confuse the doctor’s prescribing with the increased opioid (narcotic) death rate by thinking prescription drugs lead to heroin. This is not true. They may be both involved but causation has not been shown in carefully designed studies. Deaths from narcotic overdoses usually involve multiple, non-prescribed, street drugs, not pain medicines prescribed by caring doctors.

Studies have shown that addiction patients rarely find what they need by using prescriptions from their doctors. We need to start putting real numbers and percentages to the problem – not combining all narcotics under the umbrella of the buzz word “opioids.” The narcotics or opioids killing people are not from our prescription pads.

That small percentage of the population really hooked on alcohol and narcotics are not weak, flawed, or sociopaths. They are patients with a brain chemical receptor disease that turns intense organic-driven “seeking” behaviors into ruined lives.

Brain receptors are locks that open chemical channels in the brain with fitted keys called “ligands.” Something is clearly wrong with the key and lock system in the brain of those “addicted.” These abnormal opioid receptors are incapable of desensitization; what we call “down regulation.” They remain far too sensitive to opioids. Once the opioid chemical ligand is inserted into the receptor “lock,” the door opens and the person experiences euphoria and less pain. The “addicted person” has far more euphoria than would the 97 percent of people who take narcotics and alcohol without the disease. We shall call this brain receptor problem “Chemical Receptor Disease” (CRD) replacing the term Chemical Dependency (implying dependent personalities). This failure to regulate receptors and quiet them down in the face of high ligand levels inside the biochemistry of the brain is a disease – CRD.

Uncontrolled euphoria

Euphoria is normal. Our bodies normally make our own opioids called endorphins. We make these when we exercise regularly. This is why we feel good after a workout. Runners are grouchy if they don’t run for four or five days, experiencing withdrawal. The endorphin opioids, drive us to continue exercising. If we had receptor dysfunction or CRD, we might want to exercise 10 times a day.

Unfortunately other opioid ligands can unlock the receptors as well, like heroin, OxyContin, Percocet, Fentanyl, and Morphine. What makes heroin group ligands different is they are dealing with hyperactive receptors and worse are presenting the receptors with huge numbers of keys or ligands. The euphoria is unimaginable. The drive to maintain this level of euphoria can be unstoppable. The failure of the brain to modulate or down regulate, as the biochemists would say, is probably inherited and present for life.

Teenagers should be taught in “health class” that CRD may show up in just a few people exposed to alcohol and narcotics, where most will have no problem. The key symptom to monitor for those few with appearance of strong “seeking” behaviors. Once looked for they are easy to pick up. This person needs quick, early intervention with a medical receptor blockage program. Court ordered talk-based therapy will not work; it’s like talking to cancer, or diabetes.

Doctors are not contributing to “addictions.” This is a myth of guilt. Evidence has been around a long time that doctor prescribing has virtually nothing to do with the vastness of the “seeking” problems. There will be drug seeking as long as we have the disease. Restricting supply always fails, from Richard Nixon’s “War on Drugs” to more attempts now. Reducing supply stimulates the criminal supply chains. Studies have shown the CRD drug seeking behaviors usually bypasses the typical doctor’s office. Seeking patients will find.

An effective new Chemical Dependency (Receptor) Disease program is needed in North Carolina and could be used as a model nationwide. Creating a program centered around naltrexone for both alcohol and narcotic chemical dependency is needed. Less jail time, less court expenses, less expense of failed rehab programs could easily pay for a real “turn yourself in for treatment” medical, receptor control program.

People will always need pain relief. A suggestion to try Tylenol first is cruel. We would harm 95 percent of those with pain who will never become addicted. If everyone who has received prescription to “opioids” were to become addicted, as implied by opioid restrictions to prevent addiction, then nearly the entire adult population who ever received a narcotic would be “addicts.” We need to shed these myths.

It is time to shift away from blaming and shaming and away from, arrests, dragnets and useless attempts at supply restriction and move to compassionate, understanding programs respecting this lifelong biochemical disease as we would with cancer, diabetes, and lung disease. It is not a new war on opioids; that war is already taking place inside the patients with organic dependency – CRD.

We have our first opportunity to address this problem of chemical- based disease and on what we know of the biochemistry of the brain. We should focus our treatment on the abnormal opioid receptors with medicines like naltrexone and away from tired, failed supply restriction remedies and away from blaming the patients.

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Medication Error(s) & Termination

http://allnurses.com/nursing-patient-medications/medication-error-s-1102978.html

Hi, I’m a pediatric nurse practitioner that recently started a new job at a school-based health center and I’m about 5 months into the job. The clinic that I “took over” from previous NPs was always missing basic things like gloves, white copy paper, and cabinets were filled to the brim with expired point-of-care tests (ie: rapid strep kits, ua/culture tubes), needles, medications, etc. I have been trying very hard to get this clinic back up to par, and made a full Excel sheet of inventory and expiration dates for all meds and lab supplies.

The other day I found that our “private stock” (non VFC or federally funded vaccines) had plenty of expired vaccines, so I pulled them out of the fridge and freezer(s) to be thrown away. The vaccine had been expired since 5/2016 and I started my position in 12/2016. So why the vaccine was still even there was beyond me. What were the previous MA’s and NP’s doing?? However, my medical assistant had inadvertently placed the expired MMR back into the freezer AND onto the VFC shelf.

I didn’t know this until I had jumped in to help with giving vaccines on a busy, under-staffed afternoon (I only had that one MA with me) and gave the expired MMR vaccine to an infant because STUPID me missed the double check on the vials before drawing them up. Usually I re-verify all vaccines, but since I had just done all the inventory just 4 hours earlier and knew there shouldn’t be any more expired vaccines in the freezer, I didn’t recheck. Which is still my own fault.

Not only this mistake though, an incident report regarding vaccine errors has been filed 4 times in the past 5 months for my clinic. First I had ordered an extra flu shot on an 18-year old because I missed that he had already gotten the flu shot this season (we have to look on our EMR and on a paper copies of vaccine records to piece it together, because they don’t enter all vaccines into the EMR at this place). The second time, one of my medical assistants had given an incorrect vaccine because they went off a verbal order of mine but had grabbed a wrong vaccine and gave it WITHOUT looking at the order in the computer OR verifying the vaccine with me. The third time one of my newer medical assistants discovered she stuck herself with a needle after giving vaccines and had to go through the entire needlestick injury report/protocol.

But as the NP at the clinic, I feel responsible for all of the issues that has happened– and I’m afraid that in the end, that is what my clinic manager and administrators will see too and fire me. My clinic manager was supposed to have come in to do an in-service with our clinic after the 2nd vaccine error but it never happened because she “got too busy”. In your experience, do you think I can be terminated (“3 strikes you’re out”)?

These “medical errors” – for the pts – were a non issue, but on top of the 200,000 – 400,000 pts that die because of medical errors… how many of these “non-issue” medical errors are just swept under the rug … or… the healthcare professional in charge is discharged because of under staffing and poorly trained ancillary staff that contributed to medical errors ?

Probably doesn’t take much for a over worked or poorly trained staff to cause a otherwise non-issue medical error to become a “fatal medical error”

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Everyone is dependent on numerous things to assure their quality of life… All of us are DEPENDENT on food, water, sleep.  NO ONE is ADDICTED to these things… but a individual’s quality of life or life itself suffers if these are not available in adequate quantity and quality.

While most babies are born “perfect”…  life’s path that each of us much take can lead in different directions… “bad genes”, infections, diseases, accidents, aging… all take their toll on a individual’s quality of life

Both nurture and nature can affect us both physically and mentally… Luckily our pharmaceutical/medical industry has developed means of diagnosing and treating many of the maladies that impact all too many people. Without many of these products we may have more suicides than the 40K -50K that we already have.

Many people are dependent on certain medication, not only for their quality of life but could also shorten their life expectancy as well, if they didn’t have access to them.

Things such as insulin for diabetics and Warfarin and other blood thinners for those who suffer from A-Fib and/or their body  – for some reason – tends to develop blood clots that could end up in their lungs, heart, brain and the result could be FATAL.

Many physical impact on many disease when properly treated becomes “invisible” to the pt’s friends and relatives and typically eliminates/minimizes the physical/mental impact on the pt themselves.

It is both unfortunate and inhumane that some in our bureaucracy have a self-serving agenda that they have developed various rules/laws/programs that in all too many ways… deny care to untold numbers of people.

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