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Kidney Angiomyolipoma

Angiomyolopoma.

Benign (not cancer).

Vascular mass.

A hidden ticking time bomb of sorts.

Has the potential to

Bleed.

Can be

Catastrophic.

Increasing size equals

Increasing risk.

Typical size that prompts treatment is between 2.5 – 4 cm, depending on consensus between caretakers, ie urologist and interventional radiologist.

Pre-embolization right kidney angiogram images demonstrating lower vascular blush which corresponds to a 5cm angiomyolipoma:

Post-embolization angiogram image depicting absent arterial supply after being treated with oil and alcohol mixture (Lipiodol and absolute ethanol):

HPV Vaccine and Promiscuity are Opposing Forces

 

From what I can tell, teens nowadays are even more vigilant about unsafe behavior than past generations. They are absorbed in their electronic devices to a degree that physical interactions are minimized. The natural offshoot of this behavior is a decrease in sexually transmitted diseases. I’m no epidemiologist, but these anecdotal observations correlate with the following report summaries and may bode well for the health of our children.

 

Here’s the recent AMA Daily comment on HPV vaccine:

Getting HPV vaccine does not increase risky sex among teens, research suggests

USA Today (10/15, Haller) reports a study published in the Canadian Medical Association Journal found that teens do not make poor sexual choices after getting the HPV vaccine. USA Today adds that the FDA “announced that the HPV vaccine is expanding for use for adults up to age 45.”

Reuters (10/15, Carroll) reports that the research suggests “vaccinated girls may actually be less likely to start sex younger, less likely to have more sexual partners, and less likely to ignore safe-sex methods.” To test the effects of the vaccine, researchers examined data and surveys following the Canadian province of British Columbia’s implementation of a publicly-funded HPV vaccination program in schools for girls beginning in 2008.

HealthDay (10/15, Norton) reports the research “findings align with smaller studies from the United States and Europe.”

Low dose aspirin holds no benefit?

This may be good news. Speak with your doctor. All “blood thinners” raise the risk of adverse events such as intestinal bleeding. If there is no clinical benefit to a medical regimen, such as low dose aspirin, why take it? Everything we do has unintended consequences, whether herbal remedy or prescribed medication. Know your risks and benefits. Be informed.

As reported by the AMA:

“Research finds no benefit of low-dose aspirin for primary prevention”

“The Washington Post (9/16, Bernstein) reported that research indicates “a regimen of low-dose aspirin offers healthy, older people no benefit in staving off cardiovascular disease, dementia or disability and increases their risk of bleeding in the digestive tract and brain.” The findings were published in three articles in the New England Journal of Medicine. To view the NEJM articles, click herehere, and here.

NBC News (9/16, Carroll) reported on its website that “the new research reinforces the results from a study published in late August, which found that daily low-dose aspirin was too risky to be prescribed to patients at moderate risk of heart disease.””

Dairy is Healthy! (Confused yet?)

From the AMA:

“Whole-fat dairy may reduce CVD risk, research suggests

The New York Times (9/11, Bakalar) reports a study published in Lancet links “whole-fat dairy food consumption to a reduced risk for cardiovascular disease.” The results clash with “current dietary guidelines, which suggest substituting fat-free or low-fat dairy for full-fat products.” Researchers analyzed 136,384 people in 21 countries over an average of nine years.

TIME (9/11, Ducharme) reports, “The research suggests that eating dairy products of all kinds is associated with a lower risk of premature death, cardiovascular disease and stroke.” Study co-author Mahshid Dehghan, a nutrition epidemiology researcher at the Population Health Research Institute in Canada, said, “We are suggesting that dairy is healthy, and people should be encouraged to consume dairy.” The study found that “compared to people who didn’t eat dairy, those who consumed more than two servings per day had lower total mortality rates (3.4% versus 5.6%) and cardiovascular mortality rates (0.9% versus 1.6%).””

I must say, it is challenging to say the least, to attempt to “eat healthy.” I return to a simple mantra every time I read these kinds of reports: all things in moderation. There seems to be a constant generation of conflicting information in this world. But regardless, it seems logical that moderating one’s intake of all things is reasonable. At the least, read reports such as the one above with a skeptical eye and use the information judiciously as you attempt to manage your own health.

Make America Healthier Through Better Coverage

One of my favorite aspects about America is that we are a “melting pot,” the diversity that in my opinion makes America great and has been inexorably increasing for generations. As of 2017, according to an article from Modern Healthcare by Maria Castellucci (9/10/2018), the total population is 18.1% Latino, 21.2% “not-Latino, not-white,” and 60.7% “not-Latino, white.”

The challenge we face in this country is to focus our attention on how better to care for the people within our borders.

We have a crisis on our hands and it has to do with outcomes, or the results of the care being delivered. Outcomes are directly tied to healthcare access and quality of care being provided, both of which are also tied to reimbursement.

The real issue that we all face is that “17% of Latinos are uninsured, the highest rate among all ethnicities.”

Additionally, census data projections show 24.6% of the population will be Latino by 2045, and the U.S. will be minority white.

Texas, which didn’t expand Medicaid, had a 16.6% uninsured rate in 2016, the highest in the U.S. According to 2010 census data, 39.4% of the population was Latino.

Only “California, which in 2015 became the first state in the nation to see the number of residents who identified as people of color eclipse whites, now has better outcomes than the rest of the nation because of the state’s diversity. The study found all populations except for blacks had lower rates of mortality and infant mortality and higher life expectancy than the national averages. The major drivers were better outcomes among both Latino and Asian populations, which combined make up 52% of the state’s population and had lower mortality and higher life expectancy than whites. One factor was that communities of color cater to their residents’ needs.

Care provided to uninsured individuals causes a drain on resources precisely because the care is unreimbursed. Fortunately, we aim to provide care to ALL individuals, regardless of their ability to pay for that care. But the fact remains that resources are finite and everything comes with a cost.

So the obvious solution is to expand coverage to all people living in America. We are all Americans and in order to continue to have a successful and thriving society, we must improve the care we provide by improving the balance between cost and resources.

The need to refocus is critical. Our willingness to retrain our attentions is the unmet challenge.