Thanks to the Internet, answers to almost any question are available with a few clicks of the mouse – including questions about health concerns. Millions of people turn to search engines, primarily Google, to look up information about symptoms, diseases, and medications. There are a lot of hazards when it comes to using 'Dr. Google' as your main source of medical advice – but that’s a topic for another episode.
Ssearch engine statistics can tell us what’s at the top of people’s minds. So we took a list of top-searched health questions and brought together experts from the Baptist Health family to serve up the facts.
Host, Jonathan Fialkow, M.D.'s guests were:
· Michael Decoske, Assistant Vice President of Pharmacy Administration at Baptist Health.
· Katie Acquino, M.D., Medical Director of Baptist Urgent Care Express in Palm Beach
· Liana Barkan, M.D., an internal medicine physician
Thanks to the Internet, answers to almost any question are available with a few clicks of the mouse – including questions about health concerns. Millions of people turn to search engines, primarily Google, to look up information about symptoms, diseases, and medications. There are a lot of hazards when it comes to using 'Dr. Google' as your main source of medical advice – but that’s a topic for another episode.
Ssearch engine statistics can tell us what’s at the top of people’s minds. So we took a list of top-searched health questions and brought together experts from the Baptist Health family to serve up the facts.
Host, Jonathan Fialkow, M.D.'s guests were:
· Michael Decoske, Assistant Vice President of Pharmacy Administration at Baptist Health.
· Katie Acquino, M.D., Medical Director of Baptist Urgent Care Express in Palm Beach
· Liana Barkan, M.D., an internal medicine physician
DR. JONATHAN FIALKOW:
Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
Thanks to the internet, answers to almost any question are available with a few clicks of the mouse – including questions about health concerns. Millions of people turn to search engines like Google to look up information about symptoms, diseases, and medications. There are a lot of dangers when it comes to using Dr. Google as your main source of medical advice – but that’s a topic for another episode.
What search engine statistics DO tell us is what’s at the top of people’s minds. So, in a recent episode of Baptist Health’s Resource Live program, we took a list of top-searched health questions and brought together experts from the Baptist Health family to give us the facts.
My guests on the program were:
· Michael Decoske, Assistant Vice President of Pharmacy Administration at Baptist Health.
· Dr. Katie Acquino, Medical Director of Baptist Urgent Care Express in Palm Beach, and
· Dr. Liana Barkan, an internal medicine physician
Let’s hear what they had to say…
DR. JONATHAN FIALKOW:
Liana, one of the top search questions has to do with something a lot of people suffer from, and that's hypertension. Keeping our blood pressure levels in check. For those who suffer from high blood pressure or who are interested in managing it. What would you say is the best way to lower your blood pressure?
DR. LIANA BARKAN:
Well, if you're on medication for blood pressure, I would definitely suggest taking your blood pressure medicine. That's for sure. To eat healthy and regular exercise and to keep your BMI within normal limits. And just in general, eating a healthy, moderate diet is very important.
DR. JONATHAN FIALKOW:
Isn't that kind of the common denominator for everything we tend to individualize about the disease states. But it's, as you just said, exercise, keep your weight under control, eat healthy foods. Well said. What about sleep? I know we've had previous resources, programs about sleep, can you speak a little bit about the importance of getting a good night's sleep?
DR. LIANA BARKAN:
Well, it's actually extremely important because, if you're sleep deprived, the rest of your health is invariably impacted. If you don't sleep well, you don't tend to eat as well. If you're not eating as well, you're feeling more tired and it's hard to maintain a healthy lifestyle. But even independent of how you function, sleep in and of itself is a restorative process. So it's important to sleep well, so that the rest of your bodily functions are working at their optimum. It's all part of the process. It's a holistic picture. You have to look at every component. It's not just, you take your medicine and then you don't do anything else or you eat well, but then you don't do anything else. It has to be a comprehensive, holistic picture.
MICHAEL DECOSKE:
Can I weigh in on that for just a moment?
You know, working in pharmacy, we see so many patients who irregularly take their medications. And, just like you're both saying, it's so important to consistently not have gaps with taking medication. So, we encourage patients to have a good routine about when they're going to pick up their refills for their medications, make sure that they always have enough refills on hand for any vacations or things like that, that they might be taking. And also if you're not able to afford your medication, don't let that be the barrier to stop you from taking it regularly, because there are lots of medications and also a lot of resources to help get discounts on medications available. So if you can't afford your medication, I just want to say that it's so important to talk with your doctor about alternatives that can help keep your blood pressure, for instance, under control but also allow you to afford the medication.
DR. JONATHAN FIALKOW:
I appreciate that Michael. We work together on quite a lot of initiatives to get people their medications for under those very concerns. Pick them up, help getting them delivered, help if there's an affordability issue. And again, we want people to make sure that they speak with their doctors, if they have trouble filling their prescriptions for whatever reasons.
DR. JONATHAN FIALKOW:
Katie, another one, certainly as the preventative cardiologist. Another frequently searched question has to do with cholesterol levels. What can people do to lower their cholesterol? Assuming that there's someone who should lower their cholesterol.
DR. KATIE ACQUINO:
Yeah, sure. The big deal with this, is that there's modifiable and unmodifiable things. So you can't help what you're born into. So we're not going to get into that full story. But as far as modifiable things, there are some lifestyle things such as what we eat and just managing certain aspects. A little bit of getting into what we eat, some of the foods that will help would be eating fish with high in omega three. It helps a ton to lower some of the cholesterol. If you do that at least two times a week, that's great. Foods and high fibers such as grains, whole grains, beans, apples, broccoli, also help in that situation. Of course, we need to avoid processed foods, foods that are fried. Anything with added sugar as well.
Another little thing that I like to tell people is, try to meal plan. And I'm not talking about meal planning, because that's a complicated thing, but just as far as what you're putting on your plate. I like to say divide it up into fourths. So, you basically say a fourth of your plate should be whole grains. The other fourth should be the low, low fat proteins. And then the rest of it should be all vegetables. So if you look at meal planning that way, it's kind of a little bit easier to have a concept of being able to lower cholesterol that way.
DR. JONATHAN FIALKOW:
That's a great response. And I love the way you approached it towards eating the healthier foods, the less processed refined foods, which is really what we were meant to eat. We didn't evolve eating cookies and crackers and things like that. Speak a little bit about also, as Liana mentioned about medications. Where obviously we want to allow people to be able to control their cholesterol. To decrease their risk of cardiovascular disease, that's the concern, heart attacks and strokes, without the need for medications. But if someone's prescribed a cholesterol lowering medication, what recommendations would you have towards making sure that they take those medications?
DR. KATIE ACQUINO:
Yeah. I mean, it kind of piggybacks off of both what Mike and Leanna said. It's, if you're prescribed it, you're prescribed medication for a reason. And we just really want our patients to understand that it's important to take it and to take it on a regular basis, because it's there to help. And it does help.
DR. JONATHAN FIALKOW:
That's great.
DR. LIANA BARKAN:
Can I interject, I'm sorry. I just wanted to say-
DR. JONATHAN FIALKOW:
Please! Of course. No. Please. This is why we're here.
DR. LIANA BARKAN:
I was going to say and it sort of piggybacks on what both of them said. You know, obviously if you don't take your medication, it's not going to work. But if you do take your medication, it will work. But you can't stop taking it because it works.
DR. JONATHAN FIALKOW:
Right.
DR. LIANA BARKAN:
I've had patients who've come to me and said, "but my blood pressure is normal now, I don't have to take it anymore." I'm like, "it's normal because you're taking your blood pressure medicine." Likewise, with the cholesterol. So, I think it's really important to talk to your doctor. If your blood pressure had been normal for a long time, maybe you can discuss other alternatives, but to continue taking your meds, your blood pressure, even if your blood pressure is controlled and the cholesterol is controlled.
DR. JONATHAN FIALKOW:
I love that. I tell patients, when you put all the aspects of where you are in a blender, your age, your gender, your weight, your exercise, your diet, it comes out, you're hypertensive. We control it with the medications. We don't cure it. If you change something major in your lifestyle for the better, maybe. But because it's controlled, doesn't mean you stop the medication. So, well said.
DR. JONATHAN FIALKOW:
Next question is for Mike. We'll start getting into a couple of COVID questions. I actually had this text twice this morning from two different patients. As the height of the pandemic, subsiding, many questions are related to COVID-19, like we said. Do I, do patients need to get a booster if they've got the COVID vaccine already?
MICHAEL DECOSKE:
Thank you. Yeah. You know, it's a very understandable question. Because every night when we watched the news, there's something on there about the vaccine. There's something on there about booster shots. And so it's very rapidly changing. But I think what's prudent for us to do today is talk about what we know on September 9th. And I recognize that what we know next week or next month might change a little bit, but in healthcare, in general, when it comes to medications, we follow the guidance of the food and drug administration. And in an issue like with COVID and we also follow the guidance of the CDC, Center for Disease Control.
So that being said currently, for the general public or population, there is no recommendation for a booster shot. Now that's rapidly changing. And we do expect to get more guidance on that in the days to come. But for the general population, as of today, September 9th, no recommendation for a booster.
= = That said, what we would call a third dose of the Pfizer or the Moderna vaccine, has been recommended for those who are immunocompromised. Those who have a weakened immune system. You might be someone that has a weakened immune system if you're a transplant patient. If you received a transplant years back, or recently. Maybe you're actively receiving cancer treatment. There are other diseases that could cause you to have a weakened immune system. So for those patients, a third dose of that vaccine is recommended. Because they are particular susceptibility to get COVID and then to have kind of a bad outcome with COVID.
MICHAEL DECOSKE:
And so if you're not sure if you have a weakened immune system or not, and therefore should get that third dose or not, particularly of the Pfizer or Moderna vaccine, you should definitely talk with your doctor. I think it's important too, that you stay in touch with Baptist Health South Florida, because this information is ever changing. I think you could think of us as a trusted source for information. So, when there's more information to come out about whether you need to have a booster shot of the vaccine, we will be sure to let the public know.
DR. JONATHAN FIALKOW:
Thanks, Mike. It's a very articulate answer. And appropriate. It's a moving target. So as you said, right now, there's a difference between a booster, if you will, and a third dose in terms of the nomenclature. But stay tuned folks, and certainly speak to your physician who will be able to give you the proper recommendations at the proper time for that.
DR. JONATHAN FIALKOW:
Michael follow-up to that, which is another question I think we all get fairly frequently, if someone got the COVID-19 vaccine, should they get the flu vaccine?
MICHAEL DECOSKE:
Yeah. Well, the short answer is yes. The short answer to that question, yes. And this is a confusing one too because, sometimes when people have COVID, they say it's like, feel like they have a bad flu. And so then they can get mixed up. These are two different diseases, caused by two different viruses. They may cause your body to have similar symptoms, but because they're caused by two different viruses, they have two separate vaccines. And it's very important as we go into flu season here, we've started and we're going to get into the deeper part of flu season, as we get into the winter and late fall, it's very important that all eligible people get the flu vaccine. Also, even if they have already had the COVID vaccine. And there's a lot of information that's emerging about that. But I think it's important to remember if you're eligible for the flu vaccine, especially even pregnant women, go ahead and get the flu vaccine this year.
MICHAEL DECOSKE:
And remember, it's not just about protecting yourself. But getting the flu shot is also about protecting you from being able to spread it to loved ones or other vulnerable members of our community. I mean, imagine if someone got the flu and COVID at the same time. That could be really detrimental to them. So vaccination is one of the best tools that we have to help prevent that.
DR. JONATHAN FIALKOW:
Okay. So, we talked about some cardiovascular prevention. We talked about COVID. Switch gears again, and we're going to bring this one to Katie. And again, these are the most commonly searched medical questions. This one's about kidney stones. Talk a little bit about kidney stones, Katie. What causes them, what can people do to prevent them? What should people, what should people be on alert for?
DR. KATIE ACQUINO:
Sure. Yeah. I've never had a kidney stone, but having family members that have kidney stones, it is. It's a very painful, painful process that occurs. So, kind of go back to the idea of diet again. Believe it or not, a lot of the stones that we create are due to our diet. There are four types of stones we can create, but the most common is a calcium stone that, once again, has to do a lot with diet and something else called a uric acid stone.
DR. KATIE ACQUINO:
So some tips, we want to hydrate. If we hydrate correctly, our kidneys will function correctly. When we do not hydrate correctly, they're just not going to function. And then, it can perpetuate these stones. Also salt. Too much salt, just like it affects our blood pressure, it affects our kidneys. So we have to be careful with that salt intake. And also too much protein as well. We don't want to have too much protein or even sugar in our diet, all that affects our kidneys tremendously. So, certain things we can't help is once again, family members that have it, we are predisposed, but as far as, if you've had a kidney stone in the past, you also predisposed to having it again. But, the diet is something that we can help.
DR. JONATHAN FIALKOW:
Do most kidney stones require a patient to present to an urgent care or a hospital for hydration and pain care, pain therapy? Or would you say a lot just, go away at home? So when someone has the pain, do you urge them to get checked out quickly or see if you can ride it out at home and see if it'll go away on its own?
DR. KATIE ACQUINO:
Believe it or not, there's many of us that had stones and never even known we've had stones. We can pass stones pretty easily, as long as they're small enough. The problem is, when they become too large, they can't pass on their own. So, that's when we would have to go to the hospital. It's that excruciating pain that would require us to get some hydration, to get some pain medication. But, when we're experiencing pain, we are, our first bet is to run to an emergency room. But it's just one of those things where you have to know your pain tolerance and basically base it on that. But running to the urgent care or emergency room is not always necessary.
DR. JONATHAN FIALKOW:
Thanks.
DR. JONATHAN FIALKOW:
Switch it over to Lianna. And again, this is the search questions. Alcohol consumption we know has increased significantly, as people spend a lot of time at home. And we've done various public service educations about the concerns about alcohol consumption through COVID. But, the question is, how long does alcohol stay in one's system? And I guess the caveat of that would be, if someone drinks a lot, clearly they shouldn't get behind the wheel of a car or, what kind of recommendation we have with that. But how long does alcohol stay in one's system?
DR. LIANA BARKAN:
Alcohol metabolism will vary by person, as always. There is a littler person will metabolize it more quickly than somebody who might be a bigger body habitus. But generally, alcohol stays in your system between six and 12 hours. And that depends also on the quantity you drink and the type of alcohol you drink. It gets metabolized at a different rate. So for example, if you had, three beers, they have a general, that it takes five of alcohol to get out of your system. And a half-life is about five hours. So, that's like a total of about 25 hours. But again, it has to do with the alcohol content in what you're drinking. Like a beer might go faster than a hard alcohol because there's more alcohol in the shot of whiskey, than there is in a beer, like a 12 ounce beer.
DR. JONATHAN FIALKOW:
Mike, going back to you on a COVID 19 question. Something actually I wasn't even aware of, and I always love learning from guests during these Resource Lives. So the COVID-19 vaccine apparently can cause some temporary enlargement of lymph nodes. And apparently these can show up on mammograms. So speak a little bit where we think right now that if someone has the COVID-19 vaccine, is there a recommendation, is there a timing of not getting a mammogram too soon? Cause it may show some findings, not related, or related to the vaccine that we otherwise wouldn't be able to differentiate.
MICHAEL DECOSKE:
Yeah. And let's be clear. Both of these are extremely important and should not be, in general, delayed. If you're due for a screening mammogram, you need to get that done. The COVID vaccine is one of the single greatest things that we can do for our health care right now, in September of 2021, if we haven't already done it. That said, when the two come together, we just have to keep this in mind. Because it can cause a larger lymph node, and particularly we call it the axillary lymph node, that could show up as a false positive on your mammogram and then cause needless concern and next steps. So, the recommendation today is this: get your mammogram before the COVID vaccine or wait four to six weeks after your COVID vaccine series is complete, and then go ahead and get the mammogram.
DR. JONATHAN FIALKOW:
So it's fair to say that lymph node enlargement related to the vaccine is expected. That's normal. That's your body's reacting to the vaccine. It's more of a timing of the mammogram. And certainly we know there's a lot of delays in getting appropriate medical care and screenings through this COVID pandemic. So your points are well taken, which is to get your mammogram and get the vaccine. Just time them appropriately, based on that recommendation.
DR. JONATHAN FIALKOW:
Katie, question about sexually transmitted disease. What's HPV? A lot of HPV in the news, vaccines kids, et cetera. Speak a little bit about HPV. This seems to be a highly searched question on the internet.
DR. KATIE ACQUINO:
Sure. HPV is something called the Human Papilloma Virus. It's passed easily from person to person through sexual contact. So, it actually is the most common sexually transmitted infection. There's a lot of types of it. Some can cause warts and lesions in the genital area. Some can even cause cancer. And the crazy part is most people who are infected with HPV don't have symptoms. You can have it for a long time, not even know. You can even spread it without knowing it. So one of the key things here, is if you're a woman, have regular pap tests. These pap tests can help identify changes in cells that lead to cancer. You want to talk to your GYN about how often you need these tests. Currently, there's no approved tests for HPV in men, but there is HPV vaccine that can really help prevent some HPV infections and even related cancers, which is amazing. So you really want to speak with your healthcare provider to see if you're a candidate for that vaccine.
DR. JONATHAN FIALKOW:
Thank you.
DR. JONATHAN FIALKOW:
To Lianna. We all have heard about the freshmen 15, which has to do with weight gain when people start college. But now we have the quarantine 15, which we're certainly seeing as medical providers. A lot of people are home. A lot of people change their lifestyles. They've gained weight through COVID. What are you recommending to your patients regarding both recognizing this and getting back to a healthy weight if they've gained some weight? You're getting all the tough questions with all the variables. But-
DR. LIANA BARKAN:
No! That's okay!
DR. JONATHAN FIALKOW:
What are you actually seeing?
DR. LIANA BARKAN:
I actually thought it was the quarantine 19. They were trying to match it up with the COVID 19.
It's very hard and it's very challenging to maintain a healthy lifestyle, when the normal things that you have access to, you no longer have access to. We just moved down from the Northeast. And up there, there was nowhere to exercise. You couldn't go outdoors. It was really particularly challenging. Here, in South Florida, obviously people were a little bit luckier. But food was the biggest impediment to maintaining a healthy weight.
DR. LIANA BARKAN:
So, how many calories and whatnot a person should eat, again, is very variable. Based on your age and your sex and the weight that you're starting at. So, just as an example, people in, women between thirties and fifties who are, lightly active let's say, should be eating between 1200 and 1500 calories a day. But if you're more active, that number will go up. With men, their baseline caloric needs are higher than women. Or if you're highly active, your baseline caloric needs are higher. So you have to adjust it accordingly. Basically there are ways you can figure, there are actual calculations where you can figure out what your basic caloric needs are, and in order to lose weight, you want to do about 500 less than that. That's sort of like a roundabout way of figuring it out.
DR. JONATHAN FIALKOW:
Mike, a couple of quick hits, in the last few minutes we have. Does COVID-19 vaccine affect fertility?
MICHAEL DECOSKE:
I think that's a very good question and not surprisingly it's one of the most searched questions. Because we know that that is one of the things that has led to some vaccine hesitancy among our younger population. But think about this, through August in the United States, there have been 369 million doses of this vaccine administered. So with that kind of volume, we have a really good idea of its safety and its efficacy. So, regarding its impact on fertility, the answer is no. There's no evidence, with all those doses given, there's no evidence that COVID-19 vaccines impact either the menstrual cycle or fertility. And those who are trying to become pregnant or concerned about that in the future, don't need to avoid pregnancy at all, after they've received the COVID-19 vaccine.
DR. JONATHAN FIALKOW:
And in follow up to that, and I think that's well said. 369 million doses have been given. That's a large cohort of people to get knowledge from. If someone's had COVID, are we recommending they get vaccinated?
MICHAEL DECOSKE:
Yes. That's the short answer. If you've had COVID, like take some time to let your current active symptoms resolve and then at a convenient time after that will be appropriate to be vaccinated.
DR. JONATHAN FIALKOW:
Right. Right. We don't know how strong your immune response is and how long it lasts. So the vaccine we know, does as work.
DR. JONATHAN FIALKOW:
Let me throw this at Katie. It has to do with urinary tract infections. Can you tell us a little bit about the common symptoms of a urinary tract infection and when someone should seek professional help, for example, in an urgent care?
DR. KATIE ACQUINO:
Of course, yes. Urinary tract infection is one of the most common complaints walking into the urgent care. It's usually just, you feel like you have to go more. It might actually burn when you pee. You feel sometimes even hesitancy when you pee. You really do notice that something is wrong. But the most common is that there is a lot of pain. So, coming to an urgent care is very easy. We run your urine real quick and check it out. And if you need an antibiotic, we can prescribe it. It's no need to ever run to an emergency room with those symptoms, unless you have a crazy high fever or severe abdominal pain. But besides that, urinary tract infection very simple to take care of. And if you have those symptoms, you should get checked out.
DR. JONATHAN FIALKOW:
And again, very commonly searched cause very commonly occurring medical condition. Katie, last question for you. We'll give you the soap box. Tell us the difference between symptoms, if there are any, between flu and COVID.
DR. KATIE ACQUINO:
Ah, that's a tough one. That's a tough one. But, coming in and out of the urgent care, patients come in actually writing they have flu like symptoms. And right now the flu is not as prevalent. It's not the time of year, you can say. But both of them present very similar. But one of the ones that we noticed that a lot of patients complained about, is the loss of taste and smell. That is still a huge one. That's very strange to have with a lot of other viruses. So when someone complains of that, their test seems to be positive more than negative. But, a lot of the fever, cough, sore throat, pretty much all of the same symptoms. So it's hard to differentiate. That's why getting tested is so important, when you have those symptoms.
DR. JONATHAN FIALKOW:
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We’d love to hear your comments and suggestions for future topics. You can email us at Baptist Health Talk at baptisthealth.net. That's Baptist Health Talk at baptisthealth.net.
Thanks for listening and stay safe!