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FROM THE DOC
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DEALING WITH THE WORLD WE LIVE IN: KEEP CALM, AND CARRY ON
The new coronavirus infection in China has shown us just how interconnected we all are and it was particularly apparent when the fifth case of infection in the US was identified in Tempe, with others subsequent to that.
Sure, we all knew this virus could end up touching us at some point, but the issue became more apparent when we were put on the front lines with this news.....no time to wait.
There are many unknowns about the current coronavirus infection, in particular how deadly it is, how widespread it will become, and how much we individually have to worry about this issue, and how we prepare for ourselves and family. Let's review the issues:
- How deadly is this virus? Based on current information, it appears to be about 10 times more dangerous than the flu, but not nearly as dangerous as previous versions of this virus that we heard of in the past (SARS and MERS). It is CERTAINLY NOT on a par with lethal viruses like EBOLA.
- How widespread? It appears it is becoming widespread and will be an issue around the globe as time goes on. Human to human transmission is clearly happening, and it's even possible that this can take place with asymptomatic people. How frequently this occurs is unknown but very important in containing the outbreak.
- How much do we individually have to worry? For generally healthy people, the worry factor is very, very low, but for patients with serious lung and heart conditions (patients who are significantly symptomatic...not just labelled has having heart or lung issues that are being monitored), for patients with severe diabetes or on immune suppressing medications, or patients who are generally sickly....this infection has more impact and risk, and they need to be more concerned and attentive to preventive strategies.
- How do we prepare ourselves?
- First, are the basic precautions of hand washing and cleansing.
- Second, is to avoid people with respiratory infections to the best of your ability, but right now, with the spread limited, we do not need to treat such people as pariahs and avoid them completely, but rather consider being more cautious if there is evidence that the virus has landed in our community with some numbers (not just the limited amount seen.)
- Third, patients with underlying illnesses should be careful in the above areas.
- Fourth, exposure in travel situations needs to be considered, although not necessarily avoided. For instance....I would not avoid a plane trip at this time, but as time goes on, this may become something to consider or at least balance against alternative travel methods (personal vehicle). I would avoid trips to Asia if they are elective. I would definitely avoid cruises in Asia at this time. Avoiding air travel out of (not into) San Francisco, New York City, and LAX.....are a very slight consideration, given that these pose the higher risk for the virus.
At present, this is a developing issue that requires all of us to be attentive. We will keep you posted on latest developments here on our website. For now.....we shall do like the great British Quote: KEEP CALM, and CARRY ON.
Yours in good health,
- Dr. Lakin
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VOL 16 / Issue: #1
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Winter/ 2020
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2020 Message
'FROM THE DOC'
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As yearly events mark the passage of time, I do get to reflect on my work and my choices.....and overall, I'm satisfied with my path...... It's an interesting place in one's career.
I'm 57 years old now.... the age my father was when he retired back in 1991 after struggling with health issues. Fortunately, I am healthy, and I don't see any end in sight for my career. I am moving into my 30th years of practice (33rd as a physician) and I love what I do.
In giving my staff impressions for the upcoming few years in the office, I made the point that I have an impressive group of contemporaries from Johns Hopkins that I compare myself with.
My class is a group of outstanding individuals...and they've accomplished a great deal. They are..... Head of Oncology at Johns Hopkins, Head of Scientific Research at Johns Hopkins Medical School, Head of Urology at Johns Hopkins, Dean of Medicine at University of Indiana, the Dean of Meharry Medical School....and these are just the ones that I can readily identify. In addition, just a month ago, one of my medical chiefs (William Kaelin, MD) won the Nobel Prize in medicine for 2019. And this is just to name those whom I have readily heard about.
I, on the other hand, have pursued a more straightforward path, one of traditional practice, but I think in doing so we have created something special here in Scottsdale. Myself, and the entire staff, are dedicated to the principles that were inculcated in me at Johns Hopkins....that of excellence and care.
We were taught in training that: Excellence is not an act...it is a habit. You are what you do every day.
With this in mind, we strive, every day in this office, to be the best we can in providing personal attention and highest level medical care to those who seek our assistance and expertise.
With such accomplished medical brethren, I would feel satisfied with nothing less.
It is an honor to serve you now...and in the coming years.....and as my oldest patient, a 104 year old fellow, tells me....'you're just getting started.'
All the best.
Dr. Lakin
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February Is American Heart Month: 10 Tips for a Healthy Heart
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With Valentine's Day just around the corner, many view February as the month of love, but it is also
American Heart Month. Heart disease is the leading killer of Americans, taking the lives of 2,200 people each day. In addition, 103 million adults have high blood pressure and 6.5 million are living with heart failure. While genetic factors do play a part in
cardiovascular disease, the good news is 80 percent of cardiovascular diseases may be preventable with education and action. Simple lifestyle changes can make a big impact when it comes to heart health. Show your heart some love with these 10 tips.
1. Stop smoking
Quitting smoking is the best thing that can be done for the heart and for overall health. Smoking is the most preventable cause of premature death in the United States, and smokers have a higher risk of developing many chronic disorders, including atherosclerosis, or the buildup of fatty substances in the arteries. When combined with other heart disease risk factors, smoking increases the risks associated with those factors. Quitting is never easy, but there are lots of helpful
resources for those looking to start.
2. Know your numbers
Maintaining a healthy weight, blood pressure and
total cholesterol play a significant role in maintaining a healthy heart. While there are standard guidelines for
blood pressure and cholesterol, ideal weight goals are individual to each person. A physician can help determine an appropriate goal weight based on additional factors such as age and height.
3. Screen for diabetes
Untreated
diabetes can lead to heart disease, among many other complications. Diabetes can be easily detected through a simple blood test and managed a variety of ways under the care of a physician.
4. Get active
Heart pumping physical activity not only helps to prevent cardiovascular disease but can also improve overall mental and physical health. The American Heart Association recommends five 30 minute moderate exercise sessions each week. While this may seem daunting, it is important to note that these sessions can be broken up into two or three 10 or 15-minute segments throughout the day. Walking, jogging, biking and swimming are all great forms of exercise. It is important to remember that something is always better than nothing. Opting to take the stairs and parking farther back in the parking lot are great ways to squeeze in activity when the time is short.
5. Build some muscle
Strength training compliments cardiovascular exercise by toning muscles and burning fat. In addition, proper strength training can improve daily functional movements, decreasing the chance of injury. The American Heart Association recommends getting in two days of moderate to high-intensity strength training each week.
6. Eat smart
A healthy diet full of heart-smart foods is essential to a healthy heart and lifestyle. Salmon, nuts, berries, and oats are just a few of the heart "superfoods" that may help reduce the risk of atherosclerosis. Dark chocolate is also on the list and is a great way to satisfy a sweet tooth (in moderation).
7. Limit junk
To reap the full benefits of a heart-healthy diet, it's important to limit intake of nutrient-poor junk foods. Added sugars, saturated fat and excessive sodium can all negatively impact heart health, as well as overall physical health. These foods, when eaten in excess, can cause weight gain, raise blood pressure and clog arteries, which are all risk factors for heart disease.
8. Stress less
Stress increases cortisol, which leads to weight gain, a key risk factor for heart disease. In addition, stress can lead to other unhealthy habits, making it harder to stick to a heart-healthy program. Stress can also decrease overall happiness and increase the risk for anxiety and depression. Many of the items on this list can also help with
reducing stress, in addition to practicing positive self-talk and incorporating mindfulness meditation breaks throughout the day.
9. Sleep more
Sleeping restores the body, helps decrease stress and increases overall happiness. To reap the full benefits, clocking seven hours each night is key. A calming bedtime routine and going to bed and waking at the same time each day are all great ways to establish
healthy sleep patterns. Getting ample sunshine and physical activity throughout the day also aid in improving sleep quality.
10. Smile
A happy heart is a healthy heart. Making time for enjoyable activities and hobbies helps relieve stress and improves the overall mood, providing a great foundation for a heart-healthy lifestyle.
- BIOIQ
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LISTEN TO DOCTORDOUG ON THE FLU
SEASON. . . . .
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The FLU SEASON is here...
Take a listen to my latest
PODCAST ON THE FLU. Getting ready for this season..it's time. Remember....."Failing to prepare...is preparing to fail." Let's keep the FLU at bay......take a listen
>>>>HERE<<<<
Read more about he FLU below:
This information and other health topics can be found at....
DoctorDoug.com
The Flu
This is a specific viral illness that has similar and overlapping symptoms with common cold/respiratory viruses but is unique in that it is much more virulent (symptoms are significantly worse). This infection is specifically seasonal, typically in Arizona from November until March with the peak incidence in December, January, and February.
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
- High fever (often over 102 degrees, but can range from 99's to 104+)
- Aching muscles throughout the body
- Pain in the muscles around the eyes with movement of the eyes
- Sore throat
- Sinus congestion
- Severe cough
- Excessive mucous production (sinus and chest)
- Headache
- Occasionally diarrhea
What to Do at Home
Symptomatic treatment for the most bothersome symptoms
Aches and Pains and Fever:
- Use anti-inflammatory medication. Advil (Ibuprofen 200mg), 2-3 tablets....2-3 x per day or Aleve (naproxen 220mg), 1-2 tablets...1-2 x per day, or Tylenol 650-1000mg four times per day.
- Drink good amounts of clear liquids (anything you can see through)
Sore Throat:
- Dissolve 1 teaspoon of salt in a glass of warm water.
- Gargle for 15 seconds and spit.
- Repeat during the day every 2-4 hours to relieve pain.
- Pain relief medications: Advil (Ibuprofen 200mg), 2-3 tablets....2-3 x per day or Aleve (naproxen 220mg), 1-2 tablets...1-2 x per day, or Tylenol 650-1000mg four times per day.
Sinus Congestion and Drainage:
- Use a decongestant such as Sudafed 30mg, 1-2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
- Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
Cough:
- Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
- Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
- You may require a prescription cough syrup with Codeine. Contact me if that is the case.
When to Seek Medical Assistance
- If it's during flu season and you have high fever, aches and pains, and sore throat/cough....prescription treatment is reasonable to reduce symptoms and shorten the course of illness.
- Flu medication (Tamiflu..twice daily for 5 days) can shorten the course of symptoms. Earlier is better, but you can take this later in the course of the flu.
- Xofluza....single dose (2 pills) is best taken very early in the course of the flu (within 48 hours). It significantly reduces the duration and severity of symptoms in just one single dose.
Worsening symptoms/Signs of Complications:
- If fever is over 101 degrees and symptoms are worsening after 2-3 days and fever is persisting at a night level.
- If cough produces blood tinged mucous
- If confusion is associated with the above symptoms
- If you get a rash with the above symptoms
If any of the above symptoms occur.....you may want to be checked for complications of THE FLU. Come to the office to be evaluated
How Long to Recover
- The flu is a viral infection that will generally take from 3-5 days to improve and then from 7-14 days to completely resolve.
- Plan on being away from the general public for the first three days, although you may remain infectious for a week. Rest and drink fluids for the first few days then your activities are 'as tolerated.'
How to Prevent
- Avoid people who you know are significantly ill particularly during the flu season
- Consider getting the FLU SHOT. This is an immunization that is given in late summer through the winter and can markedly reduce your chances of getting the flu.
Wash your hands and use alcohol-based hand cleansers frequently.
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How To Wash Your Hands Properly, According To Doctors
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Believe it or not, there's a right way to wash your hands.
"As a doctor, I have to be really careful about keeping my hands clean and avoid spreading viruses from patient to patient. But when I'm
out at a restaurant
sometimes, I notice that people either wash their hands too quickly, don't use enough soap or worse, don't wash at all," says Segal. We've seen it too and, frankly, as hand-washing is the easiest way to prevent the spread of illness and disease, we'd like to encourage the practice. With flu season in full swing, we thought it might be helpful to ask Dr. Segal and
Timothy Laird, MD
, board certified physician from
Health First
, for their healthy hand-washing tips.
- Wet your hands (to the wrist) with clean, running water (the temperature doesn't matter). Turn off the tap, and apply a good amount of soap.
- Lather up the soap by rubbing your hands together. Don't forget to spread that lather to the backs of your hands up to your wrists, between your fingers, and under your nails.
3.
Scrub your hands for at least 20 seconds. Both doctors recommend
humming the "Happy Birthday" song from beginning-to-end twice to
get the timing right. "Before surgery, surgeons have to stand at the
scrub sink for 5 full minutes, and use an under-the-nail brush, and a
very strong soap with a scrub brush on each finger, both sides of
their hands, and scrub all the way up to their elbows. No one
expects the rest of us to scrub as much, but that gives you an idea
of what is needed to really kill most germs," Laird says.
4.
Rinse your hands thoroughly under clean, running water.
5.
Dry your hands using a clean paper towel (best bet), hand dryer
(OK), or let them air dry (in a pinch).
According to both doctors and the CDC, you should wash your hands:
- Before, during and after preparing food. "Keeping clean hands and clean food prep surfaces, like counters and cutting boards, and washing raw produce, are all ways to prevent diarrhea and other illnesses," says Laird.
Right before eating food.
Think of your hands as food utensils. "The main germ portals of entry to our bodies are our mouths and nose, and our hands," Laird explains. "Our
- hands inoculate germs into our bodies when they touch our face or food. We then ingest the germs and get sick."
- Before and after caring for someone at home who is sick with vomiting or diarrhea. Viruses that cause vomiting and diarrhea, like norovirus, are super contagious and hand-washing is your best line of defense to prevent going down yourself.
- Before and after treating a cut or wound to prevent infection.
- After using the toilet, changing diapers or cleaning up a child who has used the toilet - "even a microscopic amount of fecal matter can contain millions of germs," says the CDC.
- After blowing your nose, coughing or sneezing. Contagious germs from a sneeze can live in the air for hours, many different viruses can cause colds, and the influenza virus can live on a surface for minutes to hours after an infected person is exposed to it, says Segal.
- After touching an animal, animal feed, treats or animal waste. According to the FDA, pet food can be contaminated with bacteria that cause foodborne illnesses, such as salmonellosis and listeriosis.
- After touching garbage. Because, ew.
- Depending on where you are when you're washing, here a few things to keep in mind
- Be diligent at restaurants
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- When you go out to eat, you use your hands to open the door, pull out the chair and handle the menu. That's why washing your hands right before you eat will help keep germs at bay - and keep you healthier, says Segal.
- Be even more diligent in public restrooms
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- "The door to a public restroom - or most things in any restroom - are a hotbed of germs," says Segal. "That's why automatic sinks and paper towel dispensers work well against the spread of virus. You don't have to touch them." If those aren't available, use whatever is there and be sure to dry your hands thoroughly - germs cling to moisture, Segal explains. Hang onto your hand towel, or grab a new one, and use it to open the door to keep your hands clean. Not everyone washes their hands after using the restroom.
- Carry sanitizer
-
Hand-washing holds a slight edge over sanitizer
when it comes to keeping your hands clean, but a sanitizer that contains at least 60 percent alcohol can help stave off germs if there's no sink or soap around. "Rub it around your hands for at least 20 seconds, and until the hands are dry. It doesn't work if hands are very soiled or covered in oil, but it's a good alternative if soap and water aren't readily available," says Laird. "There are even a few germs that are better killed by the gel than soap and water. So, in healthcare settings, we try and do a bit of both. We use gel frequently and use soap and water hand scrubs after several gel uses."
-
Segal recommends bringing sanitizer wipes onto planes (very germy) and cleaning every surface that touches you, like the airplane seats, touch screen, belt and tray. Traveling across land? Use sanitizer on your hands after dealing with car service belt buckles, train seats and subway poles.
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All told, hand-washing is a fine art well worth perfecting. "Hand-washing is one of the best ways of keeping you and your family healthy," says Laird, who shared an anecdote about the 'father' of hand-washing (yes, there is such a person!), Dr. Ignaz Semmelweis, who studied the incidence of infections on the maternity wards in Vienna. "He discovered that the incidence of what was called 'childbed fever' could be dramatically reduced by the use of hand-washing in obstetric clinics. However, his findings conflicted with the established scientific and medical opinions of the time and he was mocked and rejected by the medical community. Doctors were offended by the thought that they may be the cause of the infections. He couldn't offer a scientific explanation of his findings, as the discovery of germs as a cause was still years away. He suffered a nervous breakdown and was committed to an asylum where he passed away. The wisdom of hand-washing was only embraced years later when Louis Pasteur and Joseph Lister discovered Semmelweis was right all along."
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Poor guy. But thanks to him, we probably get to live a bit longer
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By Vivian Manning-Schaffel
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How To Ease the Pain of New Year High-Deductible Plans. . . . . .
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 Here are some tips to get relief from high deductible costs, from patient advocates.
The New Year often starts harshly for people with high-deductible health insurance.
Many deductibles reset Jan. 1, forcing patients to pay thousands of dollars for care or prescriptions before most insurance coverage starts. Such a financial hit can be brutal for patients with cancer or a chronic condition, some of whom may have just satisfied the previous year's deductible the month before.
More patients are using tax-exempt health savings accounts to set aside money that can soften this early-year crunch. But there are no simple solutions to erase the problem for those without such accounts or the means to stock them.
However, patient advocates see several ways to get relief. Here are some examples.
Know the coverage
It's hard to plan for a big expense when you don't understand your financial exposure.
Patients should know the size of their deductible and what they must pay after satisfying it. Insurance plans can require patients to continue footing a portion of their bill for care until they hit their out-of-pocket maximum for the year.
It's a good idea to review these requirements annually. Double check the coverage of any regular prescription drugs too, in case that has changed.
Some companies make certain medications like diabetes drugs exempt from high deductibles so patients can continue to receive regular care.
It's also worth double checking the balances in any health savings or flexible spending accounts you have. There might be some forgotten money in there.
Online resources
The Internet is full of websites offering help with medical expenses.
JDRF, a nonprofit that funds diabetes research, has corralled more than a dozen links on its
website. It lists help from drug and medical device makers, as well as connections to prescription discount cards and patient-assistance databases.
The site lists every avenue JDRF is aware of to get people help, said Jesse Bushman, senior health policy director.
Another non-profit, Patient Advocate Foundation, also maintains a
site to connect patients with assistance.
Separately, Patient Access Network Foundation offers grants to help pay drug costs from almost 70 disease-specific funds. That non-profit mainly helps those with Medicare prescription drug coverage and touts an application process that takes only a few minutes. People can apply by phone or
online.
Patients should check with their insurer if they use a drugmaker's financial assistance to fill a prescription. Some plans will not count that amount toward meeting a deductible. That means you might get the prescription but still have a big deductible hole to fill.
Help yourself
You may be able to pare some expenses by shopping around. Your insurer may offer an app or an online tool to help with that.
The cost of an imaging exam can vary greatly depending on whether it's done at a hospital or a separate imaging center. A telemedicine call or drugstore clinic can be cheaper than a doctor visit for minor illnesses.
For more extensive care, the doctor's office may be willing to put patients on a payment plan so they don't have to absorb the full financial hit at the start of the year.
If faced with a particularly daunting bill, patients should ask doctors if they can recommend a less-expensive alternative. But they also should understand whether the cheaper option is equally effective.
Always make sure the care providers you use are in your health insurer's network. Deductibles and other payments can be higher for care sought outside it.
"What we recommend is kind of to be crafty about how you approach your health care spending and plan as much as you can," said the Patient Advocate Foundation's Caitlin Donovan.
Avoid skipping care entirely because of the cost. That may make your condition worse, and the unpaid deductible you're trying to avoid might still need to be satisfied.
- Associated Press, 1/2020
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Dr Lakin's New Book:
The New Guide
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Dear Patients,
This guide is one of a series of books meant to provide simple answers for day-to-day health questions. It is my effort to pass on 55 years of wisdom accrued as a child of a physician and as a Johns Hopkins-trained internist with over 30 years in practice. I hope this advice is helpful to you and your family. It's actually meant for my own.
DoctorDoug
Paper copy available in our office or you can read it online....
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Would You Like to be 'Paged' for Your Appointment?
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We have brought back the option to wait outside the office for your appointment and be 'paged' when it is your time.
Yes, now you have the option to wait outside the office; in the main lobby or even in your car!
When it is time for your appointment, we will page you so you can avoid close contact with any possible environmental infections.
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Sarah & Her Little Helper
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Simply check in at our front desk, then we will give you a pager to keep in touch. It is that easy!
Stay healthy my friends!
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GET ON BOARD
THE Q STRESS SYSTEM!
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'After 30 years our old treadmill machine finally gave up the ghost and conked out. State of the art in 1990, it was a workhorse and provided rather impressive results for heart screening in our patients .
As a result, we have now purchased the 2019 state-of-the-art treadmill to carry on with cardiac screening for patients at risk for heart disease.
The new equipment has cutting edge computer technology and systems that make it a pleasure to use and a pleasure to run on.
If you have concerns about your heart, we can consider doing a treadmill test to allay concerns about potential troubles.
Let's discuss this at your next physical exam. I'm excited to be able to carry on our high level of cardiac screening for out patients!'
Dr. Lakin
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What Determines Your Tooth Color?
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Dr Marie Jacobs
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Introduction
Tooth color is one of the most important factors in dental and facial esthetics.
Extensive studies have been done regarding tooth color correlations using a variety of technologies. Results have basically concluded that skin and eye color significantly correlate with tooth color; however, certain teeth in the arch do not correlate significantly with eye color. It was also concluded that tooth shade value is significantly influenced by age. Younger subjects have lighter tooth shade values. In addition, the illusion of greater contrast between skin color and tooth shade explains the visual perception that individuals with darker skin color have lighter shades of teeth.
When the color of dental restorations is being considered, color is a significant factor affecting dental appearance of maxillary anterior (the upper front) teeth in patients and, therefore, the clinician must be very careful in choosing the appropriate one by using reliable tools. The knowledge of human tooth color and its distribution are extremely important in aesthetic dentistry.
"Normal" tooth shade
The appearance and perception of tooth color is the result of a complex interaction of factors such as lighting conditions, translucency, opacity, light-scattering , gloss, and the human eye and brain. Of these, the intrinsic pigmentation (color within the tooth structure) of a tooth is the most influential which is determined by genetic and natural factors. Light hitting a tooth undergoes reflection, absorption and transmission by varying degrees in each tissue layer of the tooth substance. Reflected light detected by the human eye determines the perceived appearance of a tooth.
Teeth have a relatively thin enamel layer on the outer surface. The enamel layer is whiter and semitransparent, and contributes blue, pink-green tints to the tooth color. The underlying dentin layer is darker than enamel, yellow/brown in color, and less transparent. Dentin forms the bulk of the tooth substance and contributes most to the overall tooth color. At the core of the tooth is soft connective tissue termed the dental pulp. The pulp is pink/red due to its vascularity (artery, vein, nerve), but is rarely visible through the overlying enamel and dentin unless the thickness of these layers is reduced by tooth wear (or rarely internal resorption).
Public opinion of what is normal tooth shade tends to be distorted often by portrayals of cosmetically enhanced teeth.
Tooth color varies according to race, gender, and even geographic region. Females generally have slightly whiter teeth than males, partly because females' teeth are smaller, and therefore, there is less bulk of dentin, partially visible through the enamel layer. For the same reason, larger teeth such as the molars and the canine (cuspid) teeth tend to be darker. Baby teeth (deciduous teeth) are generally whiter than the adult teeth that follow, again due to differences in the ratio of enamel to dentin.
Tooth discoloration is abnormal tooth color, hue or translucency and should be considered. External discoloration (extrinsic) is accumulation of stains on the tooth surface. Internal (intrinsic) discoloration is due to absorption of pigment particles into tooth structure. Sometimes there are several different co-existent factors responsible for discoloration.
Extrinsic discoloration causes
Extrinsic discolorations are common and have many different causes. The same variety of causing factors can possibly stain the surface of restorations - such as non-metal fillings/crowns, composite fillings, porcelain facings or crowns. Some extrinsic discolorations which remain for a long time may become intrinsic.
Dental plaque: Although usually virtually invisible on the tooth surface, plaque may become stained by chromogenic bacteria, which have pigment/color-producing substances, that can stick to tooth enamel.
Calculus: Neglected plaque eventually calcifies and leads to formation of a hard deposit on the teeth, especially around the gumline. The color of calculus varies, and may be gray, yellow, black or brown.
Tobacco: Tar in smoke from tobacco products (and, also smokeless tobacco products) tends to form a yellow-brown-black stain around the necks of the teeth above the gumline.
Certain Foods and Drinks: Foods such as vegetables or colored liquid drinks, that are rich with carotenoids or xanthonoids can stain teeth. Generally, any food or drink that can stain clothes can also stain your teeth. This is the reason dark-colored foods and beverages, including red wine, colas, chocolate and dark sauces - such as soy sauce, balsamic vinegar, spaghetti sauce, and curries - can discolor teeth. In addition, some fruits and vegetables - such as grapes, blueberries, cherries, beets, and pomegranates - have the potential to stain teeth. These items are high in pigment-producing substances, chromogens, that can stick to tooth enamel. Popsicles and candies are other foods likely to stain teeth. An exception to this food-color/staining phenomenon is apples. Apples are light colored, but contain a ripening chemical, polyphenol oxidase, that also causes them to turn brown. This same oxidation occurs in the mouth when apples are eaten and resulting stains may become embedded in enamel. Apples are healthy snacks and are beneficial after a meal since they are mildly acidic and help "clean" teeth surfaces. Simply rinsing with water after eating an apple can prevent potential staining.
Acidic food and beverages can promote staining by eroding tooth enamel and making it easier for pigments to latch onto the teeth. Tannin, a bitter compound found in wine and tea, also helps chromogens attach to tooth enamel, which ultimately causes staining. However, good news for tea drinkers is that a 2014 study published in the International Journal of Dental Hygiene found that adding milk to tea reduces it chances of staining teeth because the proteins in milk can bind to tannin.
Chlorhexidine (antiseptic mouthwash) binds to tannins, indicating that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining of teeth.
Cetylpyridinium chloride: This is found in many antimicrobial mouthwashes and can result in staining due to dead bacteria residue.
Metallic compounds: Exposure to such metallic compounds may be in the form of medication or other environmental exposure. Examples include iron (black stain), iodine (black), copper (green), nickel (green), and cadmium (yellow/brown).
Antibiotics: Some antibiotics may form insoluble complexes with calcium, iron and other elements that cause extrinsic staining.
It is noted that tooth whitening tends to be more effective on extrinsic teeth discoloration.
Intrinsic discoloration causes
Causes of intrinsic discoloration generally are those that occur early, during tooth development, and those that may be acquired later in life.
Dental caries: Tooth decay typically begins as an opaque white spot on the surface of the enamel. As demineralization progresses, the lesion eventually cavitates and the underlying brown color becomes visible.
Excess Fluoride: Fluorosis may occur when there is chronic and excessive exposure to fluoride during the years of tooth-development. Fluoride is a naturally occurring mineral in water, although some regions have higher levels than others, and in many areas, fluoride is added to water supplies in low levels to help prevent tooth decay. Exposure can also occur via bottled water and fluoride toothpaste. In its mildest form, fluorosis appears as small opaque white flecks on the enamel surface. More severe cases show severely hypoplastic (white) patches of enamel, which are also prone to the accumulation of surface stains. Chronological, fine white bands of fluorosis may be seen that correspond to times of high exposure to fluoride.
Trauma and pulp necrosis: Dental trauma may result in discolorations. Following heavy impact injuries, red discoloration may develop almost instantly. This is due to severance of the venous microcirculation to a tooth, while the arteries continue to supply blood to the pulp. The blood is then decomposed gradually, and a blue-brown discoloration develops. Falls or sports injuries in young children can also disturb the formation of tooth enamel when children's permanent teeth are still developing and can result in a grayish appearance. Similar injuries that damage the nerves or chip teeth in adults may also lead to a discoloration of permanent teeth. In addition, people who grind their teeth excessively, often while sleeping, may slowly remove the outer layer of tooth enamel exposing the yellowish dentin beneath it.
Teeth may turn gray from a trauma induced pulp necrosis (death of the pulp). The resulting discoloration typically develops weeks or months after an injury and is caused by incorporation of pigments released during the breakdown of the pulpal tissue and blood in the dentin. Pulp necrosis may also occur as a result of extensive tooth decay; however, it may also follow dental trauma or extensive removal of tooth structure during preparation prior to restoration.
Yellow discoloration may occur following pulp canal obliteration and subsequent root canal treatment.
Internal resorption: This may occur for an unknown reason or sometimes following dental trauma. In this case, the dentin is resorbed and replaced instead by hyperplastic (over-grown), vascular pulp tissue. As this process approaches the external surface of the tooth, a pink hue of this replacement pulp tissue may become visible through the remaining overlying tooth substance. This appearance is often termed "pink tooth."
Internal staining, for various reasons, is quite common following root canal treatment. It can be a result of the canal filling materials and their effect on the dentin, or the result of the tooth's circumstances prior to the root canal treatment.
Amalgam fillings often stain tooth material. This is particularly seen in very old amalgam restorations. In addition, metallic fillings cast a shadow that can be visible through the tooth and make it appear darker.
Medications can be incorporated into teeth, cartilage, and bone. Tetracycline (no longer widely used) is a broad-spectrum antibiotic, and its derivatives, minocycline being one, are common treatments for acne. These are examples of such medications. Ingestion of these types of drugs during the years of tooth development causes a yellow-green discoloration of dentin, which is visible through the enamel. After the tetracycline oxidizes, the staining results in a more brownish hue. Because tetracyclines cross the placenta, a child may have tooth staining if the drugs are administered during the mother's pregnancy. Even some relatively common drugs, such as antihistamines, antipsychotics and blood pressure medications can sometimes yellow teeth.
Genetic disorders can affect tooth development (odontogenesis) and lead to abnormal tooth appearance and structure. Conditions which affect the development of tooth components or the calcification can result in teeth that are discolored and affected in such ways as to render the teeth more susceptible to further staining acquired throughout life.
Systemic medical treatments can produce tooth discoloration. Undergoing chemotherapy as well as radiation to the head and neck can result in intrinsic stains.
Aging - intrinsic discoloration tends to accompany aging. Throughout life deposition of secondary dentin occurs along the internal walls of the pulp chamber. Secondary dentin is darker and more opaque than primary dentin. This gives the dentin an overall darker appearance. At the same time, the enamel layer is gradually thinned by tooth wear processes such as attrition and acid erosion, a degree of which is considered normal.
Management, Prevention, and treatment
Management of tooth discoloration depends on the cause. Most discoloration is harmless and may or may not be of cosmetic concern to the individual. However, In some cases it may indicate underlying pathology such as pulp necrosis or, rarely, a systemic disorder.
The best prevention for tooth discoloration, particularly extrinsic staining, is closely monitoring what foods and beverages are consumed. It may possibly be helpful to use a straw to minimize the time that fluids remain on the surfaces of teeth and rinse with water after consuming foods or drinks that may stain. Also, and importantly, maintaining good oral hygiene is crucial - exercising appropriate daily home care and seeking professional oral hygiene care. Doing so will prevent not only the buildup of extrinsic discoloration, but also potential caries and periodontal disease.
To address intrinsic discoloration generally requires consultation with an oral health care provider. One of the many types of tooth bleaching/whitening may be recommended or the application of dental restorations. There are numerous treatments available that can be performed which could lead to a bright, healthy smile.
Here's to your good health.
Marie C. Jacobs, D.D.S.
Professor Emerita Loyola University Chicago
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Genetic Testing By Myriad, Available In Our Office Now. . . . .
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The Myriad Hereditary Cancer test is a 28-gene panel that identifies an elevated risk for eight hereditary cancers:
Genetic screening is now a practical tool that we can use to help in the management of your health and the health of your family. It is recommended by the USPTF (United States Preventive Services Task Force.) This has implications for you, but also for your family, and I think it is worthwhile to consider.
We are at the beginning stages of applying this science in the clinical setting, so it is of limited scope of application. I want to help determine if it can be applied to your particular family history. This questionnaire is meant to do just that.
- Determine if you are at risk for cancers that run in the family
- Determine if genetic testing, at it's current state of development, is applicable to your situation
- Have the testing done to determine the best monitoring strategy, as well as helping guide you and your family in future testing and monitoring.
You will notice that this questionnaire has a specific focus on certain cancers, as that is the state of practical application of current genetic testing.
We are using a 24-gene panel from Myriad labs, the inventors of the BRCA test, which was the first large-scale genetic test validated for breast cancer family history.
For now, only a select group of patients can benefit. In the future, genetic testing will become commonplace and perhaps done routinely for everyone.
Answer the following questions and we will determine if you can benefit from this testing right now.
As for the cost, insurance coverage, and privacy issues related to such testing, this will be answered prior to running the test, so feel free to provide this information to initially see if you can benefit.
The process:
Complete this questionnaire
Submit a specimen of saliva (spit test).....this will be the material that is genetically tested.
Myriad labs will contact you to review cost, insurance, and privacy issues before any testing is performed.
Once completed, you will receive a detailed report and we can review it together to determine the best strategy for monitoring your health on an ongoing basis, as well as having specific advice for monitoring of your family members.
In the future, should additional testing become available that is valid to do, your current information will be used in such an analysis.
** Click HERE for more information and to take the Myriad Genetic test
to see if you are at risk.
If you think you are at risk and would like more information, please contact our office to schedule an appointment with Dr Lakin.
'Knowledge is Power!'
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DR. LAKIN'S NEW SECURE PATIENT PORTAL
'MyHealthRecord.com'
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Dr. Lakin and staff are very excited to announce we have upgraded our secure patient portal!
We changed vendors, and our new secure portal,
MyHealthRecord.com, is easier to use and easier for us to respond to your requests.
At your convenience
- View your health record from any Internet-enabled device
- Exchange secure messages with Dr. Lakin or our staff
- Request and manage appointments
Anytime access
- Lab orders
- Test results
- Upcoming appointments
- New Document and articles from Dr Lakin
To access our new patient portal, MyHealthRecord.com, you are required to complete a short questionnaire. This is a very simple process.... quick and easy. If you need assistance, we are always here to help.
Call us for your invitation email!
It will give you all the information you need to use our secure portal, MyHealthRecord.com, for your medical care!
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TOM'S TRAVELS:
Chile: A Long and Slender Delight. . . .
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Santiago, the capitol and largest city in Chile, is a contrast between the old and the new in architecture and was the starting point for our visit. Our first excursion took us to a lapis lazuli gem museum and store where we admired this Andes Mountain mining p
roduct. Then on to a winery with tour by the owner and dinner there of local specialties. I have always enjoyed the sauvignon blanc white wine from this region. 
An all day trip took us to the coastal port of Valparaiso, the San Francisco of Chile due to its hilly terrain and port activity. We rode a historic funicular to the upper town for a view and tour of poet Pablo Neruda's home, a Thanksgiving Day lunch of chicken, and witnessing up close a student demonstration in favor of free university tuition. 
Driving south to the small port city of Puerto Varas, the tour leader had us take part in a marketplace search for a rare product each small group had and return with it at the lowest price we could bargain for. A visit to a colony of German expats from years ago had a wonderful museum of German artifacts including an impressive huge music box larger than a grandfather's clock. 
Finally a visit to the volcanic region's national park where we walked among waterfalls and visited a working ranch. A lesson by Chilean cowboys call huasos (not gauchos which is Argentnian) on rodeo contest events capped by a dinner there was a highlight of Chile.
A snag in the tour had us take a bus crossing the Andes into Argentina rather than fly due to debris from an active volcano whose dust covered homes, shrubs, and terrain along the way as if we were traversing an eerie and ash covered planet. 
I would be happy to share travel info with you at my email:
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Rx Prior Auth News From Jeff
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We Say Hello, They Are Saying Bye Bye
 Hello? Is there anyone there? Trying to call your health insurance plan or Prescription Benefit Manager (PBM) only to be screened and "greeted" by a robotic voice-system and then turned over to a long phone menu filled with choices but short on answers? Welcome to the new world of business non-telecommunications.
Is it most noticeable while trying for medication prior authorizations (PAs). Unfortunately, it's become harder to speak with a live person to ask questions or get assistance or customer service when your prescription medications are denied payment. Health insurance plans and PBMs are moving further into the background. The trend has curtailed live phone support to increasingly 'employ' robotic phone systems for "customer service" requirements. It may say a lot about artificial intelligence (AI), but the lack of direct contact speaks much louder. They are turning a deaf ear to their subscribers. Shunning transparency.
Businesses today, healthcare included, almost require callers to submit their questions and requests by email, chat, blogs or websites. Social media ad nauseum. The privilege of speaking with a person is not offered. There used to be ways or workarounds to bypass a lengthy phone menu, "Press O for operator now" for instance, but that simple option has disappeared from most phone-system choices. What they offer limits what you can find out, any custom selection seems 'non-formulary' and not available.
When we receive a prior authorization (PA) request from a pharmacy or patient and are given a toll-free number to call, seemingly as a help, that traditional route is useless mostly. The last thing we do when initiating a PA is to call insurance or PBM call-centers. If we can get thru to, speak with and understand an agent - there are many foreign call centers with accent issues - we must still provide support data, labs and forms to present a plausible case for a patient to be granted a denied medication. We must prove "medical necessity" despite insurance rejections for one of many reason(s), e.g., non-formulary, step therapy, generic vs brand, high-risk medication, tier exception, opioid allowance, etc.
A common misconception is that medical offices have better phone numbers to call and speak with insurers or PBMS than patients do. No so. Whenever we must resort to calling a health plan or PBM, we must navigate and endure the same possibly long and tenuous phone menu and re-directs as our patients. And we must have patience. We will take this route if our earlier attempts by fax or computer (an electronic-PA or ePA) are stalled, go unanswered or are rejected for seemingly no good reason.
In the latest wrinkle, many insurers and PBMs are "retiring" fax numbers as well and only accept PAs submitted electronically (ePAs). They continue to pull direct contact further into the background and make it even harder to reach a live agent. At the same time, any also encourage medical offices to sign up and submit PAs, as a "service," only thru their proprietary online medication screening systems, meaning more menus, ID numbers and passwords to keep, navigate and manage.
 According to the GoodRx website, health insurers and PBMs dropped over 90 medications from their preferred, or formulary, listings in 2019. In 2020, GoodRx says a larger number of medications - 300+ - were dropped by major insurance formularies and PBMs. The need to initiate a prior authorization grows larger as well.
Our office, however, hears you loud and clear. We continue to pay close attention to our patients' requests. We answer our phones and support our patients' medical prescription needs. If a therapy makes sense, regardless of the medication, we will pursue the most reasonable and best results on your behalf. It's not a bother but a benefit. And that may require placing numerous and lengthy phone calls. We're reversing the trend towards non-telecommunications - one call at a time.
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Doctor's Visits:
Why Checkups Are Vital. . . . . .
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Annual Physicals 101:
When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you've grown older, you may have gotten out of this habit.
Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor's visit will help you live a long and
healthy life.
It is also very important for you to play an active role to get the most out of your doctor's visit. Before your exam, review and update your family health history, be prepared to ask if you're due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.
During your actual doctor's visit, don't be shy about getting your questions answered. Also, if the doctor gives you advice about specific health issues, don't hesitate to take notes. Time is often limited during these exams, but by coming prepared you're sure to get the most out of your checkup.
Have you scheduled your physical for 2019 yet?
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Heart-Shaped Lasagna Bundt
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Ingredients
Kosher salt and freshly ground black pepper
One 16-ounce box lasagna noodles
2 tablespoons olive oil
1 medium onion, chopped
3 cloves garlic, minced
1 1/2 teaspoons dried oregano
1 1/2 pounds ground beef
One 6-ounce can tomato paste
One 28-ounce can crushed tomatoes
2 teaspoons sugar
12 ounces ricotta
8 ounces shredded mozzarella (2 cups)
2 large eggs
1/2 cup grated Parmesan
1/4 cup chopped fresh flat-leaf parsley
Directions
Special equipment: a 10-cup heart-shaped Bundt pan
- Preheat the oven to 375 degrees F.
- Bring a large pot of salted water to a boil and cook the lasagna noodles to al dente according to the package directions. Line a baking sheet with a clean kitchen towel or paper towels. Drain the noodles and spread them flat on the baking sheet to dry them completely (you may need to create 2 to 3 layers to fit all of the noodles; put paper towels between each layer).
- Meanwhile, heat the oil in a large pot over medium-high heat. Add the onions and cook, stirring occasionally, until softened and just beginning to brown, 7 to 8 minutes. Stir in the garlic and oregano and cook until the garlic is fragrant, about 1 minute. Add the beef, 2 teaspoons salt and a generous amount of black pepper, and cook, breaking up the meat with a spoon and stirring occasionally, until the beef is just cooked through, 7 to 8 minutes. Stir in the tomato paste and cook until well incorporated and heated through, 1 to 2 minutes. Pour in the tomatoes, sugar, 1 cup water, 1 teaspoon salt and a generous amount of black pepper and bring to a boil. Reduce the heat to low and simmer until the sauce is slightly thickened, about 20 minutes.
- Meanwhile, mix the ricotta, mozzarella, eggs, Parmesan, parsley, 1/2 teaspoon salt and a few grinds of black pepper in a medium bowl.
- Cut six noodles in half crosswise.
- Line the bottom of a 10-cup heart-shaped Bundt pan with 4 of the half noodles (2 along the straight lines of the heart and 2 along the arches). Lay 12 whole noodles in the bottom of the pan, slightly overlapping and directly on top of the half noodles, making sure that one side of each noodle hangs 2 to 3 inches over the edge of the pan and the other side of the noodle runs up the center of the pan.
- Pour 1 cup meat sauce on top of the noodles, then spread 1 cup of the ricotta mixture over the sauce. Top with 4 noodle halves. Repeat the layering 1 more time. Pour 1 cup meat sauce and spread the remaining ricotta mixture over the top (the ricotta mixture will be less than the 1 cup used in previous layers).
- Fold the edges of the overhanging lasagna noodles the lasagna towards the center, covering the filling and the hole in the center completely. Bake until the noodles on top are turning golden brown and are starting to crisp up, 45 to 50 minutes. Let sit for 10 minutes. Invert the pan onto a cutting board. Reheat the remaining sauce if necessary and pour into the center of the heart. Slice and serve immediately.
- By Food Network
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Insights By Steve: Check it Out!
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Insight By Steve (Author)
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"Five Foods That Fight Sunburn"
.... and more news you can use!
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We Need Your Help!
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 Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
Tips:
1. If you need a refill, be sure to call your pharmacy FIRST, not our office. They will know if you have more refills, and if not, they will call/fax/electronically message us with your request. Then we will contact you if there is a question or concern.
2. Remember to call your pharmacy in plenty of time so you do not run out of your medications. Sometimes we need up to 48 hours to complete a request and we do not want this to be a hardship for you.
3. Register and use our SECURE PATIENT PORTAL for refill requests. We monitor this continually and again will contact you if there is a problem.
4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office. We cannot mail or any medications outside our office. Please plan ahead and make arrangements!
We are always here to help you and appreciate the opportunity to care for your healthcare needs!
Yours in good health,
Dr. Lakin & Staff
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Have a Safe & Healthy
Winter!
Dr. Douglas Lakin & Staff
Paradise Valley Medical Clinic PC
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