Hospitals worldwide are short of saline. We can’t just switch to other IV fluids – here’s why
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Last week, the Australian Therapeutic Goods Administration added intravenous (IV) fluids to the growing list of medicines in short supply. The shortage is due to higher-than-expected demand and manufacturing issues.
Two particular IV fluids are affected: saline and compound sodium lactate (also called Hartmann’s solution). Both fluids are made with salts.
There are IV fluids that use other components, such as sugar, rather than salt. But instead of switching patients to those fluids, the government has chosen to approve salt-based solutions by other overseas brands.
So why do IV fluids contain different chemicals? And why can’t they just be interchanged when one runs low?
We can’t just inject water into a vein
Drugs are always injected into veins in a water-based solution. But we can’t do this with pure water, we need to add other chemicals. That’s because of a scientific principle called osmosis.
Osmosis occurs when water moves rapidly in and out of the cells in the blood stream, in response to changes to the concentration of chemicals dissolved in the blood plasma. Think salts, sugars, nutrients, drugs and proteins.
Too high a concentration of chemicals and protein in your blood stream leads it to being in a “hypertonic” state, which causes your blood cells to shrink. Not enough chemicals and proteins in your blood stream causes your blood cells to expand. Just the right amount is called “isotonic”.
Mixing the drug with the right amount of chemicals, via an injection or infusion, ensures the concentration inside the syringe or IV bag remains close to isotonic.
What are the different types of IV fluids?
There are a range of IV fluids available to administer drugs. The two most popular are:
- 0.9% saline, which is an isotonic solution of table salt. This is one of the IV fluids in short supply
- a 5% solution of the sugar glucose/dextrose. This fluid is not in short supply.
There are also IV fluids that combine both saline and glucose, and IV fluids that have other salts:
- Ringer’s solution is an IV fluid which has sodium, potassium and calcium salts
- Plasma-Lyte has different sodium salts, as well as magnesium
- Hartmann’s solution (compound sodium lactate) contains a range of different salts. It is generally used to treat a condition called metabolic acidosis, where patients have increased acid in their blood stream. This is in short supply.
What if you use the wrong solution?
Some drugs are only stable in specific IV fluids, for instance, only in salt-based IV fluids or only in glucose.
Putting a drug into the wrong IV fluid can potentially cause the drug to “crash out” of the solution, meaning patients won’t get the full dose.
Or it could cause the drug to decompose: not only will it not work, but it could also cause serious side effects.
An example of where a drug can be transformed into something toxic is the cancer chemotherapy drug cisplatin. When administered in saline it is safe, but administration in pure glucose can cause life-threatening damage to a patients’ kidneys.
What can hospitals use instead?
The IV fluids in short supply are saline and Hartmann’s solution. They are provided by three approved Australian suppliers: Baxter Healthcare, B.Braun and Fresenius Kabi.
The government’s solution to this is to approve multiple overseas-registered alternative saline brands, which they are allowed to do under current legislation without it going through the normal Australian quality checks and approval process. They will have received approval in their country of manufacture.
The government is taking this approach because it may not be effective or safe to formulate medicines that are meant to be in saline into different IV fluids. And we don’t have sufficient capacity to manufacture saline IV fluids here in Australia.
The Australian Society of Hospital Pharmacists provides guidance to other health staff about what drugs have to go with which IV fluids in their Australian Injectable Drugs Handbook. If there is a shortage of saline or Hartmann’s solution, and shipments of other overseas brands have not arrived, this guidance can be used to select another appropriate IV fluid.
Why don’t we make it locally?
The current shortage of IV fluids is just another example of the problems Australia faces when it is almost completely reliant on its critical medicines from overseas manufacturers.
Fortunately, we have workarounds to address the current shortage. But Australia is likely to face ongoing shortages, not only for IV fluids but for any medicines that we rely on overseas manufacturers to produce. Shortages like this put Australian lives at risk.
In the past both myself, and others, have called for the federal government to develop or back the development of medicines manufacturing in Australia. This could involve manufacturing off-patent medicines with an emphasis on those medicines most used in Australia.
Not only would this create stable, high technology jobs in Australia, it would also contribute to our economy and make us less susceptible to future global drug supply problems.
Nial Wheate, Professor and Director Academic Excellence, Macquarie University and Shoohb Alassadi, Casual academic, pharmaceutical sciences, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Everything you need to know about cervical cancer
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Every year, around 11,500 new cases of cervical cancer are diagnosed in the U.S. While cervical cancer used to be one of the most common causes of cancer death for U.S. women, the vaccine against the human papillomavirus (HPV), and increased early screening and detection have resulted in a decrease in rates.
“Cervical cancer is almost always preventable and typically diagnosed in patients who have either never had a screening test or have gone many years without one,” says Fred Wyand, director of communications at the American Sexual Health Association, which includes the National Cervical Cancer Coalition.
January is Cervical Cancer Awareness Month, so we spoke to experts to learn more about what it is, its symptoms, and what you can do to prevent it.
What is cervical cancer?
Cervical cancer is a type of cancer that starts in the cervix—the lower part of the uterus that connects the vagina to the uterus. Cervical cancer can affect anyone with a cervix but is most frequently diagnosed in women ages 35 to 44, according to the American Cancer Society.
There are two types:
- Squamous cell carcinoma: Cervical cancer that starts in the thin squamous cells on the outside of the cervix. This is the most common type of cervical cancer.
- Adenocarcinoma: Cervical cancer that starts in glandular cells that line the inside of the cervix. This type of cervical cancer is less common.
In some cases, cervical cancer has features of both types.
What causes cervical cancer?
Almost all cases of cervical cancer are caused by high-risk cases of HPV, a virus that is spread through sexual activity or other close skin-to-skin contact. But don’t panic: HPV is very common, and getting HPV doesn’t always mean you’ll get cervical cancer. Around 85 percent of people in the U.S. will get an HPV infection in their lifetime, but for most people, the virus clears on its own.
However, there are many strains of HPV, and some are linked to cervical cancer. In those cases, when the virus does not clear on its own and the HPV infection persists, it can cause a range of cancers in both men and women, including cancers of the cervix, anus, penis, throat, and vagina.
That’s why HPV vaccination is so important for all people: It can help prevent many types of cancer, including cervical cancer caused by those high-risk HPV infections.
What are the symptoms of cervical cancer?
Cervical cancer doesn’t usually have symptoms in its early stages, but once cancer begins to spread, the symptoms can include:
- Vaginal bleeding between periods, after sexual intercourse, or after menopause.
- Heavier and longer menstrual periods than usual.
- Vaginal discharge that has a strong odor and is watery.
- Pelvic pain or pain during sexual intercourse.
In more advanced stages, symptoms of cervical cancer can include:
- Leg swelling.
- Difficult or painful bowel movements or bleeding during a bowel movement.
- Blood in urine or difficulty urinating.
- Back pain.
“Most women present with no symptoms,” Dr. Kristina A. Butler, gynecologic oncologist at Mayo Clinic, tells PGN. “Therefore, the checkups with visualization of the cervix, speaking with your provider, and having a Pap smear are so important.”
How can you help prevent or reduce your risk for cervical cancer?
Vaccination: Cervical cancer is highly preventable. The most effective way to help protect yourself from it is by getting the HPV vaccine. The HPV vaccine is most effective before a person is first exposed to HPV, typically before becoming sexually active.
“If we are able to vaccinate children before they become adults [and] are subsequently exposed, those individuals are maximally protected against the [worst effects] of the virus, which could ultimately be cancer,” Butler adds.
You’re eligible to get the vaccine if you’re between 9 and 45 years old, but there are specific guidelines for each age group. The Centers for Disease Control and Prevention recommends HPV vaccination for children ages 11 or 12 (though it can start at 9 years).
The CDC says that you can get catch-up doses until you’re 26 if you didn’t get vaccinated earlier, but if you’re between 26 and 45 years old, you should talk to your health care provider about your individual risk for HPV and to see if you should get the vaccine.
Screenings: This is another effective way to prevent cervical cancer.
Dr. Deanna Gerber, a gynecologic oncologist at NYU Langone’s Laura and Isaac Perlmutter Cancer Center, tells PGN that regular screenings can catch HPV before it has a chance to become cancer.
“Now that we’re encouraging people to see their gynecologist and get screening more regularly, we’re catching cancer at earlier stages,” she says.
Screenings for cervical cancer include:
- Pap smear: During a Pap smear, also known as a Pap test, cells are collected from your cervix to find precancerous or cervical cancer cells. Pap smears should start at 21 years old, regardless of when you start having sex.
If you’re between 21 and 29, you should get a Pap smear every three years. If you’re 30 to 65 years old, it’s recommended you get one every three years, a Pap and HPV test together every five years, or an HPV test alone every five years.
- HPV test: During an HPV test, cells are collected from your cervix to look for infection with high-risk HPV strains that can cause cervical cancer. If you’re between 21 and 30 years old, it’s only recommended that you get an HPV test if you had an abnormal Pap smear result. After 30, an HPV test is recommended with a Pap smear every five years, as long as other results were normal.
(People over 65 years old should talk to their health care provider about whether they need screening.)
Not smoking: Avoiding smoking can reduce your risk of developing cervical cancer because “HPV and smoking tobacco work together to accelerate the negative effects of HPV,” says Gerber.
Wearing condoms: Although condoms don’t completely prevent HPV infection, they provide some protection. And according to the CDC, the use of condoms has been associated with a lower rate of cervical cancer.
There is hope with early detection
There is hope for people diagnosed with cervical cancer. “Compared to the survival [rates] 10 years ago, women survive much longer now with the great treatments we have,” adds Butler.
Some of those treatments and advances include radiation, chemotherapy, and surgical therapy.
And while there may be some stigma surrounding sexual health, it’s important to advocate for yourself, says Gerber.
“Being comfortable and bold talking to your doctor about your health or any concerns that you have, feeling comfortable with your provider by asking all these questions is really the best thing you can do.”
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
This is Dr. Rhonda Patrick. She’s a biomedical scientist with expertise in the areas of aging, cancer, and nutrition. In the past five years she has expanded her research of aging to focus more on Alzheimer’s and Parkinson’s, as she has a genetic predisposition to both.
What does that genetic predisposition look like? People who (like her) have the APOE-ε4 allele have a twofold increased risk of Alzheimer’s disease—and if you have two copies (i.e., one from each of two parents), the risk can be up to tenfold. Globally, 13.7% of people have at least one copy of this allele.
So while getting Alzheimer’s or not is not, per se, hereditary… The predisposition to it can be passed on.
What’s on her mind?
Dr. Patrick has noted that, while we don’t know for sure the causes of Alzheimer’s disease, and can make educated guesses only from correlations, the majority of current science seems to be focusing on just one: amyloid plaques in the brain.
This is a worthy area of research, but ignores the fact that there are many potential Alzheimer’s disease mechanisms to explore, including (to count only mainstream scientific ideas):
- The amyloid hypothesis
- The tau hypothesis
- The inflammatory hypothesis
- The cholinergic hypothesis
- The cholesterol hypothesis
- The Reelin hypothesis
- The large gene instability hypothesis
…as well as other strongly correlated factors such as glucose hypometabolism, insulin signalling, and oxidative stress.
If you lost your keys and were looking for them, and knew at least half a dozen places they might be, how often would you check the same place without paying any attention to the others?
To this end, she notes about those latter-mentioned correlated factors:
❝50–80% of people with Alzheimer’s disease have type 2 diabetes; there is definitely something going on❞
There’s another “smoking gun” for this too, because dysfunction in the blood vessels and capillaries that line the blood-brain barrier seem to be a very early event that is common between all types of dementia (including Alzheimer’s) and between type 2 diabetes and APOE-ε4.
Research is ongoing, and Dr. Patrick is at the forefront of that. However, there’s a practical take-away here meanwhile…
What can we do about it?
Dr. Patrick hypothesizes that if we can reduce the risk of type 2 diabetes, we may reduce the risk of Alzheimer’s with it.
Obviously, avoiding diabetes if possible is a good thing to do anyway, but if we’re aware of an added risk factor for Alzheimer’s, it becomes yet more important.
Of course, all the usual advices apply here, including a Mediterranean diet and regular moderate exercise.
Three other things Dr. Patrick specifically recommends (to reduce both type 2 diabetes risk and to reduce Alzheimer’s risk) include:
(links are to her blog, with lots of relevant science for each)
You can also hear more from Dr. Patrick personally, as a guest on Dr. Peter Attia’s podcast recently. She discusses these topics in much greater detail than we have room for in our newsletter:
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Come Together – by Dr. Emily Nagoski
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From Dr. Emily Nagoski, author of the bestseller “Come As You Are” (which we reviewed very favorably before) we now present: Come Together.
What it is not about: simultaneous orgasms. The title is just a play on words.
What it is about: improving sexual wellbeing, particularly in long-term relationships where one or more partner(s) may be experiencing low desire.
Hence: come together, in the closeness sense.
A lot of books (or advice articles) out there take the Cosmo approach of “spicing things up”, and that can help for a night perhaps, but relying on novelty is not a sustainable approach.
Instead, what Dr. Nagoski outlines here is a method for focusing on shared comfort and pleasure over desire, creating the right state of mind that’s more conducive to sexuality, and reducing things that put the brakes on sexuality.
She also covers things whereby sexuality can often be obliged to change (for example, with age and/or disability), but that with the right attitude, change can sometimes just be growth in a different way, as you explore the new circumstances together, and continue to find shared pleasure in the ways that best suit your changing circumstances,
Bottom line: if you and/or your partner(s) would like to foster and maintain intimacy and pleasure, then this is a top-tier book for you.
Click here to check out Come Together, and, well, come together!
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Retrain Your Brain – by Dr. Seth Gillihan
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15-Minute Arabic”, “Sharpen Your Chess Tactics in 24 Hours”, “Change Your Life in 7 Days”, “Cognitive Behavioral Therapy in 7 weeks”—all real books from this reviewer’s shelves.
The thing with books with these sorts of time periods in the titles is that the time period in the title often bears little relation to how long it takes to get through the book. So what’s the case here?
You’ll probably get through it in more like 7 days, but the pacing is more important than the pace. By that we mean:
Dr. Gillihan starts by assuming the reader is at best “in a rut”, and needs to first pick a direction to head in (the first “week”) and then start getting one’s life on track (the second “week”).
He then gives us, one by one, an array of tools and power-ups to do increasingly better. These tools aren’t just CBT, though of course that features prominently. There’s also mindfulness exercises, and holistic / somatic therapy too, for a real “bringing it all together” feel.
And that’s where this book excels—at no point is the reader left adrift with potential stumbling-blocks left unexamined. It’s a “whole course”.
Bottom line: whether it takes you 7 hours or 7 months, “Cognitive Behavioral Therapy in 7 Weeks” is a CBT-and-more course for people who like courses to work through. It’ll get you where you’re going… Wherever you want that to be for you!
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Grapefruit vs Lemon – Which is Healthier?
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Our Verdict
When comparing grapefruit to lemon, we picked the lemon.
Why?
Grapefruit has its merits, but in the battle of the citrus fruits, lemons come out on top nutritionally:
In terms of macros, grapefruit has more carbs while lemons have more fiber. So, while both have a low glycemic index, lemon is still the winner by the numbers.
Looking at the vitamins, here we say grapefruit’s strengths: grapefruit has more of vitamins A, B2, B3, and choline, while lemon has more of vitamins B6 and C. So, a 4:2 win for grapefruit here.
In the category of minerals, lemons retake the lead: grapefruit has more zinc, while lemon has more calcium, copper, iron, manganese, and selenium.
One final consideration that’s not shown in the nutritional values, is that grapefruit contains high levels of furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.
This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!
PS: the same substance is quite available in pummelos and sour oranges (but not meaningfully in sweet oranges); you can see a chart here showing the relative furanocoumarin contents of many citrus fruits, or lack thereof as the case may be, as it is for lemons and most limes)
Adding up the sections gives us a clear win for lemons, but by all means enjoy either or both; just watch out for that furanocoumarin content of grapefruit if you’re on any meds affected by such (again, do check with your pharmacist, as our list was far from exhaustive—and yes, this question is one that a pharmacist will answer more easily and accurately than a doctor will).
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← citrus fruits in general make the list; they inhibit tumor growth and kill cancer cells; regular consumption is also associated with a lower cancer risk 🙂
Enjoy!
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Beet “Kvass” With Ginger
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Kvass is a popular drink throughout Eastern Europe, with several countries claiming it, but the truth is, kvass is older than nations (as in: nations, in general, any of them; nation states are a newer concept than is often realized), and its first recorded appearance was in the city state of Kyiv.
This one is definitely not a traditional recipe, as kvass is usually made from rye, but keeping true to its Eastern European roots with (regionally popular) beetroot, it’s nevertheless a great fermented drink, full of probiotic benefits, and this time, with antioxidants too.
It’s a little saltier than most things we give recipes for here, so enjoy it on hot sunny days as a great way to replenish electrolytes!
You will need (for 1 quart / 1 liter)
- 2¾ cups filtered or spring water
- 2 beets, roughly chopped
- 1 tbsp chopped fresh ginger
- 2 tsp salt (do not omit or substitute)
Method
(we suggest you read everything at least once before doing anything)
1) Sterilize a 1-quart jar with boiling water (carefully please)
2) Put all the ingredients in the jar and stir until the salt dissolves
3) Close the lid tightly and store in a cool dark place to ferment for 2 weeks
4) Strain the beets and ginger (they are now pickled and can be enjoyed in a salad or as a kimchi-like snack), pouring the liquid into a clean jar/bottle. This can be kept in the fridge for up to a month. Next time you make it, if you use ¼ cup of this as a “starter” to replace an equal volume of water in the original recipe, the fermentation will take days instead of weeks.
5) Serve! Best served chilled, but without ice, on a hot sunny day.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- What To Eat, Take, And Do Before A Workout
- Ginger Does A Lot More Than You Think
Take care!
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