Sunday, December 30, 2007

General Health Topic - Clinical Research Studies

Hello Everyone,

Are you generally healthy, non smoker, have a little free time and would like to make some extra $$$. If so, you may want to participate in a Clinical Research Study.

In San Antonio, Austin and most major cities around the country, there are Physician Offices, Clinics and Research Companies that are conducting clinical research studies.

Participating in clinical trials is beneficial in many ways. First, that is the way that medications are tested in humans. Secondly, to entice participation in those studies, the pharmaceutical companies sponsoring those trials, pay people who enroll in those studies. That is how people use clinical trials to make some extra money.

Clinical trials are conducted in a series of steps, called phases. Each phase is designed to answer different and separate research questions.

If you are going to participate, it is helpful to know and understand the different phases.

· Phase I: Researchers test a new drug or treatment in a small group of healthy people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

· Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.

· Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, (usually the study subjects have the condition the medication is intended to treat) monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

· Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

There are other types of studies that are conducted. One of the other types of study is bio-equivalence studies. In those studies, a generic drug manufacturer is trying to prove that their generic formulation is the same as the brand name product.

Additional Resource Information on clinical trials can be found at

Many of the Clinical Research Companies like CEDRA or PPD conduct phase I trials. If you decide to participate in one of the phase I trials, there are some things that should be considered.
Length of Study

How many inpatient visits and how long is each inpatient stay.

How many blood draws will there be.

How many out patient visits are there.

How frequent are the follow-up visits.

Do you mind being stuck with a needle for frequent (very frequent) blood draws.

Can you swallow pills, tablets and capsules. (There are many subjects that enrolled in a trial and at the time of dosing, they admit that they cannot swallow tablets. That is a huge waste of time for the patient and the investigating company. It is also a large expense for the investigating company and the loss of income for a person that could not participate due to the study being full.)

What type of drug is being investigated.

Are you a picky eater. (Many studies require that all the subjects eat the same meals. You are expected to eat everything that is put in front of you in a specified time. Usually, there is no menu selection available. You eat what is provided.)

For more information on clinical research companies and to get an idea what trials are available, please check out:

Good Luck,

Dr. Paul

Saturday, December 29, 2007

General Health Topic - Redirect Unused Medical Supplies to Those In Need

Hello Everyone,

Even though it is always time to help those in need, around the Holidays, it seems to take on special importance.

If anyone has received home Intravenous therapy or has had a family member that has used home health care services, the supplies that are provided to assist in the therapy are not all used and can add up. Those leftover items like syringes, gauze, tubings and dressings are still sterile, however, they can not be reused in the United States.

Don't discarding those unused items. There are non-profit clearing houses that can re-direct those supplies to disaster victims and patients in need throughout the world. If you are interested in donating unused medicals supplies, here is a list of organizations that can help:

REMEDY (Recovering Medical Equipment for the Developing World)

Medical Bridges, Inc.

Project Cure

Note: These organizations may be associated with groups that may or may not be in line with your personal and/or religious beliefs. If you are concerned about that, please investigate before donating supplies or money.

Giving to these and other organizations can be inspiring and very fulfilling. Knowing that those supplies will be going to a good cause and not a landfill can be a great feeling.

Thank you for your support.

Dr. Paul

Thursday, December 27, 2007

General Health Topic - Medicare Open Enrollment Ends Monday, December 31.

Hello Everyone,

I want to remind everyone that the open enrollment for Medicare Part D, The prescription drug plan ends on Monday December 31, 2007.

For more information on the Medicare plan, please read my posting from Tuesday, November 13, titled General Health Topic - Medicare Fall Open Enrollment - November 15 - December 31 2007

Please pass on this information to everyone you know that may be eligible or people that have family members eligible.


Dr. Paul

Tuesday, December 25, 2007

General Health Topic - Are You Ready for An Emergency?

Hello Everyone,

I was reading and have been hearing on the news about the ice storms that are gripping the Midwest USA. Snow storms are raging in the northeast and power is out in thousands of homes across the country.

For those out there that have a serious medical condition or if you have a family member with a medical condition we have to be thinking about our emergency plan.

If you have to be in frequent contact with your physician, what will you do if your phone or the Dr's phones are not working? Do you have a plan? Does your Doctor have a plan?

If you are on a medical device that requires electricity to operate, do you have a plan if your power is out for more than just a few minutes?

If your doctors office has a fire, how will you replace your medical records. Do you have a copy of your medical records. Does your doctor and pharmacist have a plan in place to replace the records if they are destroyed for any reason.

After Hurricane Katrina, thousands of people were left without any records of any kind. Their medical records were destroyed, lost and inaccessible. After evacuating, hundreds of cancer chemotherapy patients were hard pressed to tell their new doctors what kind of medications they were receiving for their cancer treatments.

Hopefully you get the point. With natural disasters, you have to be prepared and find out what kind of preparations your health care providers have in place.

Consider the area where you reside. Are you on or near the gulf coast where hurricanes are a threat. Do you live in an area where earthquakes are possible. Are wildfires a constant threat in your neighborhood. Does your area flood every time it rains. What will happen if there is a really big storm.

Please don't take for granted that someone else is going to do the planning for you. Please read or re-read my earlier post from Tuesday, October 30, 2007

Identify Yourself and your Medical Conditions

If you take care of an elderly parent or sick child, you have to plan for yourself and the person you take care of.

I know this is not necessarily a pleasant topic to have to think about. However, if you don't and something does happen, that is even worse. Many of us make New Year's Resolutions to try to better ourselves. Why don't we make a resolution to get our medical records in order and have an emergency plan. I can help you do that if needed. Email me for information.

Wishing you the best.

Dr. Paul

Sunday, December 23, 2007

General Health Topic - Large Waist = Increased Heart Attack Risk

Hello Everyone,

Need more motivation to lose that spare tire around the mid-section?

Did you know that increased waist size is an indicator that you may be at increased risk for a heart attack? True story! Why you ask?

Here's why.

There are two main areas where fat stores in the body. One is the fat under the skin (subcutaneous fat) and the other is deep in the abdomen, around organs like the liver and stomach. that deep stored fat (visceral fat) is the one that causes the problems.

The visceral fat near the liver provides a steady supply of fat that is converted into cholesterol. That cholesterol then circulates throughout the body which can be deposited in the blood vessels and clog them. Clogging of the blood vessels and arteries can cause heart attacks and strokes.

Visceral fat also acts like a body organ and can secrete chemicals (Interleukin 6 (IL-6), C-Reactive Protein (CRP)) that can cause inflammation in the body. That includes inflammation of the arteries. Those inflamed arteries can also become obstructed causing heart attacks and stroke. Studies also indicate that increased levels of IL-6 and CRP can predict the development of Type 2 Diabetes. There are other studies that support the hypothesis that body fat is the main determining factor of metabolic abnormalities and chronic low inflammation (Nutr Metab Cardiovasc Dis. 2004 Apr;14(2):66-72)

According to Dr. Paul Donohue, a man's waist should measure 40 inches or less and a woman's should be 35 inches or less.

Here is the good news. Walking, jogging, biking and swimming and other forms of exercise can reduce visceral fat.

I'm going to be on the treadmill soon. Right after lunch!

Until later,

Dr. Paul

General Health Topic - Getting Fit in the New Year

Hello Everyone,

Yes, I'll have another little piece of cake, Thank You. And an extra tamale as well. Some eggnog sounds good. Margarita on the rocks will hit the spot. I really haven't eaten much, I've just been grazing at the buffet table. I am going to splurge a little... It's the holidays after all!

Sound Familiar?

I know I have a tendency to over eat during the holidays. There are so many goodies around this time of year. I can't get those little "Polvorone" cookies at any other time of the year. I have to get my fill.....Now!

The time for getting fit, eating right and taking off those unwanted pounds is just around the corner.

Getting fit in the New Year. That's the ticket!

The American Heart Association has a website that has an on-line nutrition and fitness tracker.

Find information on Start! for individuals at:

By using MyStart! Online for your free tracking tool, you can start logging your daily activity and nutrition. You’ll also receive weekly and monthly e-newsletters filled with tips and motivation to keep you moving.

It is about making small lifestyle changes for large health benefits. It helps you build regular activity and a healthy diet into your everyday life and ensures you're getting the right balance to achieve your long term goals.

There is also a section for Start! for employers. If you have a company check out:

For those that need extra little gadgets to get motivated and don't mind paying a yearly fee, you can check out:

Start thinking about those New Year goals. After that next trip through the buffet line, that is!


Dr. Paul

Saturday, December 22, 2007

General Health Topic - Help with Holiday Grief

Hello Everyone,

As Christmas gets closer and closer, it is a time for family, joy, gifts, parties and merriment. The little ones are looking forward to gifts of all sizes and shapes and they can barely contain their excitement.

For some people, the holidays are a time of sorrow, loneliness and grief. Some people have lost a loved one since the last holiday. The expectation of the spending the once joyful season without that loved one is not a pleasant thought.

This time of year always brings back family memories for many people. If those family members are no longer with us, the holidays can be a very difficult time.

There are professionals in the community that can help you cope with the feeling of loss and despair. If you are feeling blue and depressed, please seek help from your physician, preacher or other person that can get you through this trying time.

I learned of a professional that can help you through this once joyous, but now difficult time.

If needed, please check out:

Marguerite O'Connor is a bereavement educator. She is a licensed funeral director and is a certified death educator.

Hopefully, she will be able to assist you if needed.

Until later,

Dr. Paul

Friday, December 21, 2007

General Health Topic - Sudden Cardiac Arrest Risk Factors

Hello Everyone,

On my last post we discussed the differences between Sudden Cardiac Arrest (SCA) and a heart attack. Today we will talk about how to try to prevent SCA and some of the risk factors.

Sudden cardiac arrest can often strike active, apparently healthy individuals. What can a person do to try to prevent SCA?

First, a heart-healthy lifestyle is important in the prevention of coronary artery disease and other heart conditions.

Eat a heart-healthy diet. (
Exercise regularly.
Lose weight if you are overweight or obese.
Take your heart medications as directed.
Drink alcohol only in moderation.
Do not smoke.

Next, realize that eighty percent of SCA victims have signs of coronary artery disease. Many individuals do have signs or symptoms that could indicate an increased risk for sudden cardiac arrest. These are some of the symptoms:

An abnormal heart rate or rhythm (arrhythmia)
A rapid heart rate, even when at rest (tachycardia)
Episodes of fainting (syncope)

Thirdly, there are indicators that suggest high risk for sudden cardiac arrest, such as:

Prior sudden cardiac arrest
Prior heart attack
Heart failure ? (Shortness of breath, fatigue, or heart palpitations with physical activity and maybe at rest.)
Ejection fraction less than 40%
Family history of sudden cardiac arrest

Consult a cardiologist if you have any risk factors for sudden cardiac arrest.

By controlling underlying medical conditions or abnormal heart rhythms that can lead to sudden cardiac arrest, risk can be greatly reduced.

The following website has information on steps you and your family can take to help prevent SCA:

As we get closer to the start of a new year, it may be a good time to make that resolution for a heart-healthy lifestyle.

There will be a few more posts concerning SCA and the medications that are used to control the risks.

Until then,

Dr. Paul

Sunday, December 16, 2007

General Health Topic - Information on Sudden Cardiac Arrest (SCA)

Hello Everyone,

On my last post I was talking about Automated External Defibrillators (AED). I received an email asking about how the AED works for heart attacks.

Sudden Cardiac Arrest (SCA) is very different from a Heart Attack. They are not the same thing! SCA results from an abrupt loss of heart function. The victim may or may not have diagnosed heart disease. The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease.

SCA is also known as Sudden Cardiac Death because when SCA occurs, the odds of survival are low. Time and mode of death are unexpected and it occurs within minutes after symptoms appear. The American Heart Association estimates about 325,000 people per year die from SCA without being taken to an emergency room or hospitalized. One of the most devastating aspects of sudden cardiac arrest is that it often strikes active, healthy individuals that seem healthy.

The causes of SCA are usually some underlying heart disease. All known heart diseases can lead to cardiac arrest and sudden cardiac death. Most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart (bradycardia).

In the majority of adults that have a SCA, two or more major coronary arteries are partially or completely blocked by fatty buildups. Scarring from a prior heart attack is also found in two-thirds of victims. When sudden death occurs in young adults, other heart abnormalities are more likely causes. Adrenaline released during physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present. Under certain conditions, various heart medications and other drugs can lead to abnormal heart rhythms that cause sudden death.

SCA is very different from a heart attack. Heart Attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in a cardiac arrest or the death of the heart attack victim. A heart attack may cause cardiac arrest and sudden cardiac death, but they are not the same thing.

Think of a heart attack as a problem with the heart's plumbing system. SCA is caused by a problem with the heart's electrical system. That is why an AED is effective in treating a patient with SCA but not a heart attack.

Brain death starts to occur in just four to six minutes after someone experiences cardiac arrest. Cardiac arrest may be reversible in some victims if it is treated within a few minutes with an electric shock to the heart to restore a normal heartbeat with defibrillation. According to the American Heart Association, a victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. CPR can double or triple a cardiac arrest victim's chances of survival. Few attempts at resuscitation succeed after 10 minutes. If someone becomes unconscious, call 9-1-1 immediately. They may be suffering from sudden cardiac arrest.

In my next post, I will cover some recommendations that can be taken to try to prevent SCA, who is at risk for SCA and if you are are at risk, how can you manage that risk.

If you have any other questions, do not hesitate to email me or post a comment.


Dr. Paul

Wednesday, December 12, 2007

General Health Topic - Automated External Defibrillators

Hello Everyone,

Did you know there is a piece of equipment that is located in almost every airport, large sports stadium, shopping malls, government buildings, many private buildings that is there to save your life in case of sudden cardiac arrest (SCA)?

They are called AUTOMATED EXTERNAL DEFIBRILLATORS or AED's. The AED is a computerized medical device that is used on a patient that has collapsed due to cardiac arrest. An AED, when properly applied to a person's chest, can check the heart rhythm and it can recognize a rhythm that requires a shock.

Who is the rescuer? It may be you. AED's are designed to be used by non-medical personnel. An automated external defibrillator requires very little training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Most AED's found in public locations are semi-automatic models which will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. This will give the rescuer the chance to sound the "ALL CLEAR" command. In most circumstances, the user cannot override a "no shock" advisory by an AED. When advising the rescuer that a shock is needed, the AED uses voice prompts, lights and text messages to tell the rescuer the steps to take.

In most classes that teach Cardiopulmonary Resuscitation (CPR), there is now a component that teaches how to use an AED.

Here is what the Red Cross says about AED's at

"In the time it takes you to read this information, sudden cardiac arrest will have claimed another victim. Statistics show that more than 200,000 Americans die of sudden cardiac arrest every year. Up to 50,000 of these deaths could have been prevented if someone had initiated the Cardiac Chain of Survival, and an automated external defibrillator (AED) had been available for immediate use at the time of the emergency."

What is the cardiac chain of survival?

The cardiac chain of survival is a series of four critical steps. All four steps must be present to help ensure survival from sudden cardiac arrest. The four steps are:

Step one: Early access to care (calling 9-1-1 or another emergency number)
Step two: Early cardiopulmonary resuscitation (CPR)
Step three: Early defibrillation
Step four: Early advanced cardiac life support, as needed

The third step, delivering an electrical shock to the heart, which is known as defibrillation, is recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.

If you would like to read an account of how an AED and quick acting co-workers saved a life, please check out this link:

What does this all mean to you?

I would like for you to be aware that these machines exist. They are all around. Next time you are in an airport or a shopping mall, look around. You have probably never noticed them before. If you or a family member are at risk of Sudden Cardiac Arrest (SCA) you should really note where the AED's are located.

If you work in a large building, find out from the building management where the AED's are located. If they do not have them, find out when they are going to get them. If you would like to start an AED program, please contact me for information.

One type of location that I think should have several AED's located strategically around the facilty is RV Parks. Many of the residents at RV parks are older and may be at higher risk of SCA. Any RV Park Residents out there that would like more information, please email me.

If you would like information on purchasing an AED, here is one of many links:

Hopefully, you or your loved ones will never need to use an AED. However, knowing about them and how to use one can save a life.


Dr. Paul

General Health Topic - Another Prescription Assistance Program

Hello Everyone,

I received a comment from Dr. Rich Sagall stating that he has an organization that also helps with Prescription Assistance called Needy Meds.

Here is his comment:

Another source of information on all the PAPs is NeedyMeds ( We have data on over 1000 programs including PAPs, disease-based assistance, state and local programs, and more. All our data is current, easy to access, and free. We are approaching our 10 millionth visitor.

Rich Sagall, MD
President, Inc.
P.O. Box 219
Gloucester, MA 01931

A special thanks to Dr. Sagall for the valuable information. Please visit his website and tell your friends about his valuable service. 10 Million visitors! That's impressive.

Dr. Rich, next time you are in the S. Texas area, let me know. I'll treat for some great Mexican food. It's good to know that my blog is being read up in the great Northeast.

Thanks again,

Dr. Paul

Saturday, December 8, 2007

General Health Topic - Medical Debt Assistance

Hello Everyone,

On my last post, I wrote about getting help in paying for prescription medications. I was reading some information and found a reference to an organization that helps patients lower their hospital bills.

The following is an excerpt from that article from:

The article was about Logan Roberts. "The 26-year-old had started work as a business analyst near Atlanta but had no insurance when he was rushed to an emergency room for an appendectomy. The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America.Roberts was billed $21,000. After advice from advocacy group The Access Project, Roberts spoke with hospital administrators, telling them he couldn't pay in full. Hospitals frequently work with patients, offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial-assistance office. It paid off for Roberts, whose bill was sliced to $4,100, 20% of the original.

That organization, The Access Project, is out there to help patients and family members cope with medical debt, hospital billing and collection problems and helping the uninsured and patients on Medicaid. In addition, this very ambitious group is working on the national, state and local levels to affect change in health care.

The mission of the Access Project is to strengthen community action, promote social change, and improve health, especially for those who are most vulnerable. By supporting local initiatives and community leaders, The Access Project is dedicated to strengthening the voice of under served communities in the public and private sectors.

The Access Projects works with community organizations across the country to examine the consequences of medically-related debt for individuals and families. Their findings indicate that debt resulting from medical bills deters people from seeking future care, which can result in the need for more expensive treatment later on. In addition, medical debt can affect the overall financial security of families and can ruin their economic stability.

On their website,, they state that if you or a family member have medical debt, they would like to hear from you. They provide this information that for help with bill management and negotiation strategies, to contact Andrew Cohen at: (617) 654-9911 x231,toll-free (866) 918-5232 x231, or

If you would like to help support this worthy project, They are currently taking donations. Your donations will help them to:

Continue to study the adequacy and cost of health insurance, and present the findings to interested stakeholders.

Provide direct technical assistance to groups in states where health reform discussions are taking place.

Increase their capacity to assist families struggling with medical debt.

Sponsor trainings for community leaders in locations across the country.

Develop new strategies to address the issue of increasing out-of-pocket medical expenses .

If you are interested in making a donation, please visit their website and click on "Donate Now"

I am going to close now so I can go make a donation.

Thanks for your support,

Dr. Paul

Friday, December 7, 2007

General Health Topic - Prescription Assistance Plans

Hello Everyone,

I want to share this very important topic with you and I would like to ask you to forward this information to everyone you know that might benefit. Everyone could potentially benefit.

As you know, the cost of many prescription medications keeps rising. If you do not have insurance or a prescription drug plan, the cost of many of these drugs can be unaffordable.

I want to bring to your attention is a fantastic service called the "Partnership for Prescription Assistance"

The Partnership for Prescription Assistance helps qualified patients who lack prescription coverage get the medicines they need through public or private programs. Many patients can get covered medications free or at little cost.

They bring America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups together to provide a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies.

The Partnership for Prescription Assistance mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. In order to find out what patient assistance programs you may qualify for, all you have to do is answer a few short eligibility questions. Their web site will help supply you with the information you need to get involved in a program and will allow you to download applications online. You can then follow the instructions on the application to apply.

Here is the important link:

The web site has areas for patients, for caregivers and also for prescribers. You can select on your particular state to find a free or discounted drug program. For patients in Texas, it will direct you to and has items specific for Texans. They also have information in Spanish. On that site you can sign up for an e-mail newsletter as well.

To see a list of participating programs and companies, click on this link:

To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

Please pass this information along to all your family, friends and patients.

Hope you find this information helpful.


Dr. Paul

Wednesday, December 5, 2007

GENERAL HEALTH INFO - Drugs in the News

Hello Everyone,

There has been an recent unfortunate medication error that has garnered alot of press. It appears that the twin children of the actor, Dennis Quaid were given an inappropriate dose of the anticoagulant drug, HEPARIN. Fortunately, the children are doing well and should make a full recovery.

Heparin is an anticoagulant that prevents the formation of blood clots in the body. It works by inhibiting the coagulation enzymes Thrombin (Factor IIa) Factor Xa and Factor IXa.

Heparin is used for the prevention of blood clots for patients that have had a heart attack, cardiac bypass surgery, prevention of blood clots in the legs and many other conditions where the formation of blood clots need to be prevented. The prevention of these conditions normally use higher doses of heparin. These doses are often called "Therapeutic doses"

Heparin is also used in lower doses for the prevention of blood clots forming in intravenous catheters or at the end of intravenous catheters. (Catheter Flush)

Heparin is not absorbed if taken orally so it must be given as an intravenous or subcutaneous injection.

The major side effect of heparin is unwanted bleeding. Heparin is also know as a "HIGH ALERT DRUG" A High alert drug is one that can cause significant harm to a patient even when used as intended. They cause harm more commonly and the adverse effects tend to be more serious.

I was asked, "How did this mix-up occur?"

Heparin is commercially available in many different strengths, reported as "Units/milliliter" (U/ML) (units/ml)

Because different conditions required different doses of heparin, most hospitals carry all the different strengths in their inventory.

Heparin is available in:

10,000 Units/ml \
1,000 Units/ml /

For Flushing Intravenous catheters the common strengths are:

100 Units/ml for adults
10 Units/ml for pediatric patients

In the incident with the Quaid children, they were supposed to receive a dose of the 10 Unit/ml Heparin but instead received a dose of the 10,000 Unit/ml heparin. That is a 1000 fold error.

See if you can see the potential for error in the following example:

Heparin 100u/ml IV as directed. - With the word "UNIT" not spelled out, the u could be mistaken for another zero. Therefore a dose of 1000 Units could be given instead of 100 units. Imagine if that order were hastily written out and not typed. It would be more difficult to read correctly. It can happen that easily!

There are many strategies out there to try to prevent these errors. The most important strategy is for the Pharmacists and Nurses to be constantly vigilant and aware that the potential for these errors exist. Check and Double check. If I am not sure, I ask. Then double check again!

For more information, please read the following from the Institute for Safe Medication Practices (ISMP)

For information on High Alert Medications please see this link.

Thanks for your attention.

Dr. Paul