Health Connection - March 2020

MarinHealth and COVID-19

Information about the Coronavirus (COVID-19) is changing daily as the pandemic develops and scientists learn more about the virus and how it spreads. MarinHealth have been closely following the most up-to-date information from the CDC since COVID-19 first became an issue in January 2020 and continues to adhere to all the CDC recommendations.

MarinHealth and other hospitals alike are well practiced in caring for patients with infectious diseases while keeping caregivers and others safe from transmission. In fact, we do it every day. MarinHealth Medical Center is here for our community and prepared to take care of patients who need hospital care, whether it be for COVID-19 or not.

In addition to our standard infectious disease protocols, we are working closely with Marin Public Health and instituting new measures to screen for and prevent spread of the virus, including:

• Restricting Visitor Access to MarinHealth Medical Center
• Launching Telemedicine Appointments through MarinHealth Medical Network
  Our clinic staff and providers have been working tirelessly to build a telemedicine program so that a substantial portion of patient visits can be done without bringing patients into the office.
• Standing up a Treatment Tent in Preparation of a Possible Surge
  While we do not currently have a surge of COVID-19 patients at MarinHealth Medical Center, we have decided to prepare in advance. We have installed a tent on the patio outside of the Emergency Department that is available if the need arises.
• Establishing a COVID-19 Testing Center with Marin Public Health
  With support from MarinHealth Medical Center, Kaiser, and Novato Community Hospital, Marin Public Health has opened a COVID-19 testing facility to enhance countywide capacity for testing. Individuals referred by their physicians can complete drive-through testing without having to get out of their vehicle. If you think you may have contracted COVID-19, contact your primary care doctor. If needed, they can refer you to the County testing center.

Do you have a fever, cough, or shortness of breath?
The symptoms of COVID-19 infections can range from very mild to severe respiratory illness and may include fever, cough and shortness of breath. These symptoms can be very similar to the flu.

As the CDC recommends, if you think you have been exposed to COVID-19 and develop symptoms such as a fever, cough, or difficulty breathing, contact your healthcare provider right away. Be sure to call ahead before you visit the office, clinic, or hospital. Do not go to the emergency department if you do not require emergent care. Read more from the CDC: What to do if you suspect you are infected by the Coronavirus.

The best way to reduce the risk of becoming infected with a respiratory virus, whether the flu or COVID-19, is to practice good hygiene:

• Wash your hands frequently with soap and water for at least 20 seconds, especially before eating, after blowing your nose, coughing, or sneezing
• Use an alcohol-based hand sanitizer when soap and water are not available
• Cover your cough or sneeze with a tissue or crook of your elbow (not your hands).
• If you use a tissue, throw it away and wash your hands afterward
• Avoid touching your face
• Avoid close contact with people who are sick
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
• Get your flu shot to protect against flu

Stay Informed to Stay Safe
Public health recommendations may change as the situation evolves. Researchers are also hard at work studying the virus and developing potential tests, vaccines, and medicines. For the latest, valid information, please refer to the below websites:

• MarinHealth
• CDC
• California Dept. Of Public Health
• Marin Health & Human Services

Insulin: The Blood Sugar Regulator

By Linda Gaudiani, MD, FACE, FACP, Medical Director, Braden Diabetes Center

Your body uses the hormone insulin to convert blood sugar, or glucose, into the energy it needs. Insulin attaches to receptors in the cells, serving as the “key” that unlocks the cells and allows them to absorb glucose from your bloodstream.

Insulin is made in the pancreas, a small organ located behind the stomach. The pancreas has two important functions: it produces enzymes that help with digestion and it manufactures the hormones insulin, glucagon, and somostatin.

After you eat, your digestive system breaks carbohydrates down into glucose, causing your blood glucose to rise. This triggers your pancreas to release insulin. Insulin and glucagon work together to help balance your blood glucose levels and keep them from getting too high (hyperglycemia) or too low (hypoglycemia). Insulin's role is to lower blood sugar levels, whereas glucagon’s role is to raise them.

Insulin and Diabetes

The most common insulin-related medical condition is diabetes. Diabetes falls into two categories: Type 1 and Type 2.

• Type 1 diabetes is a kind of autoimmune disease in which the body creates antibodies that go after the pancreas’ insulin-producing cells. Without the ability to produce insulin, the body can no longer move blood glucose into the cells and blood sugar levels rise uncontrollably. People with type 1 diabetes need to inject insulin in order to survive. The onset of type 1 diabetes is usually before the age of 40, often in childhood, which is why the disease used to be known as “childhood diabetes.” Learn more.
• In type 2 diabetes, the cells’ insulin receptors grow increasingly desensitized to insulin, a process known as insulin resistance. The pancreas tries to compensate for the added demand for insulin by making more. Over time, the pancreas can no longer keep up with the body’s increased need for insulin and excess sugar begins to accumulate in the blood stream, causing long-term damage.Type 2 diabetes is mostly diagnosed in adults and is often associated with modifiable risk factors such as excess weight, a diet high in sugar and carbohydrates, and a sedentary lifestyle. Learn more.

Insulin as Medication

All people with Type 1 diabetes require insulin to survive. People with type 2 diabetes can often manage their blood sugar through a combination of weight loss, healthy eating, exercise, and prescription medications. However, they may eventually require insulin injections as the disease progresses and their insulin production declines.

Your doctor will determine the best insulin regimen for you based on whether you have type 1 or type 2 diabetes, your blood sugar levels, and your lifestyle. Insulin can be given by syringe, injection pen, or an insulin pump that delivers a continuous flow of insulin. There is also a form of inhalable insulin.

The Power of Prevention

March 24, 2020 is National Diabetes Alert Day, a reminder that diabetes is a serious health threat. Diabetes is the seventh leading cause of death in the US, and 1.5 million Americans are diagnosed with diabetes each year. What’s worse, the American Diabetes Association tells us that in 2018, 7.3 million of the estimated 34.2 million Americans with type 2 diabetes were undiagnosed. That’s because, unlike type 1 diabetes, in which the symptoms appear quite suddenly, type 2 diabetes develops gradually.

Long before you develop type 2 diabetes, your blood sugar may be slightly elevated. This is known as pre-diabetes. More than one out of three Americans have pre-diabetes and 9 out of 10 of them don’t even know it. This is unfortunate because 15 to 30 percent of people with pre-diabetes go on to develop type 2 diabetes within five years. That’s why it’s important to get screened for diabetes and pre-diabetes as part of your regular medical checkup. To find out if you could be at risk for pre-diabetes, take our risk assessment.

The good news is, pre-diabetes can often be stopped in its tracks, or even reversed, with somehealthy lifestyle changes.MarinHealth’s Braden Diabetes Center has a program designed to help people with pre-diabetes reverse the progress of the disease.

Linda M. Gaudiani, MD, FACE, FACP, is a MarinHealth Endocrinologist specializing in Diabetes and Metabolism.

Rotator Cuff Tears: More Common Than You Think

By Eric Bava, MD, Orthopedic Surgeon, Sports Medicine MarinHealth Medical Network

As both athletes and sports fans know, the glory of sports comes with the very real risk of injuries. From torn ACLs to concussions, injuries are part of the game and recoveries can range from a temporary timeout to a season on the sidelines.

Among the sports injuries, shoulder impairments — including dislocations, muscle strains and ligament sprains — are among the most common. That’s because the shoulder is subjected to a wide range of motion and force during sporting activities.

Baseball players, tennis players and swimmers are especially susceptible to one of the most common shoulder injuries — a tear to the rotator cuff.

The rotator cuff consists of four muscles and tendons that form a covering around the top of the arm that attaches it to the shoulder blade. This group of muscles and tendons keeps the ball of the joint in the shoulder socket and also provides the strength and movement to lift and rotate your arm and guide the movements of your wrists and hands.

Two types of injuries can occur to the rotator cuff: a complete or full-thickness tear, in which the tendon is completely detached from the bone, and a partial tear, in which the tendon is damaged but not completely severed.

Athletes aren’t the only ones susceptible to rotator cuff tears. People whose occupations involve repetitive shoulder movements, such as painters, window washers and carpenters, are also susceptible. Even routine household chores like hanging pictures, dusting ceiling fans or gardening can strain the rotator cuff when performed repetitively over time.

One surprising fact about rotator cuff injuries is that age is the number one risk factor. Most such injuries occur in people over age 40, with injuries occurring five times more frequently in people over 60. More than two million Americans seek medical help each year for a rotator cuff problem.

As we age, all the shoulder motions we have done over time — especially the repetitive ones — can cause the tendons in the rotator cuff to degenerate, often causing a partial tear. Age-related risk factors also include a decrease in blood supply that can work to repair tendon damage, as well as the development of bone spurs that rub on the tendons, causing wear and frequently leading to an actual tear.

What are the symptoms of a rotator cuff tear and when should you seek help?

As you might expect, intense pain and immediate weakness are the results of tears that happen suddenly, such as from sports injuries, falls or accidents.

For age-related rotator cuff injuries, however, the most common symptoms are pain and arm weakness. You may notice shoulder pain when lifting your arm over your head, or even when combing your hair or getting dressed. Your arm feels weak and not up to lifting things or supporting your weight when you get up from a chair. Pain medication may have helped at first, but you then notice the pain is there even when you are resting or sleeping, especially when lying on the affected shoulder. In some cases, a rotator cuff tear doesn’t cause pain, but will cause weakness in the arm.

Many people attribute aches and pains to getting older. In the case of a rotator cuff tear, however, if you keep using your shoulder and arm despite increasing pain, further damage such as a larger tear can occur.

If you are experiencing chronic shoulder and arm pain, make an appointment to see your doctor. A head start on diagnosing and initiating treatment for a possible tear can prevent symptoms from getting worse and minimize interruptions to your daily routines.

In addition to discussing your symptoms and examining your shoulder, arm and neck areas, your doctor will likely order an X-ray followed by an MRI or ultrasound to confirm the diagnosis or rule out a tear.

Doctors have several treatment options for a rotator cuff tear and, as is the case with many injuries or medical conditions, the best option is different for every person.

Stay tuned next month for part two of this article, when I’ll cover surgical and non-surgical treatment options for both partial and complete rotator cuff tears. I’ll also address exercises and other lifestyle measures you can employ to minimize your risk of a rotator cuff tear.

Dr. Eric Bava is a board certified orthopedic surgeon at MarinHealth Orthopedic Surgery | A UCSF Health Clinic.

Hormones and Your Health: A Closer Look at the Thyroid

Hormones — chemical messengers that are secreted into the bloodstream by endocrine glands — serve as a communication system between glands and other cells and organs. Hormones play a key role in regulating human growth, metabolism, appetite, puberty and fertility. We refer to the sophisticated interplay between glands, hormones, and the organs they regulate as the endocrine system.

The major glands of the endocrine system are the hypothalamus, pituitary, thyroid, parathyroids, adrenals, pineal body, testes, and ovaries. Other organs, such as the lungs and pancreas, contain hormone producing endocrine cells, but they are not considered glands. Every hormone has a specific role, and it’s common for some hormone levels to fluctuate a bit. But when your body consistently produces too much or too little of a specific hormone, the impact on your health can be significant.

One of the most common hormone imbalances involves your thyroid — a butterfly-shaped gland that consists of two lobes located on either side of your trachea. The hormones your thyroid produces play a role in regulating your metabolic rate, heart and digestive function, muscle control, brain development, bone maintenance, and even your mood.

Common Thyroid Disorders

Whether the thyroid gland produces too much or too little thyroid hormone, the hormonal imbalance can lead to a variety of troublesome symptoms. Too much thyroid hormone in the system (thyrotoxicosis) can have a variety of causes. 70% of thyrotoxicosis is caused by an overactive thyroid, a condition known as Graves’ disease. Inflammation or a benign thyroid tumor can also trigger excessive thyroid hormone production.

An excess of thyroid hormone may result in:

• Intolerance to heat
• Weight loss combined with an increase in appetite
• Increased frequency of bowel movements
• Irregular menstrual cycle
• Rapid and irregular heartbeat
• Palpitations
• Fatigue
• Irritability
• Tremor
• Hair loss
• Retraction of the eyelids, which makes the eyes appear to bulge out

An underactive thyroid (hypothyroidism) often leads to an enlargement of the thyroid gland called a goiter. Because the thyroid needs trace amounts of iodine for healthy function, goiters used to be more common before the days of iodized salt. The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis. Other causes include over-response to treatment for hyperthyroidism, total or partial removal of the thyroid for cancer treatment, radiation therapy, and a reaction to certain medications, notably lithium.

Hypothyroidism can have a variety of troublesome consequences:

• Decreased metabolic rate
• Fatigue
• Sensitivity to cold
• Weight gain combined with reduced appetite
• Low heart rate
• Memory issues
• Depression
• Dry skin
• Pallor
• Facial puffiness
• Heavy and irregular periods
• Muscle stiffness
• Infertility
• Learning difficulties and stunted growth in children. Thyroid hormones are critical to physical and mental development during childhood.

Benign and Malignant Thyroid Growths

Sometimes, the thyroid will develop solid or fluid-filled lumps called nodules. Usually, these are benign and require no treatment at all. Once a nodule is detected, your doctor will test you for hyperthyroidism or hypothyroidism. A needle biopsy may also be performed to determine whether the nodule might be cancerous. Cancerous nodules are pretty rare — thyroid cancer affects less than 4 percent of the population.

Undiagnosed, a growing thyroid cancer may cause:

• A palpable lump
• Changes in the voice, especially hoarseness
• Difficulty swallowing
• Neck and/or throat pain
• Swollen lymph nodes in the neck

Thyroid disorders may be serious if left undiagnosed, so if you suspect you may have a thyroid disorder, discuss your symptoms with your primary care doctor or specialist. For help finding a doctor, call 1-888-996-9644 or click here.