Latest / Morning Medical with Dr. Chow / ACIP Updates, Restless Legs, and Halifax's Caesarean Section Initiative

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ACIP Updates, Restless Legs, and Halifax's Caesarean Section Initiative · Morning Medical with Dr. Chow

• 0:00
  Welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow.
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  I'm your host, Dr.
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  Chi-Ming Chow, and today we're diving into some intriguing and important shifts happening in
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  the world of vaccine policy.
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  Our first segment focuses on recent changes to the Centers for Disease Control and
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  Prevention's Advisory Committee on Immunization Practices, or ACIP, as announced by the Health
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  and Human Services Secretary, Robert F.
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  Kennedy Jr.
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  In a move that's sparked quite a bit of discussion in the medical community, Robert F.
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  Kennedy Jr.
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  has appointed eight new members to the ACIP.
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  This decision follows his dismissal of the previous seventeen members of the committee.
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  The new appointments include some figures who were considered contrarians during the COVID-19
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  pandemic, such as Robert Malone, a medical doctor known for his early work on mRNA
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  technology, and Martin Kulldorff, a PhD who co-authored the Great Barrington Declaration.
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  Robert Malone has been a vocal critic of the COVID-19 vaccines, questioning their safety and
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  advocating for alternative treatments like hydroxychloroquine and ivermectin.
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  Meanwhile, Martin Kulldorff, who has faced controversy for his social media posts, was
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  reportedly let go from Harvard Medical School.
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  Kennedy has expressed that these appointments are a step towards restoring public trust in
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  vaccines, emphasizing the need for definitive safety and efficacy data before new vaccine
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  recommendations are made.
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  Among the other new members are Joseph Hibbeln, a medical doctor formerly with the National
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  Institutes of Health, and Retsef Levi, a PhD from the Massachusetts Institute of Technology
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  known for his work on vaccine-related cardiovascular events.
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  Additionally, H.
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  Cody Meissner, a medical doctor with a background in pediatric infectious diseases,
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  brings experience from his previous role on the Food and Drug Administration's vaccine advisory
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  panel.
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  However, this reshuffling has not been without criticism.
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  Paul Offit, a vaccine expert from the Children's Hospital of Philadelphia, has voiced
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  concerns about the lack of vaccine-specific expertise among the new members.
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  He specifically highlighted worries about Vicky Pebsworth and Robert Malone, describing Malone
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  as a clear anti-vaccine activist.
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  The medical community is concerned that this change could lead to the formation of
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  alternative advisory groups, reminiscent of what occurred during the Trump administration
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  when states formed their own committees due to concerns over federal vaccine policies.
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  Abram Wagner from the University of Michigan's school of public health also expressed
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  dissatisfaction, pointing out that most of the newly appointed members lack the technical
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  expertise traditionally expected of ACIP members.
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  Wagner particularly mentioned Vicky Pebsworth's involvement with groups known for spreading
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  vaccine misinformation as "incredibly problematic."
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  As we move forward, it'll be interesting to see how these changes impact public perception and
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  policy regarding vaccines.
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  The next ACIP meeting is scheduled for June 25, and it promises to be a pivotal moment in
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  shaping the future of vaccine recommendations and public health strategy.
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  Today, we're exploring a sleep disorder that many of you may not be familiar with, but which
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  affects a significant number of people: restless legs syndrome.
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  It's a condition that can have a profound impact on sleep quality and overall well-being.
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  I came across a story of Karla Dzienkowski's daughter, who experienced a stabbing sensation
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  in her legs at night, compelling her to walk around to find relief.
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  This discomfort led to sleep disturbances, crankiness, and even affected her school
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  performance.
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  It took about three years for Dzienkowski's family to finally receive a diagnosis of
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  restless legs syndrome.
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  This condition is more common than many might think, affecting an estimated four to
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  twenty-nine percent of adults in Western industrialized countries.
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  Yet, it's often unrecognized, not just by those experiencing it but also by healthcare
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  providers who may not know how to manage it effectively.
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  Dzienkowski, who is a nurse and the executive director of the Restless Legs Syndrome
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  Foundation, emphasizes this challenge.
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  Restless legs syndrome is classified as a neurological disorder.
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  Dr.
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  John Winkelman from Massachusetts General Hospital explains that it's characterized by an
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  uncomfortable sensation in the legs, sometimes the arms, that creates an urge to move.
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  This sensation is often described as crawling, aching, tingling, or throbbing, and it tends to
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  worsen when a person is resting, particularly at night.
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  The need to move in response to these sensations can significantly disrupt sleep,
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  classifying it as a sleep disorder.
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  The causes of restless legs syndrome are linked to genetics and iron levels.
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  Dr.
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  Winkelman notes that the condition often runs in families, with genetic markers predicting
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  about twenty percent of cases.
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  People with low iron levels are also more susceptible, including pregnant women, those on
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  dialysis, or individuals who have anemia.
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  Interestingly, it's twice as prevalent in women as in men and becomes more common with age,
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  though children can also be affected.
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  When it comes to managing restless legs syndrome, lifestyle changes are often the first
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  step.
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  Dr.
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  Brian Koo from Yale School of Medicine suggests evaluating factors that might exacerbate the
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  condition, such as alcohol consumption, certain medications, and dietary choices like high
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  sugar intake.
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  If iron levels are low, supplements or intravenous iron may be beneficial.
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  Dzienkowski recommends having a 'bag of tricks' for managing symptoms, which might include hot
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  or cold packs, massages, or engaging in mind-stimulating activities that help keep
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  symptoms at bay.
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  For those who do not find relief through lifestyle adjustments, medications may be
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  necessary.
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  Dr.
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  Koo mentions that drugs like gabapentin or pregabalin, which belong to a class called
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  alpha2-delta ligands, are often used.
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  Although dopamine agonists were once commonly prescribed, they're now less favored due to
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  their potential to worsen the syndrome over time.
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  In severe cases, low-dose, long-acting opioids may be considered.
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  If you're experiencing symptoms that motivate you to move your legs while at rest, and these
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  symptoms are affecting your sleep, it's important to consult a doctor.
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  Not all healthcare providers are familiar with restless legs syndrome, so seeking a referral
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  to a sleep specialist can be beneficial.
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  It's also advisable to get lab work done, particularly an iron panel with ferritin, to
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  assess iron levels and availability in your body.
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  Early diagnosis and treatment are crucial, as untreated symptoms can spill over into daytime
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  activities, affecting mood and energy levels.
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  Let's delve into a fascinating study on sleep and temperature regulation.
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  Researchers have been exploring how a cooling mattress pad might help reduce the frequency of
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  hot flashes that occur at night for women who are peri- and postmenopausal.
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  This small trial, shared at the SLEEP meeting jointly hosted by the American Academy of Sleep
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  Medicine and the Sleep Research Society, showed some promising results.
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  The Pod, a mattress pad that actively controls temperature, demonstrated a 54% reduction in
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  nighttime hot flash frequency.
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  This was a drop from an average of 1.78 hot flashes per night with the device turned off to
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  0.75 hot flashes with it on.
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  Although this reduction did not meet the minimum clinically significant reduction of two
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  vasomotor symptoms per day in this low-severity group, it still provided relief for many.
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  In fact, 65% of the women in the study experienced at least half the number of hot
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  flashes per night.
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  These findings align closely with another trial that used a passive cooling mattress pad, which
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  also reported a 52% reduction in vasomotor symptom frequency at night after eight weeks of
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  use.
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  However, the use of the Pod did not result in longer total sleep time or less time awake
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  after sleep onset.
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  Similarly, there were no improvements in the durations of light, rapid eye movement, or deep
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  sleep stages.
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  Jennifer Martin from the University of California, Los Angeles, who was not involved
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  in the study, noted that while it's challenging to completely stop hot flashes, nearly all
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  participants wanted to continue using the cooling mattress pad beyond the study period.
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  This interest suggests potential benefits beyond the immediate trial results.
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  Martin highlighted the importance of maintaining good sleep habits and being
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  prepared for nighttime hot flashes, such as having extra pajamas ready to minimize
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  disruptions.
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  Nonpharmacological methods like changing clothing, using damp towels, or discarding
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  covers can help, but they don't prevent awakenings like a cooling pad might.
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  Megan Holm from Eight Sleep, the device maker, emphasized that the Pod's effectiveness should
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  be seen as a proof of concept due to the study's small size and lack of randomization.
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  Holm and her colleagues underscored the need for further research to assess long-term
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  benefits.
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  It's crucial to remember that there are no simple solutions to complex problems.
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  Some women find significant relief from reduced hot flash frequency, which improves their sleep
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  dramatically.
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  However, for others with underlying sleep disorders, such as chronic insomnia or
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  obstructive sleep apnea, products like the Pod should not be perceived as standalone
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  solutions.
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  The Pod operates by using a powered hub that sits beside the bed, sending heated or cooled
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  water through a cover that fits over the mattress.
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  Users can set the temperature to automatically adjust throughout the night or manually change
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  it as needed.
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  The study involved thirty-eight healthy women, with an average age of 50.6, who reported
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  between five to ten weekly hot flashes at baseline.
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  They used the Pod with temperatures off for several nights, then turned on to self-selected
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  temperatures for subsequent nights.
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  Participants recorded the timing of their hot flashes each night and completed the Menopausal
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  Rating Scale to evaluate symptom severity and comfort.
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  The average score improved from 15.0 during the off period to 13.0 with the Pod on, indicating
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  better physical comfort.
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  Most hot flashes occurred during light sleep, with the fewest during deep sleep, possibly due
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  to greater responsiveness to external stimuli during lighter sleep stages.
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  While the trial was funded by Eight Sleep, it's important to approach these findings with an
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  understanding of the limitations, such as the small sample size and the lack of
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  randomization.
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  However, it's an intriguing development in the ongoing quest to improve sleep quality for
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  those affected by menopausal symptoms.
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  In our final segment today, we're shedding light on a fascinating approach taken by a
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  Halifax hospital to potentially reduce the number of unplanned caesarean sections,
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  inspired by an age-old superstition.
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  The IWK Health Centre in Halifax has been exploring a method called the "full moon
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  circuit," named after the belief that more babies are born during a full moon.
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  This practice involves a series of labor positions that aim to facilitate childbirth
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  naturally, with fewer interventions.
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  Jennifer Jollymore, a clinical nurse specialist at the IWK Health Centre, explained that the
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  full moon circuit includes a sequence of movements designed to help progress labor more
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  smoothly.
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  It involves patients moving through positions such as lying on their sides, sitting upright,
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  and leaning forward.
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  The goal is to use gravity to encourage the baby's descent into the pelvis, thus aiding in
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  a natural delivery process.
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  Interestingly, while the technique is named after the lunar phase, it actually has nothing
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  to do with the moon itself but rather focuses on the circular motion that symbolizes the
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  cervix.
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  Since its introduction in 2023, the full moon circuit has shown promising results at the IWK
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  Health Centre.
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  Over a three-month period, the rate of unplanned caesarean sections decreased from
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  twenty-four percent to sixteen percent.
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  Although the hospital cannot definitively attribute this reduction solely to the full
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  moon circuit, it certainly offers a reason for optimism.
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  The technique is particularly beneficial for patients who have had epidurals, as they might
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  not feel the natural prompts to change positions during labor.
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  Jollymore emphasizes that the full moon circuit empowers patients by encouraging them to be
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  active participants in their labor, which can lead to shorter labor durations, less pain, and
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  reduced fetal distress.
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  The IWK Health Centre is considering developing a "full moon challenge toolkit" to help other
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  hospitals across Canada implement this strategy and potentially lower the rates of unplanned
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  caesarean sections.
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  The empowerment and engagement of patients in their birthing process have been met with very
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  positive feedback.
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  In conclusion, this innovative approach highlights how simple changes in labor
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  management can make a significant difference in childbirth outcomes.
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  It's a reminder of the power of combining traditional beliefs with modern medical
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  practices to improve healthcare experiences.
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  Thank you for joining me today on Morning Medical with Dr.
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  Chow.
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  I hope you found our discussions enlightening and informative.
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  Until next time, stay healthy and informed!