The average American is blissfully unaware of this world, even though it directly affects them, often in hugely personal ways. Your most intimate details, like medical records, may be available for sale online and there’s nothing you can do to prevent it.

When the hack, referred to as a Ransomware Attack, hits closer to home, it becomes public knowledge. Take for instance the attack in early May on American gasoline supplier Colonial Pipeline, which crippled many cities. Americans were soon queuing for gas, hoarding supplies, as gas stations across the US closed or ran out of gas. 

The hackers had taken control of the systems operating the supply of gasoline via pipelines that criss-cross America. This was personal and the American public felt the effects first hand. Ransomeware was all over the news.

What most Americans don’t realize, however, is just how common these attacks are. It’s the perfect digital crime. Take over some company’s system, shut it down remotely from a place of safety, and then demand payment from the company. Once the company pays — the ransom — their systems are unlocked and they can resume business.

Bizarrely, the hacker’s “code of ethics” for want of a better term, seems to hold true. Once payment is made, the systems are released. Payment is a simple matter, digital currencies like Bitcoin make tracking the money all but impossible. 

It could be argued that without access to digital currencies, these hackers would be unable to extort money from their victims without leaving a clear trail for authorities to pursue.

Aside from the obvious inconvenience and potential dangers to essential energy supplies and other critical systems, there is another hugely unreported consequence of these hacks. The bleeding of personally identifying data. That’s your info and mine, all of it fair game. Don’t forget, these hackers are inside the systems they compromise, they have sufficient access to lock down the system.

It would be hugely naive to imagine they simply leave it there. While companies run around trying to secure loans to pay off ransom demands, the hackers are merrily downloading every shred of data they can strip from the systems.

That’s where the real value lies. Your information or data, which is spread throughout numerous systems across the US. This data is worth real hard cash on the dark web, especially certain types of personal data, like your healthcare information. From recent reports, it would appear no systems within the US are immune.

Your Data, Healthcare, and the silent war

Most ransomware attacks never see the public light of day. They’re kept quiet and settled away from the prying eyes of the media and the public. For very good reasons. Investors don’t like companies that appear vulnerable and companies would rather not spend the next six months explaining to their customers that their data was compromised.

Healthcare is particularly vulnerable. It’s a sector favored by hackers. Easy access to poorly protected systems, rich data pickings, and a culture of “keeping it on the QT’ among medical institutions, hospitals, and healthcare systems make this sector almost irresistible. 1 in 3 companies or institutions within healthcare get hit, according to a recent whitepaper from IT Security firm Sophos. Here are the key takeaways from the paper. 

• 34% of healthcare organizations were hit by ransomware in the last year.
• 65% that were hit by ransomware in the last year said the cybercriminals succeeded in encrypting their data in the most significant attack. 
• 44% of those whose data was encrypted used backups to restore data. 
• 34% of those whose data was encrypted paid the ransom to get their data back in the most significant ransomware attack. 
• However, on average, only 69% of the encrypted data was restored after the ransom was paid. 
• 89% of healthcare organizations have a malware incident recovery plan. 
• The average bill for rectifying a ransomware attack, considering downtime, people time, device cost, network cost, lost opportunity, ransom paid etc. was US$1.27 million. While this is a huge sum, it’s also the lowest among all sectors surveyed.

Scripps is an excellent example in case. Scripps began notifying more than 147,000 individuals in early June this year that their protected health information was exposed during a malware attack. They now face 4 class-action lawsuits.

For certain patients, exposed information included names, addresses, birthdates, health insurance data, medical record numbers, patient account numbers, and treatment details. Less than 2.5 percent of individuals’ Social Security numbers and/or driver’s license numbers were involved, according to the health system.

The list of attacks is growing exponentially.

• 500,000 patient files were potentially stolen in a ransomware attack on Iowa clinics.
• 334,000 Ohio Medicaid providers’ data were breached in a vendor hack

Keep in mind that only a small percentage of these attacks are ever made public and the data above should serve as a fair warning to all healthcare organizations. No one is immune and even smaller organizations are targeted.

Protecting yourself

Clearly, we cannot exist in a modern society without sharing our most private details with companies on a daily basis. There is a huge amount of trust involved, and where many Americans now simply take this relationship for granted, assuming companies will protect their information, ransomware exploits have exposed clear flaws in companies’ approaches to protecting our privacy.

We cannot affect or restrict the data we share without compromising, for instance in a healthcare setting, our quality of care and service. In these instances, the onus falls squarely on the shoulders of the service providers to protect our data and they are failing. 

Our only recourse in this instance is to lobby our congressmen and women. Changes need to be urgently brought to bear on the holders of personal data, fines imposed for lack of proper security, and audited processes put in place to ensure our data is safe.

This is going to prove challenging, particularly when not even the federal government’s systems appear immune to attack. Perhaps it is time to apply Bitcoin-style encryption to our data and fight fire with fire.

The post Held for Ransom. A New Pandemic is Sweeping American Healthcare appeared first on Medika Life.

A burning sensation that starts in the chest and expands. Or maybe it’s a clenched fist in the stomach or a mysterious lump that cannot be swallowed. Perhaps it’s an unusual urge to cough.

Though the symptoms may vary, the cause is the same.

No shortage of stomach acid

Acid reflux, gastroesophageal reflux disease (GERD), sour stomach, or heartburn. They all describe the same condition: gastric acid hypersecretion, or too much stomach acid.

Overproduction of stomach acid can lead to a host of problems. An ulcer can occur when acid destroys the stomach’s protective layer of mucus. This leaves the inner lining vulnerable to damage. Ulcers may also form in the small intestine.

Ulcers can also be caused by a bacterial infection of H. pylori. In this case, medical intervention is essential as H. pylori can only be treated with a course of antibiotics.

GERD is the word

Gastroesophageal reflux disease (GERD) is what gives us those classic heartburn symptoms.

When gastric acid flows the wrong way back up into the esophagus, it is called reflux. Normally a gateway, called the esophageal sphincter, prevents this backflow. However, multiple factors can cause the esophageal sphincter to relax, allowing acidic contents in the stomach to escape.

These include:

• Increased age
• Pregnancy
• Smoking
• Medications like NSAIDs, heart medications, and anti-anxiety medications
• Diet
• Certain types of hernia
• Obesity

The result is pain, burning, discomfort, and if left untreated, inflammation, and eventual build-up of scar tissue. Scarring can cause the tube-like esophagus to narrow, making it difficult to swallow food. This is known as esophageal stricture, and treatment may require surgical placement of a stent.

These long term complications are why it is imperative not to let chronic heartburn go untreated.

Mandatory Disclaimer

Before undertaking any self-treatment with over-the-counter medications, have a discussion with a doctor or pharmacist. Occasionally the symptoms of heartburn can be similar to a more serious cardiac issue. This is especially true for women, who may not always display the classic signs of a heart attack.

Lifestyle modifications- unsexy advice

As a pharmacist, my first recommendation is non-pharmacological intervention. No one wants to hear it, but losing weight and quitting smoking will help. So will resisting the urge to sleep on the couch after a heavy meal. Avoiding trigger foods is also sage advice.

For me, heartburn started in my 30s. Eating fried foods would trigger my symptoms without fail. While fatty foods are a common no-no, others include:

• Protein-rich meals
• Spicy foods
• Alcohol
• Chocolate
• Acidic foods like citrus, grapes, pineapples, and tomatoes
• Peppermint
• Caffeine

I know. All the things that make life worth living.

Remember, not all of these foods will be triggers for everyone. My advice is to try an elimination diet. Take away foods that are believed to cause the pain and add them back one at a time. Soon you will have your culprit.

Stress is another cause. So many of our physical problems stem from mental ones.

I would always feel heartburn take hold after I had been at work for about an hour. I could go on about relaxation techniques — taking deep, cleansing breaths, and allowing for frequent breaks. But honestly, the only thing that helped me was not eating before going in to work.

So you’ve tried all these tips and still have heartburn? Then it’s time for a chat with your doctor or pharmacist.

Antacids

For mild, occasional heartburn, the first-line treatment consists of antacids. Maalox, Mylanta, and Tums are all examples.

Maalox and Mylanta are twins; a combination of aluminum and magnesium that works quickly to neutralize the acid in the stomach. Additionally, these thick liquids coat the stomach walls, providing a temporary protective layer.

Tums, a chewable tablet, contains calcium carbonate, another fast-acting acid neutralizer.

Antacids are all similar in efficacy. Let such factors as liquid versus chewable or price be your guide.

You may see a product called simethicone added to antacids. This agent reduces gas. It will not directly help manage heartburn symptoms. However, if you feel bloated or experience lower abdominal pain, simethicone could be useful.

Aside from icky taste, there are no major side effects for antacids.

It is a good idea to space antacids apart from other medications by at least 2 hours. The compounds in them can bind with other drugs, making them difficult for the body to absorb. This is especially important with antibiotics and medicine used to treat thyroid conditions and bone loss.

Use caution in individuals with kidney disease as the buildup of magnesium, aluminum, and calcium in the body is a potential problem.

Remember, antacids are only for short term use — 1 to 2 weeks. If they are not helping, consider adding or switching to an H2 blocker.

H2 Receptor Blockers

Also known as H2 receptor antagonists, these medications are a good choice for heartburn as they help to treat the cause. Although their onset of action is slower than antacids, about 1 hour, their duration lasts longer.

H2s work by blocking histamine receptors in the stomach. This blocking, or antagonism, prevents the signal that leads to the production of gastric acid.

Four brands are currently available over-the-counter (OTC):

• Axid (nizatidine)
• Zantac (ranitidine)
• Pepcid (famotidine)
• Tagamet (cimetidine)

I feel most comfortable recommending Pepcid due to its long history of use and the near absence of drug interactions.

Tagamet, as the first on the market, has the most adverse effects. Tagamet also affects liver enzymes more than the others and therefore displays more serious drug-drug interactions.

Zantac, normally a great choice,has been temporarily recalled for NDMA contamination — a possible carcinogen.

Axid was the last player to enter the H2 blocker arena, and as such, never gained as much popularity.

Side effects of H2 blockers are mild and include headache, nausea, and vomiting.

They are generally well-tolerated, but individuals with poor kidney function should avoid using H2 blockers long term. When used sparingly, the dose should be cut in half.

Limit self-treatment with H2 blockers to no more than 2 weeks without consulting a doctor. This is especially important as longer treatment appears to result in tolerance to the drugs with a resulting decreased efficacy.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are gaining in popularity since a few made the switch from prescription (RX) to OTC a few years ago.

This class of drug displays the most benefit in reducing damage caused by the overproduction of acid. PPIs work by shutting down the pumps that produce gastric acid, giving the stomach a chance to heal.

The success of Prilosec (omeprazole) launched a series of competing “me too” drugs.

Other PPIs that made the RX to OTC switch include Nexium (esomeprazole) and Prevacid (lansoprazole).

In general, there are no practical differences between these three drugs. Honestly, pick whichever one appeals to the pocketbook.

Expect that PPIs will take a few days to start working. It may be beneficial to continue using antacids or H2 blockers until the full effects are felt.

PPI media hype: sifting truth from fiction

There have been many media reports about the dangers of PPIs. Many of these are unwarranted as this class of drugs is generally recognized as safe. Realistically, the most common side effects are headache, rash, and diarrhea.

However, when used long-term, PPIs do come with a few caveats.

Certain populations using PPIs, like the elderly or immunocompromised, appear to have an increased risk of infection. Clostridium difficile, a particularly nasty bug that causes severe diarrhea, and pneumonia are of greatest concern.

The theory is the acidic environment in our stomach normally suppresses bacterial overgrowth. If we neutralize this defense, bacteria can flourish.

Incidentally, there may be a correlation between PPI use and coronavirus. Early data suggests a link between low amounts of stomach acid and the proliferation of the coronavirus — leading to more positive tests. However, further research is needed.

Increasing the pH of the stomach may also lead to absorption problems. Calcium, magnesium, and vitamin B-12 are a few of the affected essential vitamins and minerals. Low calcium is of special concern to an elderly population already at increased risk of bone loss, or osteoporosis.

Consider talking to your doctor or pharmacist about supplementation.

It is also recommended not to abruptly quit PPI use after long-term therapy. Slowly tapering off the drug avoids the rebound effect of increased acid production.

Drug interactions with PPIs mainly result because of competition for the liver enzymes that aid in metabolism. However, they can also be a result of the increased pH in the stomach. Many drugs need an acidic environment to be activated.

Major interactions between PPIs exist with:

• Antiretrovirals (HIV medications)
• Anti-fungals
• Anti-depressants
• Chemotherapy agents
• Anti-seizure medications
• Plavix (clopidogrel) — an important antiplatelet drug used to prevent heart attack or stroke

Because of the potential for serious long term effects and severe drug interactions, I recommend talking to your doctor first before initiating PPI self-therapy.

Heartburn in pregnancy

Heartburn is a common complication in pregnancy, with the majority of symptoms occurring in the last trimester.

Studies evaluating a drug’s safety profile in human pregnancies are scarce. Usually, we rely on animal studies when making recommendations. Plus, the benefits to risk ratio must be considered.

The safest solutions for pregnant women with heartburn are the lifestyle modifications discussed earlier. Eat smaller, more frequent meals, avoid trigger foods, and elevate the head of the bed with pillows to avoid lying flat. Chewing gum to release saliva may also help promote digestion.

Consider occasional treatment of heartburn in pregnancy with a calcium-containing antacid like Tums first. Magnesium also seems to be safe in low doses. However, a few studies have agreed that limiting the amount of aluminum may be prudent.

H2 blockers have also been safely used, but it is recommended to be under a doctor’s guidance. Although they appear safe in the first trimester, PPIs should only be used under doctor supervision.

Summary

Although it seems a minor inconvenience, heartburn can lead to more serious problems. It should never be ignored.

Avoid or limit those trigger foods, and make appropriate lifestyle changes when possible.

Consider treating the occasional mild case of heartburn with an antacid. Add an H2 blocker, like Pepcid, if no relief.

If no comfort is felt from either agent, it is reasonable to consult with a doctor or pharmacist before starting a PPI. Although they work best, they also have the most potential long term effects and drug interactions. Also, a checkup can help rule out other causes.

Never ignore warning signs of a more serious condition such as:

• Blood in the stool
• Unexplained weight loss
• Food getting stuck in the throat

With a few changes, heartburn does not have to be a daily event. That fire in the stomach can be extinguished.

The post A Definitive Guide to Heartburn and Alleviating the Symptoms appeared first on Medika Life.