October 2016
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Heartburn drugs linked to kidney damage: Study finds risk in common PPI drugs

Heartburn drugs taken by millions daily are linked to kidney damage and renal failure "at an alarming rate," a new report warns this week. Heartburn, acid reflux and ulcers are treated with this medication that is one of the most over-prescribed drugs of modern day pharmacology.

A new study shows heartburn drugs are putting folks at risk for health problems with their kidneys.

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These drugs are sold over-the counter and they are also prescribed by doctors. Researchers at the Clinical Epidemiology Center at the VA Saint Louis Health Care System and Washington University in Saint Louis probed previous findings that the proton pump inhibitors (PPI) were linked to kidney disease. They not only were able to confirm these earlier findings, but they also discovered that these drugs are linked to renal failure at Methadone Opiates an "alarming rate," according to MSN News on April 15.

These results suggest the prescribing of these drugs need to be for the shortest duration possible and to use this drug only when it is medically necessary. This study entailed tracking subjects for five years. There were 173,321 subjects who were new users of PPIs and 20,270 subjects who were new users of another class of these drugs called histamine H2 receptor blockers.

These patients were all selected from the Department of Veteran Affairs national database. The findings of this study were published this week in the Journal of the American Society of Nephrology. The researchers found: "PPIs have the propensity to increase the risk of chronic kidney disease by 28 percent and developing kidney failure by 96 percent compared to the patients who took the H2 receptor blockers.

They found the longer the patients took the drugs, the greater they put themselves Methadone Locator at risk for kidney damage," according to MSN News. The H2 receptor blockers, which were the Methadone Program drugs of choice before PPIs came along, are a "kidney safe" alternative.

Researchers from Johns Hopkins University did a similar study that was published in JAMA 's February 2016 edition an they found the same risk exists between PPI use and chronic kidney disease. This latest study confirmed the results of the one published in February, which stated these drugs are linked to kidney disease, but it also took it a step further. They found that the PPI medication also "drastically increases the risk of developing kidney failure."

Besides doctors frequently prescribing these drugs, they are also sold over-the-counter. When drugs are available without prescription folks tend to feel that they are safe or they wouldn't be an over-the-counter drug. They figure that the FDA wouldn't have them available for the asking if they posed any type of health risk when taken as prescribed on the label.

This alarming study doesn't go unscathed without some critiquing. According to News Max today, Dr. Kenneth R. DeVault, president of the American Addiction Programs College of Gastroenterology and chair of medicine at Mayo Clinic in Jacksonville, looks at the study from another angle, he wants you to consider the data base of patients used in this study. He said:

"Keep in mind that the study population was a veteran's hospital, a relatively older population that had lots of other diseases. One would have to assume if you were the average healthy person taking a proton pump inhibitor for heartburn the odds would be even lower than the low odds in this study." He said that while the "risk is real, the odds are low." It doesn't sound like it's time to toss out your PPI medication, but it does sound like a conversation with your doctor on your use of the drug is in order if you need to set your mind at ease!

According to Healthline, there are seven available Proton Pump Inhibitors (PPI) medicines that are roughly equal in effectiveness and safety but differ in cost. These are "Three- omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24HR), and omeprazole/sodium bicarbonate (Zegerid, Zegerid OTC)- are available as both prescription and nonprescription drugs." There are other PPIs on the market, such as Nexium, which is often referred to the "purple pill." The Nexium website describes how a PPI works.

According to MSN, "researchers recommend PPIs should be avoided, especially when acid reflux or the like can easily be treated with kidney-safe H2 blockers." According to Healthline, the H2 receptor blockers are "acid-reducing drugs known as H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac)," along with others. They will very likely provide relief. "All of those products are available without a prescription as low-cost generics."

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Signs of Pregnancy After 1 Week

The term 'ovulation' refers to the release of an egg or ovum from the ovary. For a woman to get pregnant, the egg should get fertilized with the sperm, and get implanted in the lining of the uterus. One of the main indicators of pregnancy is a missed period.

Symptoms of Early Pregnancy

The earliest signs of pregnancy include missed period, sleep disturbances, nausea, and fatigue. It is not necessary that you will experience all of these symptoms in the first two weeks of pregnancy. Mild abdominal cramping is also one of the indications of pregnancy after 1 week. These cramps are often accompanied by clear vaginal discharge. Here are some of the common symptoms that might be experienced by women after the first week of pregnancy.

Missed Period

A missed period is one of the first and common signs indicating that a woman is pregnant. This can be due to the reason that the fertilized egg has implanted itself in the uterine wall. At times, skipped period may also mean a false alarm and might be due to stress. To confirm the pregnancy, get a home pregnancy test kit.

Changes in the Breasts

Due to hormonal changes that take place in your body after fertilization, your breasts may become tender and sore. They might also look fuller and feel heavier. The areola around the nipples may also turn darker.

Cramping and Mild Bleeding

Some women, during the first two weeks of their pregnancy may also suffer from severe cramping. These cramps are usually similar to menstrual cramps. The cramps are accompanied by mild bleeding or spotting. Mild bleeding is caused when the fertilized egg gets attached to the lining of the uterus, which is normally after 10 to 15 days of conception. This is referred to as implantation bleeding or spotting. The bleeding is usually lighter in comparison to the normal menstrual period, and does not last long.


During the initial stages of your pregnancy, the levels of progesterone rise rapidly. If the level of progesterone goes higher than normal, you might feel sleepy. If you are affected by low blood sugar or low blood pressure, it will deplete your body energy levels drastically.


Women often experience nausea and vomiting due to increased levels of estrogen in their body. In the initial stage of pregnancy, women have an increased and deepened sense of smell. So, any kind of strong odor related to food, paint, or cigarette smoke might cause nausea. Morning sickness is also one of the classic signs of pregnancy in its initial stage, and is a result of fatigue.

Food Cravings/Aversion

Hormonal changes can lead to food cravings in pregnant women. Some women may also develop an aversion to certain foods, while they are pregnant.

Mood Swings

The change in hormone levels in a pregnant woman can make her emotional. Mood swings are common during pregnancy.


Hormonal changes could also trigger mild or severe headaches in the initial stages of pregnancy.


In the first two weeks of pregnancy, progesterone levels rise. Higher levels of progesterone causes food to pass slowly through intestines, which may cause constipation.


In the initial stages, the blood sugar level and blood pressure drops, which causes blood vessels to enlarge. Due to this, pregnant women may feel lightheaded and dizzy. It may also lead to fainting spells.

Increased Basal Body Temperature

Basal body temperature is the oral temperature that you may record at the time you wake up in the morning. During your ovulation period, this temperature increases and remains the same until your next period. The best way to determine pregnancy is to chart down your basal temperature so as to determine your ovulation time. If the basal body temperature keeps rising after ovulation for more than two weeks, it might be a sign of pregnancy.

If you notice any of these signs, carry out home pregnancy tests or consult your gynecologist immediately. Take care and here's wishing you a safe pregnancy and a happy motherhood!


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Is fracking causing a spike in radon levels?

Nearly half of the homes in Pennsylvania have unsafe radon levels and that number has been on the rise since 2004 when the oil and gas industry began fracking in the state.

A study by Johns Hopkins Bloomberg School of Public Health researchers found that 42 percent of readings surpass what the U.S. government considers safe. They said the rising rates of the odorless gas tied to lung cancer could have been due to fracking, a process of injecting a slurry of water, sand and chemicals into wells in an area known as Marcellus shale to remove oil and gas.

"One plausible explanation for elevated radon levels in people's septic tank grease trap homes is the development of thousands of unconventional natural gas wells in Pennsylvania over the past 10 years," said study leader Brian S. Schwartz, a professor in the Department of Environmental Health Sciences at John Hopkins. "These findings worry us."

The study, conducted with Pennsylvania's Geisinger Health System, a health care network, analyzed more than 860,000 indoor radon measurements included in a Pennsylvania Department of Environment Protection database from 1989 to 2013. Many of the measurements came from assessments of homes that were either being bought or sold.

Along septic tank prices with the geography, water sources, and weather, the researchers looked at fracking levels.

Pennsylvania has been a hotspot for fracking since the boom started more than a decade ago, with 7,469 unconventional natural gas wells drilled in the state since 2005.

In the process of pumping billions of gallons of chemically laced water deep underground to extract the gas, heavy metals as well as organic and radioactive materials such as radium-226 are brought to the surface. It decays into radon and most radon exposure has been linked to the diffusion of gas from soil.

Along with the unsafe levels across the state, the study found that houses and buildings located in rural and suburban townships, where most of the gas wells are, had a 39 percent higher concentration of radon than those in cities.

"By drilling 7,000 holes in the ground, the fracking industry may have changed the geology and created new pathways for radon to rise to the surface," Joan A. Casey, a Robert Wood Johnson Foundation Health & Society Scholar at the University of California-Berkeley and an author on the study, said. "Now there are a lot of potential ways that fracking may be distributing and spreading radon."

The findings offer another troubling sign that fracking is leaving behind a myriad of environmental problems. Critics have blamed the industry for producing 800 billion gallons of wastewater each year, causing water and air pollution in communities near fracking sites and sparking earthquakes in Oklahoma and Ohio.

They also have attacked states and the federal government for failing to do enough to regulate the industry, prompting the Obama Administration earlier this month to issue the first-ever regulations for fracking on federal lands - which among other things requires companies to disclose the chemicals they are using.

Still, the latest findings on radon are likely to be disputed. The authors even acknowledged that the state of Pennsylvania recently took a comprehensive set of measurements near 34 gas wells, including air samples for radon near four wells, which did not show high levels of the radioactive gas.

Susan Rickens, a spokeswoman for the Pennsylvania Department of Environmental Protection, confirmed the state's study didn't find elevated levels near drill sites, though it didn't take samples of indoor air quality as the John Hopkins study did.

More broadly, Rickens said the state sees radon as a "public health concern," adding that that all 67 counties have shown "high levels" of the gas.

"While our study didn't signal a problem, we will take a look at the John Hopkins study in-depth," she told CBS News. "It may signal areas where we need to do more study."

The oil and gas industry, which has sued to stop the new federal fracking regulations, also criticized the radon study.

In a blog post, Nicole Jacobs of oil and gas advocacy group Energy in Depth said the researchers' "own data debunk their conclusions: their highest radon readings were in counties in Reading Prong, which have absolutely no wells - not even conventional."

Reading Prong, the authors note, has historically high bedrock uranium concentrations, which could explain its high radon levels.

"They gloss over the fact that Pennsylvania has long had naturally occurring concentrations of radon, and simply blame fracking," she wrote. "Further, study after study, including a major study from the Pennsylvania DEP, has found no credible link between oil and gas development and radon exposure. Considering all these facts, it looks like the researchers were more interested in gleaning anti-fracking headlines than producing credible science."

Schwartz countered that the industry was "cherry picking" results in attempt to discredit the study and he and the other researchers had been "fair in the balance of our claims."

2015 CBS Interactive Inc. All Rights Reserved.

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Kimberly Leach Johnson, Firm Chair, Quarles & Brady

Kimberly Leach Johnson presides over the firm's executive committee and is Firm Chair of Quarles & Brady. As an attorney, she has been practicing trusts & estates law for more than 30 years. She built her practice from the ground up by building personal and professional relationships across Southern Florida until she accumulated not only an impressive client base but a network of referral sources. Kimberly's clients include individuals and institutions alike. Her command of the tax code, coupled with her comprehensive knowledge of both the laws and the personal considerations that affect the transfer of wealth, make her a reliable source of advice and legal representation for high-net-worth persons and families, including those owning private companies.

How has your life experience made you the leader you are today?

We are all a product of our circumstances; this, however, does not mean we are victims of--or can't change--our circumstances. My mother raised me to be very involved, very present in the present--to give everything I could every day, to not let others limit my life, and to always strive for excellence. She must have told me at least 100 times to go out and make a difference in the world. Besides her cookies, my mother pushing me to make an impact on the world around me is my biggest takeaway from my childhood.

How has your previous employment experience aided your position at Quarles & Brady?

I worked for a number of years at a much infiltrator septic tanks smaller firm, where I learned the business side of the law--the importance of timely billing, making sure the time descriptions accurately reflected the value to the client, and tackling the more unpleasant tasks, like collecting your septic tanks problems receivables. For a number of years, I served as the managing partner of that firm and learned pretty early in my tenure to confront issues head-on with various attorneys. Many of the finance skills I used when I served Quarles & Brady as the Finance Chair were learned at the smaller firm. At a larger firm, you don't count on the daily revenue from one attorney to pay the bills. "Out of sight and out of mind," as the saying goes, and it becomes convenient to believe the responsibility to bill and collect to keep things running belongs to others, so how often should you have your septic tank pumped long as you get your own in before the proverbial stroke of midnight at year's end, just before the carriage becomes a pumpkin. Given my past experience, I was able to change the culture, so that many more partners at Quarles & Brady bill and collect on a regular basis. In fact, that is very much my role as Firm Chair; I serve as captain of the ship, guiding a 500-attorney firm so that it is in the best position to help our clients succeed.

What have the highlights and challenges been during your tenure at Quarles & Brady?

I've only been in this specific position for a little over a year, but it has been a jam-packed year to say the least! One of my priorities has been to sit down with clients, and I've enjoyed spending time with them to learn about their business and how we can help them more effectively. It's an interesting time to chair an AmLaw 200 firm, as the industry has changed so dramatically since the economic turmoil of 2008. The demand for legal services across the country is down and will probably never return to pre-2008 levels. Business law is nothing if not Darwinian, and our attorneys--all attorneys--need to learn how to deliver services more efficiently. This requires a change in the way we do business, and change is never easy. We now bill a little less than 20 percent of our fees on a non-hourly basis, and we are trying to work with our clients to bill more on a flat fee basis. The clients like the predictability of flat fees for a variety of reasons, not the least of which is being able to budget more effectively. To bill on a flat fee requires managing the case differently, staffing differently, and providing more transparent accountability. The legal business is more competitive than it has ever been, and we are trying to find ways to serve our clients in a manner that not just satisfies their business requirements, but exceeds them. Excellence bears reputation, not the other way around.

What advice can you offer to women who want a career in law?

Young attorneys today will need to be very astute in business development starting at an early age. Women attorneys have not prospered in the profession in the same proportions as men. In the late 1970s, when I started law school, about 30 percent of my class were women. Today, we don't have 30 percent of any segment of the legal industry leadership that is made up of women (e.g., deans of accredited law schools, equity partners in major firms, judges, etc). A recent study I read indicated that one reason women have not succeeded is they don't have a robust book of business. Cultural differences impact a woman attorney's inclination to ask for the business. I would advise a young attorney starting out to aggressively take advantage of any in-roads their firm supplies on this front. Quarles & Brady, for instance, has a variety of training programs intended to help women feel comfortable promoting themselves in the marketplace, so they can enjoy their earned share of the pie.

How do you maintain a work/life balance?

If there were a simple, magic-bullet answer, you wouldn't be asking the question. Work/life balance is very difficult. There is always a trade-off; no one has yet invented a means to make time stop or add hours to the day. When my sons were younger, I made a concerted effort to try to create balance, and the extent I was able to do so was a direct result of my husband's active participation in our home life. Today, now that my sons are living on their own, I don't have any balance in my life. The Chair role demands too much.

What do you think is the biggest issue for women in the workplace?

The biggest issue facing women in the legal business is finding their place. It can be difficult in the early years if you chose to have a family and want to spend time with them. As I noted, women also need to gain the confidence to ask for the business. Then, of course, there is always the elephant in the room--equality of pay is still an issue. At Quarles & Brady, we do blind testing based upon gender, race, and office location to try to ensure the process is not biased against any particular group of attorneys.

How has mentorship made a difference in your professional and personal life?

I've had several mentors in my career. I think, on some level, we are all influenced by the full menagerie of characters that cross our paths over the course of this journey. Some I've learned from by observing their negative behavior and some from their positive behavior; some I try to emulate, but I've honestly learned as much from seeing what I don't want to do--the kind of person I don't want to be--as I have from the positive influences in my life. Teachers come in all shapes and sizes, and each brings a different lesson to learn. At Quarles & Brady, though, we have a very successful formal program to ensure all attorneys have mentors to guide them through the system--and we vet mentors, to make sure the right kind of people are in those positions.

Which other female leaders do you admire and why?

I have great fondness and admiration for the Honorable Sandra Day O'Connor. Look what she accomplished--reaching the absolute and unquestioned pinnacle of her field--and then what she gave up, so she could be with her partner, the person she loved. She seems to always have had her priorities in the right place; there is a way to get to the top without losing sight of who you are.

What do you want Quarles & Brady to accomplish in the next year?

We need to continue to execute our strategic plan, which we designed last April. The plan is built on the conceit that, to survive in this competitive environment, we have to serve our clients in the manner they want to be served--this includes everything from our communication style, our responsiveness, and our understanding of their business. We've identified several key strategic areas to hone in on, as well as some new ones we'd like to bring to the marketplace. We are trying to ensure we provide a consistent client experience no matter in which location or practice field you need assistance. Quarles & Brady is a wonderful law firm with terrific people, from our staff to our attorneys, and we want to score a "10" every time, in everything we do. We value inclusion and diversity to a greater extent than anyone else in our industry. Our prior Chair was the first African-American to chair an AmLaw 200 firm, and I--his immediate successor--am one of only a handful of women to chair such a firm.

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