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Face Pain? It Could be TMJ

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In primary care we commonly see patients with ear pain, sinus pain or headache.  It's often hard for patients to self diagnose where the pain is originating and they want treatment for sinus or ear infections.   When examination of the ear or sinuses doesn't show a problem, many times we find out that it is from the jaw.


TMJ  (Temporomandibular Joint) or TMD (Temporomandibular Disorder) is a common cause of facial pain and can affect as many as 10-15% of adults.  It presents with pain, ear discomfort, headache and jaw pain. It is caused by inflammation in the joint that opens the jaw, right in front of the ear and sometimes there can be a snapping of the jaw as it is widely opened.  You can think of this joint as a hinge that connects the jawbone to the skull.  Like any joint, it can get inflamed and the surrounding muscles of the jaw hurt.


The treatment for TMJ is resting the jaw from wide opening and anti-inflammatory medication.  Most of the time it resolves within about 2…

What Defunding Planned Parenthood Really Means

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Planned Parenthood clinics have been a  political football for over a decade. Planned Parenthood operates about 650 health centers across the United States and 2.7 million men and women visit the clinics each year.  In fact, an estimated 1 in 5 women has received care from PP at least once in her life.  For many women, Planned Parenthood may be the only place to receive reproductive health care near where they live.  They provide basic women's preventive care (pap smears, STD testing and treatment, counseling, contraception, IUD placement and long acting reversible contraception) and even basic primary care.


 Of all the health services Planned Parenthood provides, they report that about 3% are for abortion.  Most women receive other services at the same time (pregnancy testing, future contraception) that can skew this number and critics say the abortion percentage is higher, (calculated to as high as 7%), but there is no dispute that Planned Parenthood provides more needed health…

How to know if something is infected

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How can you know if an injury is infected?  Patients are often concerned when wounds don't heal right away and this causes them to make needless visits to the doctor or emergency room.  Here is a pic of a wound that is about 6 days old.  My little dog scratched my arm while I was giving her a bath.  (Isn't she cute?)

 Is this scratch infected?

If you said no, it is healing well, you would be correct.  Even though it is still swollen around the scratch and it is obviously red and a little warm, these are signed of normal skin healing. I can picture my white blood cells and monocytes racing to the area to deal with bacteria from the scratch.  The redness and swelling are an inflammatory response that my immune system is producing to contain the bacteria and turn over new cells.

Signs of infection would be redness that continues to extend outside the wound that is worsening over time.  The swelling wouldn't stay the same, it would expand day by day.  The cut it self might st…

Why Can't I Have a Dentist EHR?

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Imagine my surprise and delight when I saw my dentist this week for a check-up and found the electronic health record to be both informative and patient friendly. As I sat in the dental chair, the large monitor screen was swung over in front of me and my dentist was at my side going over it with me. The monitor was not a barrier...it was part of my exam. The print was large, the information on the screen was easy to understand. Together we updated my health history, current meds and corrected errors. She held a small pad and changed things as we spoke. As the exam progressed she was able to swing the monitor over and show me X-rays, a fracture line in my tooth, a hazy spot that needed more investigation. We looked back in time and compared. The computer was a welcome addition in the exam room and the amount of clicking and recording of information was simple and intuitive.


Compare this with the EHR that I use, which by the way, is rated one of the best and is extremely expensive to p…

What is Shingles?

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Thanks to my patient for allowing me to use her photo to talk about a common condition known as Shingles.  The medical name is herpes zoster and it is caused by the re-activation of the chickenpox virus (varicella zoster).  This crazy virus lays dormant in the nerves and something causes it to flare up years or decades later.

This patient noticed a small rash behind her right ear and thought it was insect bites after a camping trip.  She had some tingling (a common sign) and swollen and tender lymph nodes.  Two days later when I saw her, the rash had spread down her neck and shoulder and she definitely had lymph node swelling at the neck and above the clavicle. (nuchal and supraclavicular nodes).  She had no fever but felt a little down.

Most shingles occurs in older people but it is not uncommon in younger folks too, like this patient.
The rash takes about a week to develop and can last about 2 weeks with varying degrees of pain and annoying tingling.  Some patients have pain that …

Transparency Price Tools Did Not Lower Health Costs

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For years experts have been saying if consumers knew the price of certain health care services they would be able to decide what services bring "value" and they could be better "shoppers" of health care.  Since so many patients have large deductibles and copays, it has been conventional wisdom that providing transparent prices would lower overall costs.  As people are spending their own money, giving them prices to compare should make them savvy consumers, right?
Wrong!  The Journal of American Medical Association, JAMA, did a study of employees that were given access to price transparency tools and it did not lower health care spending.
The authors compared the rate of change in health care spending among employees of two employers who offered a tool where they could compare prices of what they would pay out-of- pocket for various physician, lab and hospital services.  Top searches were for colonoscopies, obstetric services, office visits and gastric bypass surge…