Tuesday, December 30, 2008

Alcohol and Antibiotics

I am taking antibiotics for a sore throat and I want to drink alcohol on New Years Eve. What do you advise?
Jessica G.

Jessica G:
Doctors often advise not to mix alcohol and antibiotics and there is good reason for this. Excessive alcohol (like at that New Years Eve party with your friends) can interfere with your immune system, cause dehydration and prolong your illness.

But there are really only a few antibiotics that alcohol affects. They are:
Metronidazole (Flagyl)

the side-effects include flushing, breathlessness, headache, increased or irregular heart rate, low blood pressure, nausea and vomiting.

Trimetheprim/Sulfa (Bactrim, Septra)
similar side-effects are possible

and some rare antibiotics like:
furazolidone (Furoxone),
griseofulvin (Grisactin),
Antimalarial Quinacrine (Atabrine)

Bottom line, if you are not on the above antibiotics, you can have a celebratory drink on New Years Eve. Stay hydrated and sleep in the next day do help recovery. Happy New Years!

Sunday, December 28, 2008

Teen Chastity Vows Don't Work

Chastity Pledge

"By the grace of God, the love of Jesus Christ and the power of the Holy Spirit, we pledge to keep ourselves sexually pure.
We pledge, from this day forward, to look at, listen to, think about, and participate only in activities that are true, noble, right, pure, lovely, admirable, excellent, and praiseworthy as outlined in Philippians 4:8.
We pledge to do whatever we can to encourage each other to do the same

The purity ball is a place where daughters, age 12 and up, pledge to remain virgins until marriage and their fathers promise to help them remain chaste. The "True Love Waits" movement reports over 2.4 million teens have taken the pledge. The Bush government has funded abstinence programs to the tune of $176 million annually.

A new analysis of data, collected by the federal government's National Longitudinal Study of Adolescent Health, and published in Pediatrics, shows chastity commitments made by teens don't seem to work.

The researchers gathered detailed information from 11,000 students in grades 7 through 12 and followed them over time. They matched students on 100 variables and then compared those who took the virginity pledge with those that did not take a pledge in 1996. It didn't matter if they took the pledge or not. By 2001, they found 82% of those who took the pledge had broken it. More than half of both groups had engaged in sexual activity and they had an average of 3 sexual partners whether they took the chastity pledge or not. No difference!

They did find one difference, however. Unfortunately the kids who took the pledge were less likely to use a condom or any other form of contraception.

It's about time to re-look at government funded abstinence programs. It has already been shown that 80% of the curricula used in these programs provide distorted information about birth control and STDs with scientific errors and blurring of religion and science.

I am so looking forward to a new administration in 2009.

My Baby has Pink Eye

Dear Dr. T:
My baby is only 10 weeks old and this morning she had crust in her eye and it was stuck shut. It is Sunday and I just lost my insurance so I don't have a regular pediatrician and I don't want to pay for an emergency room visit. Is there anything I can do?

Dear Erin:
It sounds like your baby has conjunctivitis (aka: pink eye). It can be caused by a bacteria or a virus and sometimes in newborns it can be a blocked tear duct. Use warm water to soak the eye and help remove the crust. Conjunctivitis will usually resolve within about 7 days but it is contagious so strict hand washing and keeping the baby away from others is essential. You do not need to rush to an emergency department on a Sunday (where the bill will likely be hundreds of dollars), but you should still have a pediatrician for your newborn. The cost of an office visit us usually affordable so have your baby examined this week. The pediatrician may prescribe eye drops to clear up an infection and he can also check for a blocked tear duct.
Dr. T

Friday, December 26, 2008

Bush Does Something Right

I applaud "soon to be ex"-president Bush for doing one thing right. During his 8 years as president he opened or expanded over 1200 community health clinics in the United States in under- served cities. These clinics are essential for providing basic medical care and are often the only form of care for people without health insurance.

Even patients who are covered under Medicare and Medicaid ( aka: MediCal in California) cannot find doctors who will see them and the community clinics are their only recourse. Without such clinics our emergency departments would be even more overrun, prenatal services would not happen and basic diseases such as asthma, diabetes and hypertension would skyrocket.

Community clinics will be serving even more people as job layoffs continue and people loose health insurance. What had previously served only immigrants and very poor communities, may soon become the place for mainstream health care, especially as the need for primary care increases with fewer doctors available.

Bush, with his "compassionate conservatism", made good on his early campaign promise to fund these clinics. President-elect Obama sponsored legislation this year that would quadruple federal spending on these clinics from $2.1 billion to $8 billion. (That is a lot of money but it pales when you think of the daily billions that are being spent on the Iraq war, the bailouts for failed business and other legacies of the Bush administration.)

All of this is a step in the right direction. Expanding "universal coverage" without making sure there are clinics and facilities to see patients is a strategy that will not work. Providing health care where people need it the most...in rural areas and urban inner cities...is essential.

Also essential is making sure we have enough primary care physicians and nurses to take care of patients. Even community clinics are finding it hard to find doctors to work there. If Obama wants to continue the (only) positive legacy of Bush, he better tackle the primary care doctor shortage and do it quickly.

Wednesday, December 24, 2008

Blogging Christmas Eve

Twas the night before Christmas and all through the house
A blogger was writing and using her mouse.
With a latte beside her and itunes a 'playing
She halted and asked "Hey, what am I saying?"

'Cuz each time I blog, I sit there and ponder,
"What do readers want", I often wonder.
Is it humor or science or questions on health?
Or facts about bodies or how docs have the wealth?

Do the readers want facts or ranting and raving?
Should it be provocative or all about saving?
On Christmas Eve should I blog about Christ?
Or Buddha or Allah or a menorah is nice.

EverythingHealth can cover it all,
From health to nutrition to "how not to fall".
My choices are endless because everything in life
Is related to health and living without strife.

As the coffee gets cold and my fingers get numb
I realize the blog for Christmas Eve is done.
For my faithful readers of EverythingHealth,
I wish you the best for joy and wealth.

Tuesday, December 23, 2008

Sunday, December 21, 2008

Woopee! EverythingHealth is Nominated

I am happy to report that this humble blog has been nominated for the 2008 Medical Weblog Awards in the "Best Medical Weblog" category. I know many of the other nominees and they are outstanding blogs. But I am happy to be among the best of the best so please go to medgadget and vote for EverythingHealth. Just scroll to the bottom of the comments and comment for me. Please and thank you!

Safe drinking? Try ibreath


A breathalyzer for your ipod touch or iphone is now available as ibreath. Just breathe into this nifty attachment and you can find out if you are safe to drive after a night of alcohol. Since women metabolize alcohol at different rates than men, sometimes after as few as two drinks the blood levels may be over the legal driving limit. No more guessing with the ibreath. For $80, this is a great Christmas gift.

hat tip to Medical Quack

Where to Get Medical Info Online

The internet is such a fabulous tool. It is amazing that just 10 years ago we didn't have it and our library or encyclopedias were the way to gather information. How very last century!!!

With over 80% of Internet users searching the web for medical information, I thought I'd recommend some sites that are valid and reputable. Sure, you can google a word but you are likely to end up on commercial sites with advertising or some one's blog talking about Aunt Tilly.

The next time you have medical questions go here:

Centers for Disease Control and Prevention
- the site is a little dense, but the search bar is easy. The only problem is it leads to many scientific articles that might be hard for the layman to interpret.

Cancer.gov - Expect to spend a lot of time learning here. The search bar will take you to multiple options, including an overview on the type of cancer and scientific articles on clinical trials and treatments. It is a good site to gather information and then take it to your physician for explanation and fine tuning it to your own situation.

Mayo Clinic- This site is also busy but has a neat feature where you can look up a symptom. Most people don't know if their symptom is serious or is really a disease. Mayo gives you some good options about what your symptom (think: back pain, cough, painful eye etc.) could be. They have health tools like heart disease risk calculator and even healthy recipes.

Kids Health - What a great resource for parents. Kids Health articles are reviewed by physicians for accuracy and they cover every subject from prenatal through teen. The emotion and behavior section covers"cutting", "what happens when dad returns from war", "divorce", "bullies" and you name it. The articles are not superficial.

The Q&A section also has multiple topics that are fun and useful. A parent or curious kid could spend a lot of time on this site and learn a great deal.

- Another busy and fun site with something for everyone. It has a symptom checker, Body Mass Index (BMI) calculator, message boards, ask the expert, and even a pill identifier. Articles are verified by a physician and it is overall an easy site for someone who is not medically trained. It does have advertising but they are easily identified and labeled as "advertising".

My favorite article of the day is a link under "getting wasted".

You may have other health sites to share. Book mark these and you will be covered for most health questions and online information.

Friday, December 19, 2008

Answer to Medical Challenge

The answer my friend is blowing in the wind:

#4 Hypogonadism:
The twin on the right has evidence of central adiposity (fat), more scalp hair but loss of body hair and gynecomastia (fatty breasts) compared to the identical twin brother. These are classic signs of hypogonadism and the patient was diagnosed with a pituitary tumor.

Thanks for playing. Cushings was a good guess too, but the fat distribution would have been different and it would not affect hair growth.

Thursday, December 18, 2008

Pharma Price Gouging

Just when I thought I could not take any more outrageous greed!

The Federal Trade Commission (FTC) has brought a lawsuit against Ovation Pharmaceuticals that charges the company of illegally raising the price for the only drug that treats heart defects in newborn babies.

Ovation acquired the rights to NeoProfen, the only competitor to its own drug, Indocin, in January 2006. Once they owned the only two drugs that could treat a life-threatening congenital heart defect, they proceeded to raise the prices for both drugs, which forced hospitals to "pay Ovation's monopoly price", the FTC said.

Prior to the acquisition, Indocin (an anti-inflammatory drug that has been around for decades), cost $36 a vial. Ovation raised the price for both drugs to $500/vial, an increase of over 1000%. Over 30,000 premature babies are treated for patent ductus arteriosis defects a year and the only alternative to these medications is surgery.

This type of price gouging and greed needs to be halted in its tracks. I can't imagine what defense Ovation will propose. It looks pretty clear that they purchased their only competitor and blackmailed the medical community into paying the price.

We can't legislate morality, but at least the FTC is calling it illegal!

Wednesday, December 17, 2008

Medical Challenge - What's the Diagnosis?

This is a great challenge from the New England Journal of Medicine. These two are identical twins but look quite different. The one on the right has an endocrine disorder. What is it? The answer will be posted tomorrow. Click on the image for a closer view.

1. Acromegaly ( high growth hormone -giantism)
2. Addison's disease (low cortisol)
3. Cushing's syndrome (high cortisol)
4. Hypogonadism (low testosterone)
5. Hypothyroid (low thyroid)

Monday, December 15, 2008

Amazing Mom Performs Self C-Section

Thanks to Anesthesioboist for pointing me to this amazing story that I just have to share.

Ines Ramirez Perez was in labor, alone in a one room cabin in the mountains of Rio Talea, Mexico, with no one to help. The nearest clinic was 80km away and she had 12 hours of constant pain. Since she had delivered a dead baby three years earlier, she decided she did not want to deliver another dead baby and she would rather die herself.

So Ines grabbed a 15cm kitchen knife, took several gulps from a bottle of alcohol and...are you ready?... she gave herself a C-section and delivered a baby boy. She cut a 17 cm vertical incision next to her naval from her sternum to her pubic bone. (A usual c-section is 10 cm cut horizontally low on the abdomen.)

She cut the umbilical cord with a pair of scissors and fainted. When she awoke she wrapped a towel around her abdomen and sent her 6 year old boy to get a neighbor. The neighbor was a village health assistant who sutured her up with a needle and thread. Two other neighbors carried the mom and her new baby to the towns only road and drove them to the clinic over two hours away, where she underwent surgical repair. Seven days later she underwent a 2nd surgery to repair damage to her intestines.

That was eight years ago and she has a healthy boy now. It comes as no surprise that she also had a tubal ligation.

She is believed to be the only woman who has successfully performed a self C-section.
(For a more detailed report of the story go here)

For those of you who have never seen a C-section, it is major surgery. There are several layers of skin, fat and muscle that need to be opened before you even see the uterus. The uterus must be carefully opened and the baby pulled out. Even under the best of circumstances there is significant blood loss.

This is a big wow. It shows how resilient women are.

Wrap Rage

A writer for American Medical News contacted me after my post on wrap rage and quoted me in an article about this subject. Since I wrote it I have been even more aware of the wasteful packaging that surrounds most everything purchased. I receive non-breakable items deep in Styrofoam peanuts and the annoying clam-plastic that is sealed tight on everything from toys to toothbrushes.

Make your voice heard whenever possible for manufacturers and packing companies to stop wasteful packaging. What is created on earth, stays on earth.

Obesity Tax for Sodas

I read that Gov. Paterson in New York has proposed a 15% obesity tax for soft drinks as part of his budget for the state. He would limit this to "non-diet" soft drinks and it would generate $404 million a year. Juice, bottled water and diet drinks would be exempt.

This is the first time I have heard of a "sin tax" for these products that are empty calories. Public health officials have applauded the proposal, saying it would help the fight against childhood obesity.

Some kids and adults drink soft drinks instead of water. Enough soda pop is produced each year to give 557 cans (12 oz) to every man, woman and child in America. Composed of high-fructose corn syrup, these drinks cause a lower intake of numerous vitamins, minerals and dietary fiber and are loaded with empty sugar calories. They also contain caffeine and Yellow dye No. 5.

California, Tennessee, Arizona, Philadelphia and New York City have banned soft drinks from being sold at middle school and high school. Elsewhere the vending machines are there for easy access.

It is time to put some teeth behind the rhetoric for better health for the nation. We can't expect kids to have the wisdom to make the right choice when cheap "big gulp" soda can be found everywhere. Good work, Gov. Paterson. I'm sure you will be criticized for taking away someones personal freedom to ingest soda pop by charging $1.15 rather than $1.00.

Sunday, December 14, 2008

Beat Holiday Stress- For Women Only

This is for the women readers of EverythingHealth. I truly don't believe men suffer from holiday stress.

The holidays can be huge stressors for women and Christmas/Chanukah is probably the worst. Let's look at all of the "extra" pressures we face during the holidays:

Buying presents, wrapping presents, worrying about spending money we don't have, visiting relatives or entertaining relatives, getting kids ready for school pageants or vacations, travel arrangements, preparing special meals, decorating the house and a tree and making sure everyone else is having a special time. I could go on and on but the point is made.

Stress is bad for us. It drives hormones that contribute to inflammation, heart disease and immune dysfunction. So what can we do to stop this holiday rat race and create a more joyous and fun time? Here are some tips:

  • Bake and decorate holiday cookies with the kids or your girlfriends. Start a tradition and package the cookies as gifts. The kids will love the relaxing time with you and adding some good holiday tunes will get everyone in the mood. (This only works if you substitute the cookies for bought, wrapped gifts that no-one probably wants anyway)
  • Get comfortable saying "No". Prioritize your time. You may not have to go to that party that would be a hassle. You may say "no" to the potluck that puts you over the edge. You might say "no" to stringing the Christmas lights...or delegate the job to someone else.
  • Seek out music. Bundle up the family and go to a concert or have an evening at home with music, apple cider, a fire and everyone telling stories. If you don't have kids, this works with your partner. If you don't have a partner, this works with friends or even alone.
  • Avoid malls and driving. There are amazing sales and free shipping with ordering on-line. Any day you can spend at home and away from crowds is a stress reducer.
  • Try to do something charitable. Volunteer at a homeless kitchen, buy a "Toys for Tots". Get your kids or partner involved with this also. Giving is the ultimate stress reducer. No one has stress over generosity and giving.
  • Try to avoid being the "producer" of your family holiday fun. Let it flow. Of course the mom is the CEO of the family but don't forget the old saying: "When mom is happy, everyone is happy." So delegate like a CEO and sit back and enjoy.

Relaxing for Rainy Days

The good think about the downturn in the economy is that for many people the frantic Christmas rush is not happening. Less trips to the mall, less crowds, less parking, less stress. (Except for the poor retail merchants...sorry!)

"What I recommend on Netflix" are listed on my sidebar (scroll down to the bottom) and I really recommend the film I watched last night called "The Machinist". It is mysterious and a bit dark, but for excellence in cinematography, acting, editing and story, this film is a masterpiece. Christian Bale should have received an academy award for the lead role and the transformation in his body is a frightening work to behold.

Check it out...or any others on my list.

Friday, December 12, 2008

As Addictive as Cocaine - Sugar

I've had patients talk about "sugar addiction" and I know I have sugar cravings myself, (especially at night), but now there is a new study that reports sugar stimulates the same part of the brain that is activated in other addictions.

Scientists from Princeton University showed that sugar caused neurochemical changes in the brains of rats in the same way as drugs that are abused. The animals experienced cravings, withdrawal and bingeing, which typifies "addiction".

By feeding the rats sugar water, they round there was a surge of the neurotransmitter dopamine, just like drugs, alcohol and nicotine. When they used an alternating schedule of deprivation and bingeing, the dopamine effect was even stronger and after three weeks the rats showed signs of withdrawal.

What I found interesting is that after periods of abstinence, the rats ingested more sugar than before and if sugar was not available, they drank more alcohol. They also deprived the rats of food for 4 hours after they awoke, which duplicates skipping breakfast in the morning. The animals would then eat a larger quantity of food and drink even more sugar solution.

So what does all of the mean? Although you cannot extrapolate rat studies to humans, it does suggest that dieting, bingeing on sugar and skipping meals may create biochemical changes in the brain that sabotage our ability to maintain a healthy weight. Since many overweight people do these things, it is not a surprise that the weight increases and it is a viscous cycle.

If sugar does, indeed, have addictive like qualities, it would help to explain the obesity/diabetes epidemic that our world is facing. High fructose corn syrup is hidden in so many food products and is the main ingredient in soft drinks. We may be creating unhealthy addictions early in children that go far beyond the increased empty calories.

The brain changes in anorexia and bulimia may also be a result of a sugar effect. There are millions of people who classify themselves as "sugar addicts". These preliminary results may validate some of their proclamations.

Tuesday, December 9, 2008

The Car Bailout - Ya gotta Laugh or You'll Cry

Click on Image for a better read

Gratitude to Happy Hospitalist for this steal.

Be Happy by Hanging with Other Happy People

I love the article in the New York Times today on contagious happiness. A study in the British Medical Journal (love those Brits!) showed that emotions are a collective condition and the mood of other people...even people who are not your friends...has a major impact on your own mood.

Researchers have previously found that obesity and smoking are socially contagious and now happiness too may be influenced more by who you associate with, than by anything else.

I have observed that people who hang together and bitch about everything end up feeling worse just because they are in proximity with other unhappy people. Everyone is talking about the current lousy economy and it makes all of us even more worried and depressed.

What if we stopped talking about it and just hung around with people who were happy and light-hearted. According to this study, we would all feel better and be happier.

Monday, December 8, 2008

Glaucoma Drug for Eyelash Growth

We women love our eyelashes. Even women who don't wear much makeup would not be caught dead without their mascara...a product they have used since puberty. So imagine my excitement to read that the Irvine based company, Allergen Inc. has discovered that their glaucoma drug causes eyelashes to grow lush and long.

The glaucoma drug, Lumigan, has been declared a safe and effective way to make eyelashes longer and fuller. When Lumigan was applied once a day, they noted a significantly increased fullness, thickness and darkness of lashes. A panel of outside experts voted that the benefits of the drug outweighed the risks and advised Allergen to do follow up studies.

Lumigan (bimatoprost opthalmic solution) 0.03% is for the treatment of high eye pressure, also called intraocular pressure, in people with open-angle glaucoma. What is funny is that the Important Safety Information of the drug says:

"Lumigan has been reported to cause darkening of eyelashes, as well as increased growth of eyelashes." There is also a warning that it can cause darkening of eye color and eyelid skin. "The effects of increased darkening beyond 5 years are not known."

I hope they get the eye color thing worked out...I would like longer, luxurious lashes and I'm tired of mascara.

Shares of Allergen rose $2.12 to $38.54.

Saturday, December 6, 2008

Consumer Medicine is Broken

How can you expect the patient to make good health care purchasing decisions if they can't find out the price of a service?

My patient has a $2500 deductible before insurance will pay anything. She is young and mainly needs preventive care so she is paying out of pocket for everything until she hits $2500 (which certainly didn't happen this year).

She was charged $308 for a blood test for Vit D level. Yes $308 for one test. (Vit D found to be abnormally low so supplements prescribed by me)

$308 is no small hunk of change for a working girl. In fact it is an outrageous charge for a simple blood test. She needs a follow up test to see if her levels are improving and she has been calling around to other labs to price compare.

SHE CANNOT GET A PRICE QUOTE! I am serious. The labs are annoyed at the question and said they need a "client number" and a "request from a physician" and they will not give her a price estimate so she can be a "good consumer of health care".


Should The Doctor Say You Are Dying?

Most Oncologists say they would tell a terminally ill patient that they will die. But in the same survey of over 700 Oncologists, published in the Journal of Clinical Oncology, it was revealed that 48% of the doctors would talk about death only when their patients said "yes" they wanted to talk about it. Also, less than half of the oncologists (43%) said they would give an estimate of the time a patient has left to live. Yet 74% of those same doctors said THEY would want to know their prognosis, including a time frame of when death could be expected.

We are a society that is very uncomfortable with death. We offer unrealistic expectations of survival in patients with advanced terminal cancer and patients with end stage cardiac or pulmonary disease. There is always "one more" new drug or hospitalization that can be offered and physicians and families do not want to take away "hope". Doctors are stuck between a rock and a hard place because patients don't want to be"quitters" and they don't want a physician who will give up.

It is far easier to offer another course of Chemo than to have the difficult conversation that says; "This time with your family is important time. Chemo will make you feel weak and sap your strength and you will be on medication that will make it hard to think and communicate and enjoy your life. I would rather help you have as much strength and energy as possible and line you up with Hospice programs that can help with your symptoms and equipment needs so you can be at home. I will continue to be your doctor and we can change our mind at any time if new treatments are available or if it looks like things are improving."

Eighty percent of all deaths occur in a hospital. How would you like to spend your last days?

Friday, December 5, 2008

Senator Daschle To Lead Health Care Reform

President-elect Barack Obama, along with his newly appointed Heath and Human Services (HHS) Secretary, Senator Tom Daschle, have announced they will overhaul the US health care system. Daschle is talking about Obama’s promise to expand insurance coverage, improve quality and reduce cost as a prime goal for his new administration.

Daschle spoke Friday in Denver and assured the audience that despite the economic crisis, President-elect Obama plans to focus on health as a top priority. Mr. Daschle believes the economic health of the United States is directly related to our ability to reform our health care system.

The Obama transition team has posted a website, Change.gov, and they are soliciting comments from consumers and experts across the nation. The site has posted videos that describe how Senator Daschle, the leader of the Health Policy Team, plans to tackle health care. They are inviting Americans to post their stories, experiences and ideas and their first goal is to “listen” and get input into the problem.

Senator Daschle promises an open and transparent process, but details of what might be coming were scant. As head of the HHS, Mr. Daschle will have responsibility for 11 agencies, including the National Institutes of Health, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and The Centers for Disease Control and Prevention.

The pundits and naysayers are already active on the blogs and opinion pages in saying health reform is impossible and will lead the United States into further economic ruin. They cannot get past the fact that “Health Care Reform” does not equate to “Government Run Healthcare”. Every developed Nation has lower costs and better quality outcomes than the United States and they all utilize private insurance along with universal coverage for all citizens. The private sector should be a part of the health care puzzle but strong regulations are needed to ensure affordability and elimination of unfair underwriting and cherry picking.

Unregulated capitalism leads to greed and corruption. We have seen that in the banking industry and it is prevalent in the health industry too. Our incentives are designed to reward unnecessary care, waste, duplication and unproven technology. We have no policy for preventive care, primary care and end of life care and the patient is often far removed from the actual costs involved in health spending.

Expanding Medicare is not the solution to our problems. Medicare also rewards waste, duplication, unnecessary care with payment policies that say, “More is better” and “get all you can because it is free.” Medicare is overregulated, driving up the cost of care by providers. The insurance industry is under regulated, which allows obscene profits, denials of care and leaves millions of Americans unable to afford insurance coverage at all.

President Obama and Senator Daschle would be wise to pay attention to every detail of health care and rebuild from the bottom up. This will include revamping medical education, Medicare and Medicaid payment reform, taking on the pharmaceutical and insurance lobby, addressing the shortage of primary care and designing systems that shore up health care professionals and taking on malpractice reform and tort laws. They will be facing powerful interests that are against change and have a huge stake in keeping their profitable system going as long as possible.

No one said it would be easy. We’ve talked about the problem long enough and now it is time to do the hard work that will require more than lip service. The solutions will require Obama and his team to stay on track and provide the leadership for a long and hard struggle for change.

Thursday, December 4, 2008

What works for Irritable Bowel syndrome

Irritable bowel syndrome (IBS) is a chronic disorder characterized by cramping, bloating, constipation, diarrhea and abdominal pain. It plagues women more than men and can come and go for years. Researchers do not know the cause for IBS and there are no specific tests to diagnose it.

Whenever a medical condition is common with no proven cure, there are lots of "treatments", supplements and medications that are purported to help. A new study reported in the British Medical Journal showed that fiber, antispasmotic agents and peppermint oil are all effective when compared against placebo for treating patients with IBS.

Dietary fiber like whole grain breads, cereals, fruits and vegetables help keep water in the stool and prevent constipation. Even more effective were soluble fibers like psyllium (Metamucil). Increasing fiber slowly by 2 to 3 grams a day can help prevent gas and bloating and fiber supplements can be used to ensure enough fiber intake.

Antispasmotic agents like Levsin (hyoscyamine), scopolamine and Otilonium (not available in the U.S.) showed consistent benefit for IBS.

Peppermint oil, available over the counter and sold in capsules, was proven effective in doses from 187mg to 225mg, taken two to four times daily.

These are all old treatments but this study showed their effectiveness for treating the symptoms of IBS.

Tuesday, December 2, 2008

Hospitalists - They are Here

I was kind of surprised tonight as I sat at a Hospital Board Meeting and we needed to approve a contract for a Hospitalist Group. Although these were highly informed, medically savvy board members, they did not know what a "hospitalist" was. I thought everyone knew about the changes in medical care that have swept hospitals across the country in the past ten years. And "hospitalists" are a change that are here to stay.

For readers who wonder what I am talking about...a hospitalist is a doctor, usually trained in Internal Medicine, who does not have a practice or office but becomes the attending physician for a hospitalized patient. The Hospitalist manages all the patient's diagnosis, testing, treatment and coordination but will probably never see the patient again after they are discharged...unless they come back to the hospital. Most hospitalists are part of a "group" that covers the hospital 24/7.

Many of these patients have their own doctor "outside" of the hospital who resumes their care when they are discharged. Many other patients have no doctor "outside" of the hospital because all the doctors are becoming hospitalists instead of practicing primary care.

The hospitalist movement started out slowly, but over the past decade just about every hospital now has them and fewer and fewer family medicine and internal medicine doctors take care of hospital patients...they turn the care over to hospitalists. One reason for the shortage of primary care doctors across the nation is that young physicians are choosing to become hospitalists rather than "office" docs.

Why? Well, hospitalists have no overhead, no practice expenses, no employees to manage, they make better money, have more time off, no call, a defined start and stop time and they have the support of the entire hospital staff.

Hospitals pay the hospitalists more money than they could possibly make billing Medicare or even insurance companies for patient care. It is a win for the hospitals because they have guaranteed coverage in the emergency department, better standardized protocols of care, ability to move patients out and home sooner (called Reduced Length of Stay...worth millions on Medicare and Medicaid patients).

I read several "hospitalist blogs", like the Happy Hospitalist, Fat Doctor and Rural Doc. I've learned that nothing stays the same and the emergence of the hospitalist is a prime example of how the world of medicine continues to change and evolve. Unfortunately other evolutionary changes point to the fact that primary care physicians are soon to be extinct.

Addendum: For another take on what goes on inside the hospital between hospitalists and other specialists, check out ER Stories.

Friday, November 28, 2008

Sarah Palin's Turkey Bloodbath Causes a Stir

The election is over but, please make it stop.
Talk about poor judgment.

Hat Tip to Shadowfax at Movin Meat

Women's Self-Esteem

Stop with the retouched, perfect photos! This is why young girls develop self-esteem issues.
(Can we all agree that the unretouched was just fine the way she was?)

A Cute Baby Hippo

This photo just made me smile!
(Daniel Munoz/Reuters)


Probiotics are microorganisms with potential health benefits. I never heard about probiotics in medical school. Maybe they are teaching it now, but I've had to do my own research to find out what they are all about.

Probiotics are mainly used to treat GI conditions, including antibiotic-associated diarrhea, infectious diarrhea and irritable bowel syndrome where the microflora of the intestine has been disturbed. When the friendly microorganisms in the body have been disrupted or killed by antibiotics or stress, the homeostasis of the body is thrown off. Restoring the balance and proper immune function by placing new "friendly" organisms into the body is what probiotic therapy is all about.

The organisms we know the most about are in the Lactobacillus species that are naturally found in the human gut. Most probiotics are bacteria (Lactobacillus and Bifidobacterium) but some are yeasts such as Saccharomyces boulardii. The probiotic species must be resistant to acid and bile to survive transit through the upper GI tract and they must be taken regularly to work.

A number of studies have shown that probiotics may reduce the incidence of diarrhea in people who have taken antibiotics. The benefit is the greatest when they were taken within 72 hours of taking the first antibiotic. For adults, the greatest benefit came from doses of a least of 5-10 billion colony-forming units (CFUs).

There are no contraindications to probiotics comprised of Lactobacillus, Bifidobacterium, S. thermophilus or S. boulardii species. There are also no known interactions with medications or other supplements.

Scientific studies have shown benefits from probiotics in infections diarrhea, antibiotic induced diarrhea and irritable bowel syndrome and possibly atopic dermatitis (eczema) in infants and young children. Other allergies such as asthma, food allergy or allergic rhinitis showed no benefit.

Probiotcs are sold as capsules, powder, liquid or placed in foods. A recent study analyzed a range of brands of probiotics and found that of the 19 brands examined, five did not contain the number of live microorganisms stated on the label*. So really knowing the brand and making sure it contains enough CFUs is important.

Traditional yogurt does not usually contain enough probiotics to make a difference but therapeutic yogurts do. Look for Danactive, Activia, Yo-Plus, Stonyfield and Danimals for children.

Warning: Probiotics don't "cure" anything.

More information on probiotics can be found here. and at the National Center for Complementary and Alternative Medicine.

*ConsumerLab.com product review: probiotic supplements.

Thursday, November 27, 2008

Happy Thanksgiving

"I know it is hard to be reconciled
not everything is exactly
the way it ought to be

but please turn around
and step into the future
leave memories behind
enter the land of hope"

Zbigniew Herbert, from A Life

Wednesday, November 26, 2008

Engage With Grace

Bloggers everywhere are posting this same message today in hopes our readers will come on board and start having meaningful conversations with each other and their loved ones. Here it is:

We make choices throughout our lives - where we want to live, what types
of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in a hospital. More than 80% of Californians say their loved ones“know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to
share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

Tuesday, November 25, 2008

Miraculous Facial Tumor Surgery

Lai Thi Dao , a 15 year old Vietnamese girl, endured a huge facial tumor called a Schwannoma for most of her life. It is obvious she had difficulty eating and breathing due to the terrible deformity and its rapid growth would have killed her.

Surgeons at the University of Miami/Jackson Memorial Medical Center performed a 14 hour procedure to remove the growth in April and little Lai had additional reconstructive surgery on October 10. She still has a tracheostomy tube in her throat but that will be removed in the next round of surgery and she will be able to speak normally for the first time in years.

The surgery was made possible by the International Kids Fund.

Isn't Medicine wonderful?

Health Care is Not Recession Proof

The economists and financial experts always say Health Care is recession proof. Traditionally, health care stocks have performed better in a down-turn and people still get sick and need care and services.

But we are seeing a big drop in hospital admissions, doctors visits and elective surgery as people lose their jobs, lose their insurance and can't afford even small co-pays for health care. A large consumer survey conducted in February (seems like long ago!) reported only 11% of people felt they could handle upcoming medical bills. Heck, the economy was practically thriving in February compared to now.

With California unemployment over 8% (and rising) and millions of others working part time or low wage jobs, the ability to see a doctor or seek medical care is just out of the question for many people. Even people with insurance will postpone medical treatment because they don't want to miss work or be laid up.

"Consumer driven health care" is a code word for "you pay more", so most folks co-pays are so excessive, when given a choice of the mortgage payment or doctor bill, the house wins.

Paul Keckley, executive director of the Deloitte Center for Health Solutions, sees three likely impacts from a recession: Primary and preventive care will be delayed, people with high deductibles will delay payments on care received, and there will be an increase in the number of bankruptcies from medical debt.

This recession is really going to put a strain on hospitals, care givers and patients in equal doses. It is a glaring example of how fragile our health infrastructure is.

Monday, November 24, 2008

Age is Just a Number

The Honolulu Marathon is just 3 weeks away. Gladys Burrill, a 90-year-old grandmother is training to set a world record for her age and this will be her fifth marathon.

The great-grandmother times 22 says, "Just forget about age and enjoy getting out there and exercising and walking or running or whatever they do. It will inspire them to do more."

Nicknamed, the "Glady-ator", this lady hopes to finish the race in 8 hours and 30 minutes. You go girl.

Sunday, November 23, 2008

Holiday Dinner, 1935

I've been putting my Thanksgiving Dinner list together. This photo is Earl Pauley and his children, preparing holiday dinner near Smithland, Iowa (Circa 1935).

May we continue to give thanks and have hope and optimism for President-elect, Obama and his new administration team. For more commentary, read what Thomas Friedman from the NY Times has to say, here.

Saturday, November 22, 2008

Vitamin Roundup

More and more well done studies are being published that evaluate the true benefit of vitamins. The best studies are random, double-blind trials that use enough subjects over a long time.

Here is the latest roundup:

Vitamin E - No benefit for preventing cancer, including colon, esophageal, gastric, pancreatic or liver. No benefit for preventing cardiovascular disease and people who took over 400IU's a day had a higher risk of dying from heart failure and other causes.

Vitamin E plus Selenium - No benefit for prostate cancer and maybe did more harm than good.

Beta Carotene/Vitamin A - Smokers and non smokers may had an even higher rate of lung cancer and heart disease.

Vitamin A - had a higher risk of hip fractures than women who did not take Vitamin A supplements.

Folic Acid - essential for pregnant women but did not prevent heart disease in others.

Vitamin C - didn't prevent colds but there was a reduction in colds among people who were extreme athletes or under physical stress (soldiers)

Beta carotene, Selenium, Vitamins A, C and E (Antioxidants alone or in combo)- users had a 6% higher death rate than placebo

Vitamin B - No help for heart attack or established vascular disease.

Multivitamins - No difference in infection rates or visits to doctors.

Vitamin D - numerous studies are emerging that show the "normal" ranges are too low and higher amounts of this vitamin are associated with decreases in cardiovascular, bone loss and cancer incidence.

Calcium - Improves bone health in women and men.

Gingko Biloba - doesn't prevent dementia or Alzheimer's disease.

Bottom line: Get your vitamins from food. Use your vitamin money to buy organic food. The 5-7 fruits and vegetables recommended a day have been proven in multiple excellent studies to prevent cancer, heart disease and promote longevity.

Many people argue that the vitamin studies are flawed and they keep wasting money on supplements. That is a choice, but at the very least eat real food!

Friday, November 21, 2008

Frustration Free Packaging

(click image to enlarge)

Finally, one of my pet peeves is being addressed by Amazon. They are introducing "Frustration Free packaging" in time for the holidays.

My cortisol levels start to surge when I receive a package with plastic form fitted around the object, metal twisty wires holding it together and plastic so tough my scissors can't even cut through it. None of it is recyclable and usually the packaging is bigger than the product inside.

Amazon is now beginning to work with the manufactures to eliminate this waste and ridiculous trend that seems to have sprung up everywhere. So far they only have 19 products that feature recyclable boxes that are easy to open. Jeff Bezos, CEO of Amazon, says the initiative will take many years, but the vision is to offer their entire catalog of products in Frustration-Free packaging.

To view the selection that will avoid wrap rage, go here. We need more of this!

Thursday, November 20, 2008

Women, know your place!

"kittens are so cute and furry."

Answer to Medical Challenge

The answer is #3 Diffuse esophageal spasm.

Here is another radiograph that shows barium contrast material that highlights the esophagus in a spiral formation. The esophagus is made of smooth muscle and it contracts to propel food down to the stomach. Esophageal spasm is an abnormal uncoordinated contraction and it can cause mid chest pain and slow the progression of food after swallowing.

Signs and symptoms of esophageal spasms include:

  • Pain in your chest, often intense, which you might mistake for heart pain (angina)
  • Difficulty swallowing (dysphagia)
  • The feeling that an object is stuck in your throat (globus)
  • Bringing food back up (regurgitation)
  • Heartburn, a burning sensation that may radiate from your upper abdomen to your neck, sometimes leaving a sour taste in your mouth
Good diagnostic work, readers.

Check it Out

Head on over to "Cranky Fitness" , a cool and fun website where "healthy living is a pain in the ass". I am the guest blogger on eating a healthy breakfast. Check it out.

Wednesday, November 19, 2008

This Weeks Medical Challenge

You be the doctor. This is a barium swallow and you are seeing the esophagus within the chest area with barium highlighting it. What is the diagnosis?

#1 Ingested foreign body
#2 Esophageal diverticula
#3 Diffuse esophageal spasm
#4 Gastric linitis plastica
#5 Esophageal carcinoma

Click on the image for a better view and the answer will be posted tomorrow.

Tuesday, November 18, 2008

A Doctors View of PBMs and Pharmacy Hassles

I was interviewed for a widely read publication in the Pharmacy world called Drug Benefit News. They kindly gave me permission to reprint it on my blog:

Volume 9, Number 21 October 31, 2008

The following interview is part of an occasional DBN series that examines hot-button pharmacy benefit issues though the words of the industry’s thought leaders. To suggest a topic and com- mentator, contact Neal Learner at nlearner@aispub.com. Toni Brayer, M.D., has practiced internal medicine in San Francisco for more 20 years, and is regional chief medical officer of a large hospital/physician network in California. She is a fellow in the American College of Physicians and has served as president of the San Francisco Medical Society and chief of staff at California Pacific Medical Center. Brayer is a well-known speaker and author of the popular blog EverythingHealth (www. everythinghealth.net). DBN caught up with Brayer to get her view of how well the pharmacy benefit works in the doctor’s office.

DBN: How would you assess the state of the pharmacy benefits industry from a physician’s perspective?

Brayer: The pharmacy benefit industry is confusing and overwhelming to physicians. There is a lack of understanding about how they operate and the difference between mail-order pharmacies and PBMs. Some are subsidiaries of health plans, some used to be owned by big pharma. There are perceived conflicts of interest. It is unclear if PBMs bring any value to health care, and if they do...who benefits? Pharmacy costs continue to increase by double digits, and PBMs are thought to be part of the problem, not the solution.

DBN: Do you see significant differences in the way that individual health plans and/or PBMs provide Rx drug coverage?

Brayer: Physicians deal with too many health plans and numerous PBMs, and from our view they have no consistency. We have no way of knowing the various protocols and regulations they operate with, and new product designs make it impossible to keep up. Formularies are cumbersome and change all the time, and it is unclear who controls the formulary. It appears that formularies are based on [achieving] optimal revenue, not evidence- based. The goal should be to reduce hassles for primary care physicians and lower costs to patients and purchasers of health care. Health plans and PBMs are seen as the problem, not the solution.

DBN: What are the biggest hassles that you face every day in getting patients the drugs that they need?

Brayer: Prior authorizations (PA) are exploding and require both staff and physician time to muddle through. A drug that is covered on one plan might need a PA on another. The protocols are different for each one, and some require the physician to list every drug the patient has previously tried and failed (with dates), which means an extensive chart review. It is unclear what is considered a generic, a brand or a preferred drug with each plan or PBM, and there is no transparency in pricing. Pharmacies do not automatically refill ongoing prescriptions and call or fax the doctor’s office for refills, even when it was clearly written on the Rx. Requiring tamper-proof prescriptions is a huge hassle, and it is unclear that they reduce drug abuse, but they certainly reduce physician efficiency. Pharmacies in 2008 are akin to the DMV [i.e., department of motor vehicles]. It is a nightmare to get a prescription filled. The cost of pharmaceuticals is obscene, and the waste we see within the pharmaceutical industry (which drives up cost) is infuriating.

DBN: To what extent do you consider the cost of a drug when writing a prescription?

Brayer: Always. But information is not clear, and I advise patients to use mail order or Costco or price shop. The variation in pricing is not rational, and the fact that patients can only get one month at a time for chronic medications is just plain gouging them for the dispensing fee and monthly copayments. Certain generic drugs should cost pennies a pill, but even generics have inflated pricing if the patient pays out of pocket. It is unusual for any medication to cost under $40, even if it is a generic that has been around for decades. That is a marketplace out of control.

DBN: What would you suggest to PBMs, health plans and others to improve the system?

Brayer: Initiate education for physicians and transparency for everyone. Who benefits from PBMs? Can you really be transparent about rebates, kickbacks and back-room deals? Make formularies evidence- based, and stop the onerous PA. Price non-generic drugs lower if there is no generic to offer as an alternative (example: transdermals, bisphosphenates, certain inhalers, certain antibiotics, once-daily dosing regimens).

DBN: What can or should physicians do to improve the operation of the pharmacy benefit?

Brayer: Physicians are at the bottom of the food chain and do not have the ability to improve this operation. As I see it, PBM customers are the health plans and the pharmaceutical industry. Health plan customers are the employers or purchasers. Employer customers are the stockholders or company owners. Physician customers are the patient. Physicians and patients are out of the loop except as the user of the services. Since we are no one’s customer, in a free market we are irrelevant.

Monday, November 17, 2008

Matrix 101: The Medical School

For my medical school colleagues. It can be a very surrealistic experience!

How NOT to Be a Medical Director

Dr. Karen Kim, director of Pooler Pediatric Clinic, in Pooler Georgia, wrote the above first letter (click on it for a better read) to her staff and colleagues.

After the backlash, she wrote a 2nd letter, which further inflamed the situation. A few days later a resignation letter said she would be leaving Pooler to devote more time to caring for her 7 children at home.

This is a good case study in how NOT to be a medical director (or any other manager of people).
  • Don't bring politics to the workplace
  • Don't call the President Elect "Evil Incarnate" in writing
  • Don't threaten your staff and colleagues
  • Don't insult your staff by calling them names like "lazy" or "slacker."
  • Don't act like a victim
  • Don't be a total jerk
Great advice I received at an early age from my mother was, "Don't ever put in writing anything you wouldn't want to be seen by everyone."

Now, with the internet it means it will be seen world wide. Sorry Dr. Kim. You never met my mom.

Sunday, November 16, 2008

America's Healthiest and Unhealthiest Cities - Its the Economy Stupid

Huntington, West Virginia has been named by the Centers for Disease Control (CDC) as the unhealthiest city in America. Nearly half of the adults in the five-county metropolitan area are obese and Huntington leads in heart disease, diabetes and elderly people who have lost their teeth. Contrast that with Burlington, Vermont, the nations healthiest city. What’s the difference? It all boils down to money and education.

First let’s look at Huntington. Its poverty rate is worse than the national average. It is a blue-collar white skinned community – people of English, Irish and German ancestry. Over the last few decades the manufacturing jobs have left the area and the remaining jobs are low paying. The largest employers are the hospitals and Marshall University.

Contrast that with Burlington. Only 8% live at the federal poverty level, compared to 19% in Huntington. Nearly 40% of residents have a college degree, compared with 15% in Huntington.

In Burlington, healthy eating is popular. Vegan options are plentiful and even low-income residents have the choice of bulk rice and grains and vegetables at local markets. In Huntington, donut shops abound and Pizza, KFC and fast food offer the best bargains to poor residents.

In Burlington people ride bikes, hike, ski and garden. Huntington has few parks and even on sunny days, residents are not out and about. The rural roads are busy and there are few sidewalks.

Huntington allows smoking in restaurants and local bars and even the hospitals have not been effective in forbidding smoking. Huntington’s culture is one of “you’re not going to tell me what I can or cannot eat” and the fact that poor eating, lack of exercise and smoking causes medical problems does not seem spur change.

Huntington officials are striking back and saying that the CDC report doesn’t exactly “mention” their area by name but includes a larger square mile area, of which they are just a portion. Despite the excuses by the city officials, a local physician, Dr. John Walden who is chair of family and community health at Marshall University says,
"I don't know that I've ever been in a place where I've seen so many overweight people.”

Colbert on Drugs

In case you missed this...Colbert Nails it. Watch to the end for his take on the Statin (Jupiter) Trials.

Thursday, November 13, 2008

Medical Tourism is Here

It was only a matter of time until health costs in the U.S. rose so high that we would outsource health care. That time is here.

WellPoint, the nation's largest health benefits company has announced a new product that allows its patients to travel to India to receive care. Starting in January, 2009, "members planning to undergo certain procedures can enjoy access to an extended network of respected hospitals and health care providers in India. By electing to use the international benefit, members can receive care at accredited facilities at lower out- of- pocket costs that could result in thousands of dollars of savings."

They go on to say a dedicated case manager will coordinate all medical arrangements, including scheduling and concierge travel services. All travel arrangements are booked and paid for, for both the member and a traveling companion. The case manager also arranges any post operative follow up care.

Certain medical tourism facilities in India and Thailand have quality outcomes that rival the United States. Their doctors are trained at fine institutions like Harvard and Johns Hopkins.
The facilities are accredited (without all of the unnecessary United States bureaucracy that drives up costs).

How do they do it? They have less government interference, practically no lawsuits, lower cost structures, no unions, low wages and better customer service.

You may not like it, but that is a fact.

How about a vacation and a knee replacement?

Tuesday, November 11, 2008

Health Care Costs - Whew!

My daughter purchases her own insurance. As a healthy young lady she spends $560/month (up from $375 in 2007) for a policy with $8000 deductible a year. She has already fulfilled her deductible this year (paid the first $8K) and had good coverage for her recent pregnancy and childbirth.

She understood the baby was covered for the first 30 days under the mom's policy. Well...yes the baby is covered but there is another $2500 deductible for the baby as well as $7500 annual co-pay before the baby is covered for hospitalization. That adds up to $10K for the baby to be covered for the first 30 days.

After 30 days, the premium will be $995/month for healthy mother and baby.

Enough said?

My Pet Peeve of the Day

Anyone who reads EverythingHealth or many other health blogs (Kevinmd, Maggie Maher, Dr. Rob, Dr. Val, Happy Hospitalist to name a few) knows that primary care physicians are a dying breed. Everyone talks about the money (painfully low reimbursement) as the cause, but equally annoying is the LACK OF RESPECT for the specialty.

Repeatedly I run across doctors who have no training in Family Medicine or Internal Medicine who say "Oh, I'll just be a primary care doctor." One doctor is an 86 year old surgeon who was denied operating privileges so he's going to "be a primary care doctor." He did surgery training in 1948.

Another doctor hasn't ever seen a live patient and he originally trained in Pathology and has done only laboratory work. He is moving to Hawaii to be a "primary care doctor."

Another has been a hospital administrator for years but want's to "see patients again" so he is going to do "primary care 1/2 day a week."

Give me a break! This is not a specialty you can drop in and out of as a hobby.

There is a severe lack of understanding about primary care medicine and the medical specialties of Family Medicine and General Internal Medicine. Each of these specialties requires years of residency after internship and continued medical education and exams for board certification status.

A tremendous body of knowledge is needed to be a primary care physician. One must have diagnostic acumen, know all treatment modalities, have skills in psychology, inherent common sense, knowledge of medical economics, a vast knowledge of pharmacology and hundreds of drug interactions. Primary care physicians must keep up with all of the medical literature and current evidence to be at the top of their game.

I've practiced non-stop for over 20 years and I am still challenged by patient care. Even though I could probably deliver a baby or remove an appendix or even amputate a limb if I were stranded on a desert island, I would never be so bold as to think I could drop in and out of those specialties and render good patient care.

Unfortunately the shortage of REAL primary care doctors means the field is wide open to anyone who wants to hang out a shingle and give it a try.

Monday, November 10, 2008

Britney Spears Son Has Allergic Reaction to Food

Britney Spears two-year-old son, Jayden, was rushed to the hospital with an allergic reaction yesterday. The tot was admitted for an overnight stay and observation after he developed hives, itchy skin and irritability. A rep for the family reported, “Doctors concluded he had a reaction to something he ingested”. He was released from the hospital in good condition today.

Most of the time, in food related allergic reactions, it is difficult to pinpoint the causative agent without further testing. The most common symptom is a flushed feeling, accompanied by a hive like rash (urticaria), tingling redness of the skin and palpitations and anxiety. Most reactions are self-limited and resolve by themselves or with the addition of anti-histamine medication.

Rarely a serious reaction can cause anaphylaxis and individuals who have asthma in addition to food allergies may be at increased risk for having a life-threatening anaphylactic reaction to food.

Signs of anaphylaxis include skin symptoms or swollen lips accompanied by difficulty breathing or reduced blood pressure. Abdominal cramps or vomiting, accompanied by difficulty breathing or wheezing can be signs of anaphylaxis and the patient should have immediate medical attention. Common causes of anaphylaxis include food, medication, insect stings or latex.

There are eight foods that account for 90% of all food allergy reactions. They are: milk, egg, peanut, tree nut (walnut, cashews etc), fish, shellfish, soy and wheat. True food allergies cause an immune response in the body, which is different than food intolerance. It is estimated that only 2-5% of the population have a food allergy.

Most food allergies begin in the first or second year of life, like in the case of little Jayden Federline. Many children outgrow their allergies (unlike adults), especially allergies to milk or soy formula. The most important diagnostic tool is a good history. What was eaten? What was the timing of the reaction? Did anyone else get sick and how much did the child eat? Skin testing can usually cinch the diagnosis.

Despite the problems Britney Spears has had in her young life, if her son has a food allergy it is not her fault. Getting him to the hospital for treatment and diagnosis was the right thing to do and avoiding the offending food is the treatment going forward.

Saturday, November 8, 2008

Obama's First Major Decision - a Hypoallergenic Dog

The world is dancing in the street at the election of Barack Obama. His every word is news and everyone wants to know what he will do next. During his victory speech he announced he will be getting a new family dog for the white house and animal lovers everywhere are weighing in on the best pet for the first family. The blogosphere is buzzing with names, breeds and advice for this major decision.

President Obama (I love those two words stung together) has now related that their new pet needs to be hypoallergenic and they would love to get a dog from a shelter. First of all, the fact that we have a leader that can say "hypoallergenic" is so amazing, I am just giddy.

And the fact that he understands the best dogs are rescue dogs is also to my liking. My pets have always come from the humane society or a rescue society and, I swear, these animals have a special sense about their place in the world.

Nothing is worse than being allergic to the family pet. I have had many sad family counseling sessions with patients to deal with this subject.

So, President Obama, may I present a few breeds for your consideration? This choice will outlast your presidency, and your ability to take your time and not rush into decisions will serve you well in this decision as well.

Best breeds for allergy sufferers:
  • Basenji (Came from Africa. Would make a nice statement)
  • Bedlington Terrier (I had one as a child. Fabulous dog and fur like a lamb)
  • Bichon Frise (Cute but I bet not found at a shelter. Too pricey)
  • Cairn Terrier (Good with children and small enough to take on world tours)
  • Chinese Crested (A status symbol..probably not right for the Obamas)
  • Coton de Tulear (Improve relations with France)
  • Fox Terrier (Improve relations with Fox News)
  • Havanese (Improve relations with Cuba. They have genetic health issues and you have enough problems with Health Care in the U.S.)
  • Irish Water Spaniel (Improve relations with Ireland)
  • Kerry blue Terrier (Impressive head, just like Obama)
  • Maltese (Improve relations with Malta)
  • Poodle (Tried and true success and very smart)
  • Portuguese Water Dog (Is there a pond at the white house?)
  • Schnauzer (Improve relations with Germany. My mom has this type. Very smart)
  • Shih Tzu (Improve relations with China. Doubt available in a shelter)
  • Soft coated Wheaten Terrier (They are so cute)
  • Yorkshire Terrier (Improve relations with the UK)
Good luck, Mr. President. If you need any advice on Health Care reform, you know where to find me.

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...