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Showing posts from March, 2008

Elephant Painting

If this doesn't lift your day and perspective on life, nothing will. Enjoy!

U.S. Healthcare - Overhaul it

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I think Americans that are in a Union have pretty good health insurance overall because the unions use health coverage as one of their bargaining chits for employer based coverage. If you have AFL-CIO coverage, you are probably not one of the 47 MILLION uninsured! You also don't have Medicaid.

So I was surprised to find a survey of more than 26,400 Americans, conducted by the AFL-CIO found that people are fed up with U.S. health care. Half of the respondents said they were union members, others were family members or self insured. I see this as the famous middle class. Because it was an online survey, they at least had computer access, and were working Americans. Listen up, Washington...the people have had it!

Among the findings:
95% said the health care system in the U.S. needs fundamental change or overhaul46% reported spending $1000-$5000 in out-of-pocket costs over the past year48% said they or a family member stayed in a job just for the health insuranceNearly 1/3 said th…

Scary Technology- At Home Paternity Test

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We should have expected that this day would come and here it is. Consumers can now purchase an at home test kit for men to solve that age old question "Hey, is that funny looking kid really mine?"

A company called Identigene has developed a paternity test that is available over the counter at Rite Aid and Meijer drugstores. The test costs $29.99 and there is an additional $119 for lab fees. The kit includes swabs for the mother, child and alleged father. After the swab is taken, just slip it in the postage paid envelope for processing by a Salt Lake City lab. Voila...results in 3-5 days and then the agony can begin.

The website also offers family/marriage or genetic counselors. That is probably the most valuable aspect.

Gratitude

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Reading medical blogs can be a real downer. We bloggers like to point out the problems with healthcare financing, training and economics. Insurance companies are a drag and being on call is like carrying around a 2 ton beeper. Talking about the pleasures and privilege of practicing medicine may not be blogworthy, but the note I carry in my handbag and read each day is my reminder of how great I have it.

When the going gets tough, I pull out the note from Karen (not her real name!). This 3X5 notecard, hand written on both sides, warms my heart and reminds me of why I am a doctor.

Karen had been my patient for a few years and we developed a relationship as we dealt with the usual easy issues healthy young working moms have. One day she brought her 48 year old husband to me because he was tired and had a nagging cough. The diagnosis was not hard to confirm. A chest X-ray followed by a biopsy revealed an unexpected and "for no damn reason" lung cancer. It was the hard…

Genes and the Environment - Epigenetic

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How genes interact with the environment to cause disease has been a mystery to scientists. But now, the field of Epigenetics is starting to give clues that will help with cancer and other diseases.

Epigenetics can be thought of as chemical switches that can turn on and off the expression of genes in response to environmental factors. These chemical changes alter whether certain genes are expressed but they don't alter the genetic DNA sequence. The epigenetic changes occur most commonly during pregnancy, neonatal development, puberty and old age. The effects of these changes can occur years or decades later and, because the genes are altered, they can effect offspring also.

One example is shown in some cancers where tumor suppressor genes can be inactivated epigenetically in human tumors. There are now cancer therapies that aim to reverse inappropriate DNA methylation of such genes to allow them to function properly. These therapies don't replace a mutated gene with a good one…

Easter and Spring

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Happy Easter-Happy Spring Equinox. No matter what you call it or how you celebrate, this time of year has been celebrated by all cultures since antiquity.

Of course Easter Sunday is a Christian celebration of Christ rising from the dead to take his place as the Son of God. But the Easter celebration has Pagan roots, long before Jesus Christ, with celebrations honoring the goddess of Spring. The Spring Equinox, when crops are fertilized and there is a balance of daylight and night, has been an important time for hundreds of centuries.

Think about it...making it through the long dark winter, when there were no lights, no convenience stores, no fresh food and no treatments for pneumonia or childbirth was a marvel. Just being alive at the end of each winter must have been a cause for celebration. Seeing the first flowers bloom and the first sprouts of food crops meant you would live. Getting together with neighbors and relatives to dance and sing and eat was a testament to life. E…

Do You Need a Doctor? It better be for skin

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Breaking News (that all of us in Medicine already knew)!!! Young doctors all want to be Dermatologists. Yes, there is a sudden overwhelming interest in skin, pores and hair after spending years in premed, medical school and residency. Taking care of the whole person? Doing a work up for abdominal pain and removing a sick appendix? Evaluating kidneys or hearts or thyroid glands? Arthritis, hypertension and headaches? Forget it!

It's skin that's in!

This is the week for the Residency match and the New York Times tells us that the most sought after residencies are Dermatology and Plastic Surgery. Thank heavens there are only 320 new slots to fill in Derm or there would be no doctors left for anything else. The sad thing is that the Residents who don't get their first pick will be defaulted to other specialties and will be forced to take care of all of us when we are really sick. I don't know about you, but I kind of want my doctor to WANT to do Medicine...not …

Omega 3 FFA - More Good Heart Benefits

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I've written before about Omega 3 FFA but I just learned some new facts that I want to share because it is so important to our longevity and health. I've always been a bit confused about the amount that is needed for proven benefit so here are some important facts:

DHA and EPA are the two omega-3 fatty acids that have shown to prevent cardiovascular disease. Two major randomized clinical trials showed significant reduced mortality and heart attacks with doses of 850mg and 1.8 g/day of DHA and EPA. Higher doses (3-4 gms) have been shown to reduce blood pressure, triglyceride levels and atrial fibrillation. These results are spectacular.

Both DHA and EPA are present in all oily fish such as salmon. One standard capsule of fish oil is equivalent to 300 mg of EPA and DHA. Two tablets of fish oil taken twice weekly provides the same amount of omega-3 fatty acids as 6 oz salmon twice weekly. Evidence for cardio vascular protection from the plant-derived omega-3 FFA, alpha-l…

Carnival of Human Resources Blog

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Check out Wally Block's Three Star Leadership Blog
which features some great links for the human resources world (including EverythingHealth, thank you very much!). This great collection includes "Steps for figuring out your next career move", "CEO excessive pay", "How to interview" and even "How to be a green leader". But it's HR so don't spend all of your work day surfing the web or you could get fired. ha ha.

Paper or Plastic?

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Thanks to my friend at Frankly Green for this great link at msnbc.com to help answer that age old question:
"Paper or Plastic?"

It is a little long to watch, but it's informative.

If you don't want to watch it...I'll give you the punchline: Take reusable bags. (Keep them in the back of your car so you always have them with you) If you are caught without a reusable bag...make your decision on which paper or plastic bag you would reuse for another task. It's not simple, but if we all used reusable bags it would go a long way toward reducing our "carbon footprint".

Too Many Tests, Too Many Doctors

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I've written often about the primary care doctor shortage and the crazy system of health care financing that we have in the United States. To get a clear example of this, check out the great op ed article in the New York Times, titled "Many Doctors, Many Tests, No Rhyme or Reason."

The writer, a medical intern, had his eyes opened when he witnessed a 50 year old man who was admitted for shortness of breath, ended up staying a month in a hospital with consults by a hematologist (blood specialist), endocrinologist (gland specialist), podiatrist (foot specialist), two cardiologist, nephrologist (kidney specialist), ID (Infectious disease), pulmonary (lung), urologist (male urinary), Gastroenterologist, nutritionist, pain specialist, two surgeons and a thoracic surgeon.

The patient underwent 12 procedures, including a pacemaker and cardiac cath. His main diagnosis (which does cause shortness of breath) was anemia.

The question to be asked is, did that extensive and mind boggl…

Powerful Men and Sex

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Even in the staid medical world, everyone was talking about Gov. Eliot Spitzer today and his fall from grace. What the hell was he thinking????

The big question in my mind is why would a respected, well known, powerful man...a member of the lucky gene club, risk it all for dangerous liaisons? His crazy decision to spend a reported $80K on high priced prostitutes has brought down his marriage, career and reputation. (Not to mention Hillary Clinton lost a super delegate). And there are probably many powerful men wiping their brow right now with relief that it wasn't them caught in the sting.

The answer to this unanswerable question "Why?" may be all about personality disorders. The type of man who seeks power (that includes politicians) may also have risk seeking behavior. There is some evidence that risk seekers have a lower level of monoamine oxidase A, which is a chemical that regulates the brain's level of the neurotransmitter, dopamine. They seek novel and …

Grand Rounds

The best of the medical blogs are featured in this weeks Grand Rounds, hosted by our Canadian Medicine friends. Check it out for some good reads.

Expensive Placebo Pills Work Better

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An amazing study published in JAMA has shown that expensive placebo (dummy) pills work better than cheaper dummy pills. Researchers from Mass. Institute of Technology (MIT) recruited 82 healthy people. They said they were taking a new opioid pain pill that had been approved by the FDA. Instead they gave half the subjects a placebo pill that they said cost $2.50. They gave the same placebo to the other subjects but told them it cost .10 cents.

The researchers administered electric shocks (hope they got paid for this study!!!). Of the folks who took the $2.50 pill, 85% said it worked. Only 61% of the people who took the same placebo worth .10 cents said it worked.

The take home message for doctors is that we shouldn't be stressing how inexpensive medications are if we want people to improve. Generic Omeprazole has been shown to work as well as Prilosec for GERD. All of us have had patients who ask for the "Name Brand" (read expensive) because "It works better&q…

Reduce Stress - 3 Simple Ways

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EverythingHealth is happy to present a guest blog today from educator and writer, Susan Jacobs.

Keep Healthy By Reducing Stress - 3 Simple Ways

Let’s face it; life can be very stressful at times for everyone. With worries about jobs, families, friends, and much more, the average person deals with a considerable amount of stress daily. New research has shown that stress can have extremely negative effects on the health of a person. Life-threatening events such as strokes and heart attacks are often caused by stress. With that in mind, I decided that it would be a nice idea to provide information on 3 things that cause stress, and 3 ways to alleviate stress.

Top 3 Stressors

1. Relationships

This shouldn’t come as a surprise to anyone who has been in a relationship, but relationships can be downright stressful sometimes. There are a lot of issues that can occur between two people, which can cause considerable strain on any relationship. When relationships end the amount of stress can really t…

Nutrition and Childhood Allergy

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The incidence of allergies in children has increased over the past several decades. Asthma has increased 160% and atopic dermatitis (eczema, rashes) has increased 2-3 fold. Peanut allergy has also doubled in the last decade.

A new report, published by the American Academy of Pediatrics in Pediatrics shows that breastfeeding for at least 4 months may help prevent allergies in high risk infants. The investigators also found that breastfeeding, compared with feeding cow milk formula protected against wheezing in early life. There was slight evidence that atopic dermatitis may be delayed or prevented by the use of partially hydrolyzed formulas compared with cow milk formulas in mothers who don't breastfeed. There was no advantage in using soy based infant formula.

The authors also found no evidence for delaying certain food groups after age 4-6 months as a protective effect. This included fish, eggs and products containing peanut protein.

All of the answers about the increased alle…

Health Information Confusion

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Thanks to J.S. for today's funny.

Physicians are Sleep Deprived

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When patients complain about insomnia or difficulty staying asleep, I must admit I have no personal point of reference to what they are experiencing. I can fall asleep within minutes of my head hitting that nice soft pillow. I can doze off in a movie, sitting around with a group of friends or reading medical journals. The American College of Chest Physicians has now published results of a survey that shows the majority of doctors are sleep deprived.

I suspected it before. We just don't get enough sleep. Doctors reported they scrimp on sleep during the work week and catch up on weekends. Interestingly most physicians reported the lack of sleep did not adversely affect their work. However, 18% admitted they missed family or leisure activities in order to sleep. I think this may be a bit of the "Superman" syndrome. Oh sure, other humans need sleep for top level function, but not me! I'm a Doctor!

The National Sleep Foundation maintains that 8 to 9 hours of sleep…

Medicare Fraud - Or Just a Mistake?

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I hate waste and fraud as much as the next guy but are "Medicare coding mistakes" really the most pressing activity for our government to go after? Private audit companies, hired by Medicare, will begin scouring mountains of medical records in doctors' offices and hospitals to see if health care providers made a mistake in coding and billing Medicare. Intent to fraudulently bill does not need to be proven...just the fact that the wrong code was used is enough for the Feds to recoup enormous fines. These "recovery audit contractors" will keep 20% of the over payments...quite an incentive to look at every code and be a Monday morning quarterback.

Just to put it in perspective, there are 1.2 billion Medicare claims filed each year and during the first 2 1/2 years of the program in Florida, California and New York (big Medicare states) the error rate was less than 0.2%. Some errors are obvious, such as billing for more than one colonoscopy in a day. But some ar…

Antibiotics - Truths you may not like

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Some blogs are so good I want to repeat it for my readers. Thanks to Distractible mind for this one. Patients don't like to hear it but here is the real truth about antibiotics and YOU:

Common myths about infections and antibioticsMuch attention has been given to the fact that antibiotics are given too often.The reason for this concern is that the overuse of antibiotics can create resistance in the bacteria a person carries, making it much harder to treat serious infections in the future.For that reason, the physicians in our practice are trying to avoid using antibiotics unless they are necessary.The problem is that many patients come to the office already convinced that their infection requires an antibiotic and so will not be satisfied unless they get one.This puts our staff in a difficult position, as we want to practice good medicine, but also strive keep our patients happy.To help with this problem, here is a list of common misconceptions about when antibiotics are appropria…

Women, Now You Can...PEE STANDING UP!

You're the Doctor - Answer

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The patient in the photo below has Poison Oak (Rhus dermatitis). Don't feel bad if you missed it. She had 4 medical visits before it was successfully diagnosed.

Poison Oak is a form of a contact dermatitis (good work, "erp") and she actually contracted it while hiking in Point Reyes, California. Once the urushiol oil from the plant sets on the skin, an inflammatory and allergic response keeps it going, sometimes for weeks. The weeping blisters are common, as is the swelling redness. Contrary to common belief, the oozing blisters do not spread it. It is the underlying response of the body that keeps the dermatitis spreading.

She was successfully treated with topical and oral corticosteroids (Prednisone) but some scars have remained.

Thank you to K.M. for allowing her story and photo to be shared.

You're the Doctor- Whats the Diagnosis?

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This young woman developed this skin condition on her leg after a trip to the Grand Canyon. She was treated with two different antibiotics but it worsened. The winner gets a years free subscription to EverythingHealth. Oh, yea...it's already free. OK the winner gets bragging rights.
Answer will be posted tomorrow.

Ricin - what you should know

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The poison Ricin was found in a Las Vegas Hotel room and one man is hospitalized and unconscious after exposure. Because it takes a deliberate act to poison with Ricin, this brings up concerns about National Security and many questions that are not yet answered.

Ricin is the "waste" mash left after Castor beans are processed into castor oil. Except for cancer research, there are no medical uses for Ricin. It is a stable structure and doesn't degrade in extreme temperatures. People can breathe in a Ricin mist or it can be swallowed in food or water or it could even be injected. As little as 500 micrograms (the size of the head of a pin) could be enough to kill an adult. It kills by getting inside the cells and preventing cells from making proteins.

Symptoms of Ricin poisoning depend upon the route of exposure and the dose. If inhaled, there would be respiratory distress, fever, cough, nausea and chest tightness within hours, leading to full respiratory collapse and d…