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Showing posts from October, 2008

Healthy Halloween

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Halloween has been celebrated since ancient times and the Druids, an ancient order of Celtic priests in Britain, believed that on the night before November 1 (Oct. 31), Samhain, the lord of the dead, called all the wicked spirits together. Since the Druids were afraid of these spirits, they chose that day to sacrifice, hoping they would be protected.

During the middle ages, the Roman Catholic Church decided to allow new converts to maintain some of their pagan (Druid) feasts. But now they were switched to "Christian" feasts so they would pray to and remember the deaths of saints. November 1 is"All Saints Day" and October 31 was supposed to be "All Hallowed Evening".

Modern Halloween and trick or treating comes from Ireland. Irish farmers went from house to house begging for food to be used at the village Halloween celebration. They promised good luck to those who gave them good food and a trick to those who refused.

For little goblins and witches in the…

Balance Testing - A New Gimmick With No Value

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There are at least 5 things wrong with this offering that I (and presumably many other doctors) received in my mail this week. Perhaps you can think of more:

#1. What is this thing? Balance is a big problem for seniors. A patient might think this is a high-tech, evidence based devise for diagnosis and treatment. Since the Medicare patient is far removed from paying the cost, it would be easy for a physician to do balance testing on all of his senior patients.

#2. "Medicare reimbursement $475-700 per exam ( takes 20 minutes with no technician)."
Guess what? Medicare is insolvent. Broke. Bankrupt. Medicare doesn't pay doctors or hospitals the cost of care. Why would Medicare reimburse this at that rate? Wrong, wrong, wrong.

#3. "5 minute serial evaluations to assess treatment" means the doctor can churn and churn and bill Medicare $475-700 over and over as you retest the patient to see if your treatment (?) is working.

#4. "You can prevent fall…

Why Doctors Want To do Procedures Rather than Diagnose

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The Happy Hospitalist wrote a blog that addresses many issues in health care. It answers why doctors are fleeing from primary care specialties into the procedure specialties (Derm, GI, Cardiology, Interventional Radiology, Urology, Anesthesiology, Surgery). It also gives a peak into the Byzantine coding requirements that are required of Physicians by Medicare and continued by every health insurer. It also explains how crazy and inequitable the reimbursement schemes are in Medicine and why we have runaway costs. Here is a sneak peak...but read his entire post.

"How does the AMA define a 99232? Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the…

New Super Purple Tomatoes

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Genetically modified tomatoes that are rich in purple antioxidants called anthocyanins cause cancer prone mice to live longer. Tests on mice that lacked the p53 gene, which helps protect against cancer, showed the mice that were fed the purple tomatoes lived 30% longer than those who ate only normal red tomatoes.

British researchers from the John Innes Centre, Norwich, England, published their results this week in Nature Biotechnology. They were investigating ways to increase the levels of antioxidants in common fruits and vegetables. Tomatoes naturally contain the beneficial antioxidant compounds, lycopene and flavonoids. By taking two genes from the snapdragon plant and turning them on in the tomato, they were able to create a genetically modified fruit that added the antioxidant, anthocyanin.

The researchers created the purple tomatoes by linking the two genes from the snapdragon flower with a regular tomato plant. The anthocyanins give the tomatoes a purple color. Although t…

Universal Health Care Doomed to Fail Without Primary Care

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Senator Obama wants to provide universal health care coverage to all Americans, but the physician shortage will stop it dead in it’s tracts. With less than 2% of medical students choosing primary care medicine as a specialty and the aging physician population that is ready to retire within the next five years, we have a crisis looming.

It is the primary care specialties who manage 80% of all health care needs of our population and who keep costs under control by knowing the patient and providing continuity and preventive care. As they retire or close their practices to new patients, there are no young physicians to take their place.

There is already a shortage of primary care physicians and physicians in some basic specialties like general surgery, neurology and rheumatology. Even large metropolitan areas are lacking in gerontologists, general internists and family physicians. Rural communities face challenges for primary care and specialty care.

Young physicians in training are tu…

Hormone Therapy is Safe for BRCA1 Mutation Carriers

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The J Natl Cancer Inst. has published reassuring findings from a case control study. Women with BRCA1 mutations have a lifetime risk for breast cancer of 60-80%. Many of these women undergo prophylactic oophorectomy (removal of the ovaries) before menopause as a way to lower their risk. This surgery can cause severe, sometimes disabling symptoms of menopause and really affect a woman's quality of life. Because of the concerns about breast cancer, these women are afraid to use hormone replacement to relieve symptoms.

This study, supported by the N.I.H., looked at 472 women and matched them with controls. They found that there was no evidence of higher breast cancer with hormone therapy use in BRCA1 mutation carriers and it even provided a surprising suggestion that hormones could be protective. This important study allows us to reassure women with BRCA1 mutations that use of menopausal hormones are OK to relieve severe symptoms of menopause.

Answer to Medical Challenge

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The answer to the image from yesterday and another image above is
#5- psoriasis.

Psoriasis is a common condition and affects the skin with patches of raised red patches with silvery scales. In the United States, about 7 million people have psoriasis. As you can see, it can also affect the fingernails and toenails. In people with skin psoriasis, 10-55% have psoriatic nail disease and 10-20% also have psoriatic arthritis. Of people with psoriatric arthritis, 50-85% have affected nails.

New Medical Challenge Quiz

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You be the doctor. This patient shows you his fingernails and you diagnose:
1. Chronic Paronychia
2. Dermatomyositis
3. Selenium deficiency
4. Rheumatoid arthritis
5. Psoriasis

Click on the image for a better view. I will post the answer tomorrow!

Eating Fast Makes You Fat

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Just out from the British Medical Journal; Eating until you feel full and eating fast are associated with being overweight.

Obesity has become a worldwide problem in developed countries and the highest selling books are cookbooks and diet books. Obesity is an important risk factor for cancer, cardiovascular diseases and diabetes. This study gives us more evidence on how we can help people with weight control.

The researchers studied 4140 Japanese adults and measured their body mass index. They used a validated survey to assess speed of eating (very slow, slow, medium, fast, very fast) and they also asked about eating until full.

They found that for both sexes, those that reported eating until full and eating quickly had the highest age adjusted values for weight, body mass index and total energy intake. They further adjusted for total fibre intake, alcohol, smoking and physical activity and still found that eating quickly made you fatter. For patients who both ate quickly and ate …

Crisis in Hawaii Healthcare

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There is trouble in paradise. The big Island, Hawaii, is experiencing a massive doctor shortage and there is no relief in sight. Here are some facts that might be as surprising to you as they were to me.

There are 140,000 residents on Hawaii, the biggest of all the Hawaiian islands at over 4,000 square miles. There are three hospitals on Hawaii, 2 are state hospitals and one is private and they are all financially desperate.

For the 140,000 residents and thousands more tourists who visit, there is only one orthopedic surgeon who operates. Two ortho docs left this year because they just couldn't make it financially. There are no neurosurgeons and only two OB/GYN doctors after three retired this year.

There is one health insurance carrier who enjoys a monopoly (Blue Cross Blue Shield-HMSA) and, according the the physicians I spoke with, they have terrible reimbursement rates that make it impossible for physicians to practice here. Couple that with the " lower than cost"…

Prescription Hassles in Medicine

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I am currently out of town for a medical meeting and although I have been gone less than 24 hours I have received 7 phone calls or emails from patients and my office about pharmacy medication renewals. It is only 10:00 AM back home so that number will increase as the day goes on. If you query any primary care doctor, you will find that 9/10 will report pharmacy and drug renewals are one of the most annoying and time wasting hassles they have. (not a scientific study but if you doctors out there disagree, just tell me).

We deal with many different pharmacies, mail order drug companies and pharmacy benefit companies, each with their own rules, regulations, protocols and coverage. Patients have no idea what goes into getting them one simple medication. Here are just a few of the idiosyncrasies:
Controlled drugs (even common pain meds) and any drug for Medicaid patients needs to be written on a special tamper proof pad. They cannot be faxed or phoned in. They need to have the patient…

Allergic Reaction to Ear Piercing

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This photo shows the earlobe of a 21 year old woman who presented to a clinic with a growing hard red nodule that was located where she had her ear pierced 5 years ago. She removed the earring after a few years because it never healed and was always inflamed.

A biopsy was done of the nodule and pathology showed a skin reaction with epithelioid histiocytes surrounded by a dense infiltrate of lymphocytes.

Allergic patch testing was done and it showed a positive reaction to nickel and a strong reaction to palladium. The skin reaction to palladium (done on her back) persisted for months and was not relieved with strong corticosteroid cream.

The reaction on her skin finally disappeared after injecting it with corticosteroids. The ear lesion required surgical excision.

Allergies to metals are common and any piercing that does not heal may be an allergic reaction to one of the metals or alloys used in the metal. Similar cases have occurred with nickel, gold and platinum from ear piercings.

F…

Why Are These Guys so Happy?

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Why does Jamie Dimon (center), the chief of JP Morgan Chase look so happy after meeting with Treasury Secretary Henry M. Paulson Jr?

The largest recipients of the bailout are:
B of A: $25 billion
Citigroup $25 billion
Wells Fargo $25 billion
JPMorgan Chase $25 billion

Oh, now I get it.

Lisa Marie Presley Gives Birth To Twins

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On Tuesday, October 7, Lisa Marie Presley gave birth to twin girls. The only child of music icon, Elvis Presley, has two teenage children from another marriage and these are her first babies with music producer husband, Michael Lockwood.

The girls were born to the 40-year-old mother by Caesarian section and weighed 5 lbs, 15 oz. and 5 lbs. 2 ozs and are reportedly doing very well. Twins run in the Presley family. Elvis was a twin and her mother, Priscilla Presley, has younger brothers who are twins.

Lisa Presley’s daughters are fraternal or dizygotic twins. That means they are non identical and are from two ova (eggs) fertilized by two separate sperm at the same time. The mother must release two eggs for a possibility of fraternal twins. They implant in the uterus separately and grow like siblings together. Dizygotic twins occur more commonly in mothers over the age of 35 and with the advent of fertility treatments the rate has exploded. Fertility treatments stimulate the uterus t…

The Bailout and Why it was Needed.

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Get smart this weekend. National Public Radio has a long-running radio show called "This American Life" that is entertaining, thought provoking and just plain excellent. I downoad it automatically from I-Tunes and listen when I am driving in my car. Last weeks show was about the financial meltdown and the bailout and it is one of the best explanations of the entire mess and how it occurred. Listen and learn.

Pro Life - Can Mean Death for Women

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One of the most brilliant and provocative writers of our time is Nicholas D. Kristof, who has made it his life's work to expose the horrors against women in third world countries around the world.
In his Op-Ed, "Can This Be Pro-Life" he shines a spotlight on the Republican Right (which includes President Bush, Senator McCain, Governor Palin and their supporters) and how pro-life policies have a devastating effect on women around the world.

The opposition to condoms and birth control have had a terrible effect on women in Africa and Asia as they contract AIDS and fall further into poverty with unwanted pregnancies. Since 2002, President Bush - backed by Senator McCain- has stopped funding the UN Population Fund
which works in 140 developing countries and has international support.

Now, the U.S. Agency for International Development has ordered six African countries to ensure that no U.S. financed condoms, birth control pills, IUDs or other contraceptives are furnished t…

Wall Street Bailout

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Sluggish Adults Get New Exercise Recommendations

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New guidelines from the Department of Health and Human Services recommend adults exercise a minimum of 2 1/2 hours a week for optimal health. That's right, two and a half hours a week. Raking leaves, walking around the block or doing resistance bands seem to count.

Now I do understand that half of all adults are really sluggish and don't get this much exercise. I also understand that getting people to move "a little" is better than nothing at all. But considering all previous studies have shown that for optimal health, an hour a day of aerobic exercise is needed, this seems a little "dummied down". We are in the midst of an obesity epidemic and diabetes crisis and raking leaves is not going to shift the pendulum to the healthy side.

Somehow these new recommendations fit with everything that we are hearing from our government now. Mediocrity is where we are headed. There are no stretch goals being presented. No need to develop new forms of energy (&qu…

Use of Fan in Baby's Room Prevents SIDS

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The cause of crib death, or sudden infant death syndrome (SIDS) has been a mystery for years. New findings published in The Archives of Pediatrics and Adolescent Medicine show that placing a fan in the baby’s room can decrease crib death by 72%

Pediatricians have recommended placing babies on their backs instead of their stomachs to sleep and this has lowered the number of SIDS deaths by more than half. Despite this, SIDS continues to be the leading cause of death in babies under the age of one.

The latest research was conducted with an NIH grant by Kaiser Permanente Northern California and included 497 infants. The researchers interviewed mothers of 185 infants who died from SIDS and compared them with 312 infants of similar race and age. They found that the simple use of a fan, in conjunction with having the babies sleep on their backs, avoid soft bedding, not share a bed with other children and use a pacifier, dropped the risk by 72%.

This study did not answer the question of why…

Quality Index Scores of Healthiest Foods to Eat

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Researchers at Yale University have rated the top 100 foods based on nutrients, vitamins, sugar and salt as well as impact on blood pressure and other health concerns. The quality index scores of the healthiest foods to eat will soon be posted in major grocery stores to help consumers make choices. Shopping by the numbers may help us all on the confusing trips to the grocery stores with over 45,000 products to chose from. Here are the top choices and it is no surprise they are all natural.
The top four got ratings of 100:

Broccoli
Blueberries
Orange
Green Beans

These were closely followed by:
Pineapple,
Radish
Summer Squash
Apple
Green Cabbage and Tomatoe
Nonfat milk

Other foods that had ratings in the top 50 were sometimes a surprise:
Raw Almonds
Brown Rice
Snapper
Canned Tuna in oil, drained

Unbuttered, unsalted popcorn came in at #69
Pasta was #50 and ranked above prunes and vanilla yogurt


Heading up the bottom of the healthy (bottom=unhealthy) food list were:

Popsicle
Soda
Saltine Crackers
Bacon
Salam…

Having Trouble with Goals? Try Stickk

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Do you want to write a book? Drink less coffee? Clean that garage? Loose weight? The world is paved with good intentions, right? Well, I found a new website that I want to share because I think it is really cool. It is called Stickk.com.

This site helps you stick to goals by having you make commitment contracts and engage your friends and lovers to keep you on track. Dean Karlan, economics professor at Yale and co-founder of Stickk says the commitment contract concept is based on two well known principals of behavioral economics:
1.People don't always do what they claim they want to do, and
2.Incentives get people to do things.

At Stickk you make your commitment, invite your friends to be your coach and referee and then you put money up as an incentive. If you succeed your money is returned to you. If you fail to live up to your commitment (you define it), your money goes to a charity of your choice or, even more motivating...an anti-ch…

Health Care Sinks to Low Priority in Debates

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The anticipated VP debate has ended and both candidates held their own, but there was barely a mention of one of the most pressing issues in the United States…health care. Health care inequities and the rising costs have been a concern of Americans for a long time. I know the Wall Street meltdown has eclipsed most everything but I once you describe the “orgy of Wall Street and the greed of big business” for the 10th time, it’s time to move on and talk about your policies for change.

Palin touched on the subject by mentioning the $5,000 tax credit McCain would give for people to buy their own insurance. Biden countered with a long winded (but accurate) explanation of how $5000 wouldn’t really be enough to cover a policy that now costs $12,000 and is currently subsidized with tax breaks to employers.

That was it…end of discussion. What wasn’t said is that McCain’s health proposal would eliminate the tax benefits employers now get so more people would be dropped from work based health…

Blogger Stalker

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This post from fellow blogger, Buckeye Surgeon, really makes you think twice about blogging. Most medical bloggers are anonymous but I write Everythinghealth with my real name. It keeps me from ranting and raving and makes me more careful about what I write. But reading about this stalker who didn't like what Dr. Parks of Ohio wrote, is a bit chilling. Crazy world!

Hat tip to my blogger friend, Happy Hospitalist for alterting us.