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.

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...