Friday, January 30, 2009

More on Octuplets

Thanks to KM for alerting me to information that continues to unfold about the mother of the octuplets born in Southern California this week. It is really hard to believe...

The mom is 33 years old, unmarried and already has 6 children between the ages of 7 and 2. She has one set of twins and...are you ready for this...she lives with her parents in a 3 bedroom home. Also, the grandparents filed for bankruptcy last year.

So there will soon be 14 children and 3 adults living in the home. And, according to the grandmother, she did have in-fertility treatment for blocked fallopian tubes. That would mean that she had in-vitro transfer (implantation) of embryos.

The American Society of Reproductive Medicine considers it grossly unethical to implant 8 embryos and many experts are speaking out against fertility help at all for a woman with six children. In Germany and Italy, there is a limit of 3 embryos that can be implanted. In the U.S., there are standards but no real prohibitions or laws against fertility clinics behavior.

How this woman could afford IVF and who would actually perform it are still mysteries. There is no question that this case is highly unethical and should never have happened.

What do you think? Should personal freedom extend this far? Should Fertility Clinics follow the wishes of patients?

Wednesday, January 28, 2009

Octuplets. OMG

Eight, count em, eight babies were born to a secret mother at Kaiser Permanente Bellflower Medical Center in Southern California this week.

This is the 2nd live-born set of octuplets in the U.S. and they are all doing well, according the the hospital spokesperson. The six boys and two girls weighed between 1 lb 8 oz. and 3lb 4 oz. When you multiply that times 8...well it is a lot of poundage!

They expected 7 babies and the 8th was a surprise. I guess they all jumble up on the ultrasound.
The babies are in the newborn ICU (NICU) of course, in incubators. They will need to be hospitalized for many weeks to grow and develop. If they all survive, they will be the first known live octuplets in history.

It hasn't been disclosed, but it is likely these babies were the result of fertility drugs. It is very unusual for high multiple pregnancies to occur naturally. Fertility drugs stimulate the ovaries to produce many eggs and if they are all fertilized and implanted, it can be highly risky for the mother and babies. For that reason, many mothers are faced with the decision of selectively reducing the number of fetuses. For women who have undergone the emotional trauma of infertility, this is a heartbreaking and difficult decision. Do you risk the lives of all the babies and risk having no child? These are the painful aspects of the infertility business that no-one talks about.

Fortunately, it looks like these 8 have a pretty good chance. They are feeding and also receiving supplemental tube feeds. Most importantly, they are all breathing without respirators, which means their lungs have developed enough to live. They have good weights and the work that goes on in NICUs to stabilize and save these tiny infants is truly amazing.

It looks like "Steve and Kate plus 8" might have a competitor.

Book Contest Winner

We have a winner! Thanks to all who made comments on the blog below that gave you the unbelievable chance to win a book called "Brush Your Teeth-and other simple ways to stay young and healthy"

The comments were so compelling, heartwarming and pleading that I could not select the best. So with the help of my son...we picked names out of a hermetically sealed envelope and the winners are:

m.scott and medical student L.G.

Please email me (look at my profile) and give me your mailing address and you will receive your free healthy prize book.

The staff at EverythingHealth

Tuesday, January 27, 2009

Special Emergency Room for Seniors

Here is something new! I've heard of special Pediatric Emergency Departments (my hospital has just opened one) because children are not just "little adults".

But now there is an Emergency Department that treats only senior citizens over age 65. Located in Silver Spring, Maryland, the ED has staff trained in geriatrics and utilizes an approach to care that is structured around the needs of older people.

Each patient has a separate, uncluttered cubicle with a comfortable chair for a family member or visitor. The mattress is thicker than usual and is designed to prevent skin breakdown. Blanket warmers and pillows are there for comfort and the department is designed as a "soothing" atmosphere with special lighting and sound proofing. There are wooden handrails for safety and large face clocks. Each bed has a TV and overhead lighting controlled by a dimmer switch. (Great idea. Hate those glaring fluorescent lights).

Most importantly, the staff is trained in geriatrics and in communicating with patients who are hard of hearing or process information more slowly.

What I liked most about this new concept is that they involved the patients in planning. They really listened to what patients wanted..."keep me informed", "Keep me warm".

Nearly 3/4 of people over age 65 come to the Emergency Department for non-life threatening conditions like falls, chest pain, shortness of breath or other chronic conditions. It is these patients who are directed to the Senior ED.

In this time of high tech, expensive health care, it is amazing the impact that can be made with simple things. The center, which is separated from the regular ED, cost just $150,000 to renovate existing space and train the nursing staff.

They hope the Senior ED will run more efficiently than the general ER and patients can get in and out more quickly. They will track re-admissions and improved assessments to see if they are making a difference.

Monday, January 26, 2009

Peanut Butter Recall

Dear Dr. Brayer,
My kids love PB&J sandwiches and we all eat peanut butter. I've heard about the recall and I don't know if I should throw out all the peanut butter in the house?
Marilyn Mom

Dear Marilyn Mom:
The Salmonella outbreak that has shown up in 47 states and Canada has made everyone concerned about peanut butter. The FDA has confirmed that the source of the outbreak is peanut butter and peanut paste made by the Peanut Corporation of America at its Blakely, Ga. processing plant. Because they sell to food makers, many products have been recalled including:

Clif Bars,
Kellogg Company Austin and Keebler brand, Famous Amos Peanut Butter cookies
Kroger peanut butter ice cream
General Mills Lara Bars and Jam Frakas flavor snack bars.

This is not the complete list so you should toss out any processed peanut butter snacks and don't eat any peanut butter products served in restaurants. A full list of recalled products from the FDA is here. The list is extensive!

There has been no problem with peanut butter in jars so you can continue feeding that to the kids. The healthiest peanut butter is the type you can grind yourself (Whole Foods and some natural grocery stores) or peanut butter that has no preservatives.

Sunday, January 25, 2009

EverythingHealth Give Away

The blogosphere is a marketplace and I get contacted by PR agents all the time to post on my blog. Most of them I turn down as not really "worthy" of my astute readers.

This time I reviewed a book that is really VERY GOOD. It has a catchy title..."Brush Your Teeth (and other simple ways to stay young and healthy.)"

Written by Dentist Dr. David S. Ostreicher, it focuses on six fundamentals of good health: hygiene, diet, attitude, exercise, sleep and personal safety. Forget fad diets, overpriced supplements and tonics of youth. A few simple improvements can make a big difference in every one's life and this book gives you those tips. It is a good read.

So we here at EverythingHealth are having a "give-away". (The "We" is really me...I don't have a staff or crew). Just comment and tell me why you want better health and what you are looking for in personal wellness. The top two comments (judged by impartial ole' me) will receive a free copy of "Brush Your Teeth". Trust me, it is about more than a toothbrush.

Check back here on Wednesday, Jan 28 and I'll post the winners. If you don't want to use your name...that's OK but Anon won't do. Call yourself Madonna, or Agent 007, or Eminem or something that I can identify you with.

Make a comment on why you want to stay healthy and win a prize!

Saturday, January 24, 2009

Atul Gawande and Health Care Reform

I am happy to share my Saturday morning reading with the readers of EverythingHealth. The New Yorker featured Dr. Atul Gawande, one of the most astute and interesting physician writers of our time.

Dr. Gawande makes the case that health care reform and changes in the system are never successful with a "complete overhaul". He says a master plan for change will not work because there are so many entrenched systems that are working for "some" people. We have Medicare, Medicaid, Veterans Administration, private insurance, government insurance for government workers, employer sponsored insurance and prescription drug plans.

He says we should build upon what we have got but keep striving for better and better. The first ambition, of course, is universal coverage so everyone can receive health care and no-one goes bankrupt because they get cancer.

So go get yourself a cup of tea and read this article!

Aggressive Anti-Abortion Nurse

Talk about overstepping your professional bounds. A nurse at Presbyterian Medical Services Rio Rancho Family Health Center in Albuquerque, New Mexico was sued this week after she removed an IUD from a patient without permission because she (the nurse) was against abortion.

Allegedly, the patient went to the clinic for a routine exam and asked to have the IUD string shortened. The nurse began asking the patient about her choice of contraception and then pulled the IUD out. According the the court complaint, the nurse said "Uh oh, I accidentally pulled out your IUD" She then said, "Having the IUD come out was a good thing. I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus."

The defendant nurse said, "Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it's not true, they accidentally come out when I tug."

The nurse told the patient that it was better that she did not have the IUD because she could now use a "non-abortion" form of contraception. She made it clear she would not insert a new IUD.

The plaintiff demands damages for battery, constitutional violations and negligence.

The story speaks for itself.

Thursday, January 22, 2009

California Reports Hospital Quality Data

California is breaking new ground by publishing eight hospital mortality measures so patients can determine which hospitals have the best quality outcomes. The state is using “risk adjusted” measures to better compare how “sick” a patient is and how likely they would be to die from the condition.

The eight measures include death from three medical conditions; acute stroke, hip fracture and gastrointestinal bleeding as well as five surgical procedures: coronary angioplasty, carotid endarterectomy, craniotomy, esophageal resection and pancreatic resection.

The new data offers a snapshot of the quality of care provided by over 400 California hospitals.

"This is the first time for many hospitals that they have been able to benchmark their performance on these procedures against all California hospitals," said Joseph Parker, director of the health care outcomes center for the Office of Statewide Health Planning and Development.

Of the state's 384 such hospitals, 25 performed better than the state average on at least one of the procedures or conditions, and 94 did worse in 2007. In 2006, 33 hospitals scored better than average, and 98 rated worse on at least one of the indicators.

It is hoped that public reporting of quality data will give patients information to make health care decisions. But it would be premature to think that these measures are anything other than a raw beginning. There are a number of problems with the data that patients need to know:

1. The eight conditions it tracks cannot be generalized to looking at how a hospital performs in other aspects of patient care. They are very specific and reflect only that measure and cannot be used to conclude that a hospital is good or bad
2. A hospital can be above average on one measure and below average on another.
3. The data is old (2006,07) and many hospitals have made improvements since that time.
4. The data fails to properly account for patients with multiple conditions or those who do not wish to be resuscitated.
5. The state relied on data used for billing purposes and did not verify to make sure that the coding was correct and that it matched the patient record information.

Most patients don’t plan a stroke or a broken hip so this type of data might even be confusing and make them feel insecure about their community hospital if it scored average or lower on a certain measure.

And finally,
Not everything that matters can be measured and not everything that is measured matters.

Wednesday, January 21, 2009

Does Personality Affect Dementia?

A new study published in Neurology suggests that the risk of developing dementia might be influenced by a person's underlying personality. People who are active, social and calm may stay mentally sharp longer than people who don't have those traits.

The Researchers from Karolinska Institute in Stockholm, Sweden used a questionnaire to determine personality traits in 506 healthy older subjects. The participants were followed for 6 years and were asked about how they spent their leisure time, the richness of their social network and how optimistic they were and how they handled stress and isolation.

They found that people who were not socially active, but were calm and relaxed were 50% less likely to develop dementia than those who were isolated and distressed. People who were extroverts (social), active, optimistic and calm had the best outcomes and lowest dementia of all.

So what is the take home message here? If you are naturally neurotic and anxious, making sure you have an active, social life might buffer the effects and help protect your brain. If you are naturally a loner...try to be calm and optimistic about life. It seems the best way to age gracefully is to be social, active, stress-free and calm.

At least that is true if you live in Sweden.

Tuesday, January 20, 2009

Obama and Stem Cell Research

There is speculation on the Hill about whether President Obama (love those words) will immediately reverse the ban on stem cell research by executive order, or wait until Congress submits a bill to him that he would sign. I think it is about 50/50.

Either way, these are significant steps in the right direction after 8 years of "anti-science" and suppression of expert research under the Bush administration. Former Surgeon-General under Bush, Dr. Richard Carmona complained he was muzzled in attempts to speak out on stem cell science and other issues.

The fact that Obama is likely to be lifting the restrictions on US federal funding of human embryonic stem cell research speaks volumes about how he will govern.

Stem cell research from public funding will potentially ensure open access to research results and allow easier transition from research to development of new therapies and cures for patients with a wide range of illnesses.

In 2007, Senator Obama co-sponsored the Stem Cell Research Enhancement Act and said the study of stem cells held enormous promise for the treatment of debilitating and life-threatening diseases, like Alzheimer's, diabetes and spinal cord injury. "Instead of creating roadblocks, we must all work together to expand federal funding of stem cell research and continue moving forward in our fight against disease by advancing our knowledge through science and medicine", then Senator Obama said.

It will be interesting to see what first Executive decisions, President Obama (there it is again!) will make after he recovers from the partying night of the inauguration. He has pledged to start work on Wednesday and get a stimulus recovery bill passed ASAP. Many are hoping he makes good on reversing the Embryonic Stem Cell ban also.

Monday, January 19, 2009

It's Obama Day

In honor of Barack Obama I'll be wearing my shoes.

Remember Martin Luther King, Jr.

Remember Martin Luther King, Jr. (this is a repost from 2008. And worth re-reading)

Martin Luther King, Jr. (Jan 15, 1929 -April 4, 1968)

  • "I have a dream that one day this nation will rise up and live out the true meaning of its creed" 'We hold these truths to be self-evident, that all men are created equal."'
  • "I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character."
  • "Now is the time to lift our nation from the quicksand of racial injustice to the solid rock of brotherhood. Now is the time to make justice a reality for all of God's children."
  • "Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness."
  • "History will have to record that the greatest tragedy of this period of social transition was not the strident calmor of the bad people, but the appalling silence of the good people."
  • "Injustice anywhere is a threat to justice everywhere."
  • "Never forget that everything Hitler did in Germany was legal."
  • "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity."
  • "Our scientific power has outrun our spiritual power. We have guided missiles and misguided men."
  • "We must build dikes of courage to hold back the flood of fear."
  • "I have decided to stick with love. Hate is too great a burden to bear."

Saturday, January 17, 2009

When Ear Piercings Go Bad - Keloids

Women (and men) around the world love pierced ears. But sometimes piercings can go bad. The earlobes of this 28 year old women show huge masses that are called keloids. She had her ears pierced at age 6 and the keloids started forming when she was 9 years old.

Keloids are from excessive collagen formation that occurs during connective tissue repair. They extend beyond wound margins and usually do not regress. Microscopically you find large collagen bundles in keloids. They are common on the upper body and can develop years after injury. Persons of African American Descent are more susceptible to keloids than other races.

Keloids can be treated with intralesional corticosteroid injection, silicone gel sheeting, radiation therapy with surgery, pulsed dye laser and bleomycin.

This woman wanted to keep her keloids! I guess they do make her distinctive in a bizarre sort of way!

From Consultant, Dec 2008
Photo: Clinical Dermatology: A Color Guide to Diagnosis and Therapy

Friday, January 16, 2009

Answer to Medical Quiz

The answer to yesterday's image challenge is #1. spider hemangioma.

Spider angiomas can be seen in healthy children and pregnant women. In such cases, angiomas are few in number and resolve with time or a normalization of estrogen levels. Numerous spider angiomas are more common in patients with chronic liver disease and consist of a central arteriole from which numerous small venules radiate, resembling a spider's legs. Possible mechanisms of formation include arteriolar vasodilatation, neovascularization from angiogenic factors such as vascular endothelial growth factor, direct effects of alcohol, and estrogen excess due to inadequate hepatic metabolism.

Affordable Health Insurance

EverythingHealth is featuring a guest post today from health blogger Elaine Newland.

Get Proactive to Find Affordable Health Insurance

In the midst of the most serious economic downturn since the Great Depression, Americans are hearing frightening words like "bankruptcy" and "foreclosure" with alarming frequency. What most people don't know, especially the more than 40 million citizens who have no health coverage , is that unresolved medical expenses constitute the single most prevalent reason for personal bankruptcy in this country. There are likely many things you cannot afford in the current recession, but health coverage isn't one of them.

Businesses, especially small "Mom and Pop" endeavors are looking at the bottom line for 2009 and deciding what can be cut. Benefits will likely be the first thing to go with layoffs to follow, raising the specter of an additional 40 million Americans experiencing a break in their health coverage for a period of months or years to come. This situation will inevitably shift the responsibility for seeking coverage to individuals who may have no idea how to find affordable health insurance policies. As with all matters relative to insurance, the first thing to do is to research the facts and understand the law. Fortunately, in the vast majority of cases, time will be on your side. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), workers who lose their jobs can maintain health coverage through their former employer's plan for up to 18 months. That's more than enough time to weigh options and to find reasonable, low costs replacement coverage.

Since most families do not have a health savings account; in this endeavor, the Internet is an invaluable tool. As a bottom line position, a family of four in good health can expect to find a medical plan with a deductible of roughly $1,000 for monthly payments of approximately $400. Such plans generally include co-payments on doctor's visits of $30 and on generic drugs of $10. (Remember, the higher the deductible the policy holder is willing to assume, the lower the monthly payments will be.) Applicants will need to answer health questions, to open their health records for examination, and to potentially undergo a new physical examination. Do not rule out short-term coverage if the prospects for re-employment are good. Normally short-term coverage of six months or so will be less expensive because the policies do not cover existing medical conditions and offer less in terms of reimbursement.

After researching coverage online, consumers should take the quotes they receive to a physical insurance agency and be prepared to bargain. Even if you do not go with the agent's offer, it is likely that you will learn useful information about potential riders to your policy. Bear in mind, however, that insurers are looking for business in this tough economy as well and it is entirely possibly that through shrewd negotiation, you may get a better rate. Also, consider your membership in various professional groups -- even alumni associations -- and see if you qualify for coverage at a low rate as a benefit of your affiliation.

Through careful research and a willingness to bargain, it is perfectly possible to find affordable, comprehensive coverage. The one thing you cannot afford to do, however, is to simply let your coverage lapse or to take the first rate that is offered. Without national health care coverage, the consumer's only safeguard against disastrous medical expenses is proactive personal intervention to ensure your coverage doesn't lapse and that you aren't paying more than you can afford and more than is reasonable.

Thursday, January 15, 2009

What's the Diagnosis?

This 55 year old man showed up with these lesions on his shoulder and upper chest. What is the diagnosis?
1. Spider angioma
2. Hereditary hemorrhagic telangiectasia
3. Pyogenic granuloma
4. Nodular melanoma
5. Cherry hemangioma

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

Wednesday, January 14, 2009

NAPP Classics: The iPod Flea

Get well Soon, Steve Jobs. I love the ipod.

Steve Jobs Takes a Leave

The Steve Jobs story continues to create interest and speculation as he announced that he is going to take a six months' medical leave because his medical problems were "more complex" than he initially thought.

I blogged previously about the possible explanations for Mr. Job's weight loss after he underwent a Whipple surgical procedure for pancreatic cancer in 2004. As he became more and more emaciated, the rumors flew and Apple stock price fell with investor worries about his health. He attempted to minimize concerns last week and said the weight loss was from a hormone imbalance that caused nutritional problems.

Now, less than a week later, he announced in an email to his employees: "Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple as well. In addition, during the past week I have learned that my health-related issues are more complex than I originally thought. In order to take myself out of the limelight and focus on my health, and to allow everyone at Apple to focus on delivering extraordinary products, I have decided to take a medical leave of absence until the end of June."

The web is already responding to Steve Job's announcement with much speculation that the "Jobs era" has ended and "He probably won't come back to Apple".

I wouldn't count him out so fast. Steve Jobs may be doing the most rational and responsible thing he could by taking a break and focusing on his health. We are such a work obsessed it unthinkable that he could take a little sabbatical? He has a huge organization in place that can spin without him for awhile. Why should he stress his body and mind with travel, long work days, boards of director meetings and answering to the press when he could be focusing on nutrition, rest, and healing?

He may be making the best choice for his company as well as his family by stepping off the spinning ipod for awhile and getting in touch with his personal iSteve.

Tuesday, January 13, 2009

The Shingles Vaccine

Who should receive the Shingles vaccine?

Shingles (Aka: herpes zoster) is caused by a retrograde transport of the chickenpox virus from the ganglia (nerve root) to the skin. Ten to 30% of people develop Shingles in their lifetime and most of the time it occurs in the elderly. Normal aging causes immunity against zoster to go down.

Shingles causes a discrete rash that can be painful and lasts several weeks. Twenty percent of people develop postherpetic neuralgia, a painful condition that can last long after the Shingles outbreak.

In 2006 a Shingles vaccine called Zostavax was approved by the FDA. The Advisory Committee on Immunization Practices recommends giving a single dose of the live vaccine to healthy people age 60 or older. The vaccine prevents Shingles and postherpetic neuralgia.

Some points to know about Zostavax:
  • It is not the chickenpox vaccine (Varivax). Zostavax is 14X more potent than Varivax.
  • Zostavax can be administered with other vaccines (Tetanus, influenza, pneumococcus) but it should be given at different sites.
  • Even people who do not recall having chickenpox should receive the vaccine.
  • People who have had Shingles should have the vaccine because you can get Shingles again.
  • The adverse effects include local swelling and pain, headache. There have been no serious adverse effects compared to placebo.
  • People with immune deficiency, cancer, leukemia, lymphoma,(unless in remission) or organ transplant should not receive the vaccine.
The vaccine is expensive (total cost can be over $300) and it is seldom covered by insurance. It is covered by Medicare Part D (the pharmacy coverage) but not Part B. Usually the patient needs to take a prescription to a local pharmacy, the vaccine is placed on ice and the patient brings it back to the physician for administration.
Information Source: Cleveland Clinic Journal of Medicine, 2009

Monday, January 12, 2009

Physician Self Disclosure

How much should the doctor talk about him/her self?

There have been a number of recent articles in medical journals that showed when physicians talk about themselves it can be distracting for the patient. One study showed that 40% of physician self-disclosures were unrelated to the patient's preceding remarks. In another article they found that primary care physicians talked about themselves to 30% of patients and it was not effective in conveying understanding or helping patients with improved self-care.

The only purpose of a physicians self disclosure should be if it is directly related to the patient's needs. It can be a way to facilitate understanding, increase rapport and relationship, or educate.
The Annals of Internal Medicine discussed ways physicians can reveal themselves to patients that would be in the patient's best interest.

Here are some examples:
Right: "So you have a new baby! I remember that time so well. How is that going for you?"
Wrong: "I was so bored when I stayed home with my newborn."

Right: "I understand that you are nervous about the colonoscopy. I know from experience that they sedate you well and use medications that take away the anxiety. Tell me what concerns you?"
"I had a colonoscopy and I breezed through it. I was nervous, however, when they told me they removed a polyp but I felt better knowing I had it done and it ended up being benign so it all ended well."

Right: "I know how frightening your mother's diagnosis of Parkinsons is. Here is a website with more information and resources the family can tap into.
Wrong: " My mother was diagnosed with Parkinsons and it was such a strain for my father and the entire family. It worked out well to have a son as a doctor because I was able to intervene and get them the help they needed. I got her to the best specialist and she's on good medication now that I help manage."

If sharing pieces of your own life can improve the patient experience or education, self disclosure can break down walls and be a help in the relationship. Too much disclosure that isn't patient focused might just be self indulgent for the doctor. What do you think?

Saturday, January 10, 2009

A Great Snack

Someday I am going to write a "healthy recipe" cookbook. Until that time, I want to share the healthiest and easiest snack I know. Believe it or is just simmered cabbage. You are going to have to trust me on this one. You can use it as a side dish or just cook it up for hungry snacking.

One head of green cabbage
Cut it into large chunks
Place it in a large pan with butter (1-2 oz) and olive oil
Add 1/4 cup of water to keep moist.
Just braise it on the cooktop and put a lid on it and let it simmer.
Give it a stir and in about 15 minutes it is done. Season and enjoy!

Leftovers can be stored and warmed up for a quick snack.

I don't know the calorie count but the only fat is the butter and olive oil. Eat this instead of a full dinner and watch the lbs melt off.

Cabbage is rich in nutrients like iron, folate, calcium, potassium, Vit C, Vit K and all of the B vitamins.

Meditate on This

Thursday, January 8, 2009

Medical Challenge - Answer

The answer to yesterday's Medical Challenge is:

#3 Donating blood. This patient donates platelets on a regular basis and this time a different technician did the venipuncture. The bruised and lacerated arm is the result of blood leaking into the tissue. The treatment is first ice followed by warm compresses which allow reabsorbtion of the blood. She is doing just fine and will continue her generous donations.

Wednesday, January 7, 2009

Medical Challenge- You Be The Doctor

This young woman presented with a left inner forearm that looked like this. What is the diagnosis? Answer will be posted tomorrow. Click on the image for a better view.

1. Intravenous drug abuse
2. Victim of partner abuse
3. Donated blood
4. Suicide attempt
5. "Cutter"

(photo used with permission- thank you km

Tuesday, January 6, 2009

California - Big State, Many Uninsured

The California HealthCare Foundation has released it's data about the health of California and it ain't good. Over the past 20 years the number of uninsured continues to rise and we have the highest number of all the states - 6.6 million uninsured citizens.

Some surprising findings:

  • More than a third come from families with incomes over $50K

  • Nearly 60% are Latino

  • More than 70% of children without health insurance come from families where a parent works FULL TIME.

  • The number keeps growing as employers downsize and drop coverage for employees.

  • 8% of Californians purchase their own insurance

Make no mistake...if a person has no health insurance they are more likely to suffer ill health and die earlier. Children without health care perform worse in school and have higher risk of chronic disease as adults. The success of a nation is tied to public health.

"The best diagnostic test in America of a persons health is to look at the color of his skin" Don Berwick

So lets not kid ourselves that this is not a massive crisis. It is! We are in a downward spiral and intervention is needed. I don't want to hear another word about "the evils of socialized medicine" or "forcing everyone into Medicare" or "Taking away a persons right to choose". Those fear tactics have been touted since the 1930's when Social Security was adopted and 1960s when Medicare started. I have never met an older person (conservative or democrat, rich or poor) who turned their nose up at Medicare or Social Security.

To leave Americans to fend for themselves when we know that insurance is unaffordable is a crime. To ignore our failing hospitals and crowded ERs and pretend they can absorb the results of poor planning by our leaders is foolish.

Monday, January 5, 2009

Steve Jobs Weight Loss

When fifty-three year old Steve Jobs lost a large amount of weight and did not show up for the MacWorld Expo in San Francisco, shares of Apple stock plummeted. Since he was treated for pancreatic cancer four years ago, his weight loss has made investors nervous that the creative head of Apple was facing another serious medical crisis.

Now Mr. Jobs has released a public letter that states he is suffering from a hormonal imbalance that caused the weight loss and it can be treated with simple medication. He assured the stockholders that he is well and will continue to lead the company.

Steve Jobs was treated with the Whipple procedure, a complex surgery that removes the head of the pancreas, the gall bladder, the bottom part of the stomach (antrectomy) and part of the duodenum. This part of the pancreas secretes insulin, which regulates blood sugar, as well as a number of enzymes that help with digestion.

Weight loss after Whipple is common and extreme weight loss can occur if the patient gets "malabsorption" syndrome, when there is enzyme deficiency and foods pass through the GI tract unabsorbed as diarrhea.

If diabetes occurs, this can contribute to even more weight loss.

Malabsorbtion is treated with large doses of pancreatic enzymes (Creon, Panokase, Viokase) that need to be carefully titrated with meals.

There could be other hormonal problems that are contributing to his weight loss. Hyperthyroidism can cause weight loss, as well as "Addisons disease", which is when the adrenal gland fails to secrete cortisol. Given his history, however, I would think he has extreme malabsorption and his gaunt features would go along with this diagnosis.

Steve Jobs medical condition should be treated with privacy but since the fate of the company seems to depend upon his good health there is much speculation about what is going on. Another celeb that has battled pancreatic cancer is Patrick Swaze, and he too has lost a great deal of weight.

Each year over 33,000 Americans are diagnosed with pancreatic cancer.

Disclaimer: I am an Apple fan and I love my iPod so much, I would buy it clothing if I could. I have spent a small fortune on itunes.

Sunday, January 4, 2009

John Travolta's Son - A Tragedy

John Travolta and Kelly Preston are grieving the loss of their 16 year old son today. While on vacation at their Bahama retreat, the 16 year old went to the bathroom on Jan 1 and was found by his attendant, Jeff Kathrein the next day at 10 AM, after suffering an apparent seizure and hitting his head as he fell. An autopsy is planned.

The only thing that has been revealed by his parents about his health is that he was diagnosed with Kawasaki disease as a toddler. It is a disease of blood vessels and leads to inflammation and heart problems in young children but it is not a chronic condition. Kawasaki disease does not cause epilepsy. John and Kelly blamed household cleaners and fertilizers for the disease and became obsessed about his space being cleaned, John told CNN's Larry King in a 2001 interview. They used their religion, "Scientology", to cleanse his system.

There have been reports for years that young Jett Travolta suffered from autism, although the family has denied it. Autism and other neurologic disorders are not accepted by the Scientology community and they are against medical treatment for neurologic conditions. Scientologists believe that the they are capable of curing themselves, as long as they focus harder on the teachings of L. Ron Hubbard, the founder of Scientology in 1954.

This should be a private moment of grieving for the Travoltas, but their religious beliefs will now be open to scrutiny and there is already much criticism of their "denial" of their son's autism. By forgoing treatment or medical evaluation, their Scientology beliefs may have contributed to his death.

I am firmly against religious cults and Scientology has all of the elements of a cult. The Merriam-Webster dictionary defines five elements of a cult:
1. Formal religious veneration
2. A system of religious beliefs and ritual; also: its body of adherents;
3. A religion regarded as unorthodox or spurious; also: its body of adherents;
4. A system for the cure of disease based on dogma set forth by its promulgator;
5. Great devotion to a person, idea, object, movement, or work (as a film or book)

Scientology certainly fulfills these elements and I hope, for the parent's sake, the cause of his death was not tied to their religious beliefs.

Friday, January 2, 2009

Are Americans Too Soft?

Sometimes I think Americans are too soft. How many could survive traveling almost a year in a covered wagon? How many women could give birth without an epidural? What about experiencing "restless legs syndrome" without medication or "social anxiety disorder" (shyness?) without medication? How about suffering a common cold without needing antibiotics .

It's not entirely our fault. Now that pharmaceutical and medical device companies can advertise directly to consumers, we are lead to believe that everything has a medical label and can be cured by medication or surgery. Every condition is given a medical diagnosis and there seems to be an expensive, daily dosed medication that can help.

I believe we live in a wonderful age where medical science provides benefits and cures that were never thought possible. But I also know that many "conditions" are the result of inactivity, stress, poor diet and boredom.

Do we even know what is normal anymore? We now have imaging technology that finds "incidentalomas" in the body and we don't even know if they cause symptoms. We can detect cell changes that "might" become cancer...or might not.

I don't want to turn back the clock to the pioneer days but I do think the pendulum for "treatment" for every condition in life has swung too far. And I do think we are too soft.

Thursday, January 1, 2009

New Year - 2009

My 5 New Year Resolutions. What are Yours?

  • Take a 30 minute walk or bike ride each day
  • Stop eating JuJuBees and other refined sugar
  • Clean clutter from my life. Purge, purge, purge
  • Spend more time with family (less time blogging?)
  • Stop doubt

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...