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Showing posts from August, 2009

The Difficult Patient

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I am willing to bet that patients do not know that the medical community talks formally about "The Difficult Patient". Courses are taught on how to handle these patients and there is even an ethics study on Medscape about it. So what is the difficult patient?

Every practice encounters them and they come in many varieties. They are the patients who abuse the staff, miss appointments repeatedly, "lose" their prescriptions for pain medication and then demand instant refills. They may not follow up with important tests or stop taking needed medication and then show up with acute medical problems. Some doctors have a low tolerance for patients who are not "compliant" but even the sainted physicians experience "difficult patients".

So when the therapeutic relationship is damaged, doctors are taught the ethical ways of firing a patient from the practice. Once a relationship has been established, a physician may not abandon a patient. Medical ethi…

Kidnapped Dugan a Victim of Stockholm Syndrome

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The details of the terrible kidnapping of 11 year old Jaycee Dugard, found 18 years later living in squalid conditions after being abused by her abductor, are emerging and the case is worse that we could have imagined. He is a registered sex offender and a wacko and no one is saying anything about his wife, who was also in on the prolonged abuse. Dugard tragically became the mother of two children that she conceived at age 13 and 17, at the hands of Phillip Garrido, the kidnapper.

Over her 18 years of captivity, she had chances to escape. They lived in a neighborhood in Antioch, California, which is hardly a rural environment. She was kept isolated but apparently not completely confined. She even helped Garrido in a business card company and delivered supplies with him to customers. Why would she remain in such bizarre conditions?

The answer lies in a well known psychological condition known as the
Stockholm Syndrome. It occurs when a captive cannot escape, is isolated, terror…

Kidnapped Girl Found In California After 18 Years

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The shocking story of an 11 year old girl, snatched off the street at Lake Tahoe and found 18 years later after being held as a sex slave captive, is all over the news. Kidnapped at age 11, little Jaycee Dugard was found in Antioch, California, living in a squalid tent in her abductors back yard, with two children he fathered. The kidnapper, Phillip Garrido is a known sex offender and was on parole for a sex offense in the 90's. At least one suspicious neighbor had called police over two years ago, yet a home visit by sheriffs found nothing amiss. The car he used to kidnap the girl was still in the junky back yard, broken down and covered with a tarp, along with the sheds and tents that housed the kidnapped woman and her children. Somehow this parolee got away with this in a regular suburban neighborhood.
There are so many questions in this case and some answers may emerge over time. The tabloids will run wild with speculation and this story will eventually fade from the pu…

Hip Fractures Decline

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A study was published this week in JAMA that shows the incidence of hip fractures has been steadily declining in Canada and the United States from 1985 through 2005. The study surprised the medical profession because even through their were more older people in the population, there were actually fewer hip fractures. This is great news because when older people fall and fracture their hip, a large percentage never walk again and it is a downward spiral to a nursing home and death.

No-one knows the reasons for the decline but there are some good theories. Since health and nutrition play a big role in bone strength, perhaps better nutrition throughout the past 20 years has made osteoporosis (bone loss) less prevalent. A greater bone mass means less chance of fracture. Adding to this theory is that heavier people have greater bone mass and we all know we are getting fatter and fatter.

The bisphosphonate medications may also have played a role. Fosamax, Actonel, Boniva came on the sce…

Primary Care Doctors Have Had Enough

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Dr. Vance Harris is a primary care physician in Redding, California. His essay featured on CNN Health is a chilling warning to our Nation and why ignoring primary care will doom health care reform. I want you all to read it.

Dr. Vance says, "No one is talking about this on the national level. If they don't address these issues, then good luck having physician assistants provide the safety net with two years of training. Good luck getting newly trained physicians once they see our salaries. Good luck finding internists in your community with only 1 percent of medical students going into Internal Medicine.
Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians' Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely. "Read the well written

Where Germs Hang Out

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Who knew there was a "Hygiene Council", comprised of global experts in the field of public health and infectious disease? These folks actually conduct an Annual International Home Hygiene Study. Keep in mind that one of the corporate sponsors of the council is Lysol, but, who cares as long as they tell us where germs hang out. Well, here is what the 2009 survey of bacteria and viruses found out about where the germs linger:
TV remote . This is no surprise to me, considering how the men in my home hold and protect the remote like it is precious gold.Tub and shower. I would think the germs would be washed away with the soap, but apparently they linger. (Lysol anyone?)Pet food dishes. My cat demands a fresh, clean dish with each meal so no problem here.Kitchen sponges. (Came in at number 1) Put them in the dishwasher on the hot cycle.Microwave touch screen. Think about the microwave at work. The medical term is "Ewwww!"
Light Switches. (Lysol anyone?)Baby ch…

America Has the Best Health Care in the World?

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Let's get honest, OK? American does not have the best health care in the world. Europeans and Canadians are not flocking to our borders to get to our health care. It is time we realize that we can learn from our neighbors and we don't have to claim we are the "best" at everything. It makes us look really stupid in the eyes of the world.

Here are some facts. We do spend the most money on health care in the world. We do spend the highest percentage of Gross National Product (GDP) on health care and we do spend more dollars per capita than any other country on Earth.

The claim that the United States has the best health care in the world has been proven false by every broad metric used. The World Health Organization and the nonpartisan Commonwealth Fund rankings rate the U.S. last of the Western industrialized countries. The WHO ranks us 37th of all measured countries.

The Commonwealth Fund says, "Among the six nations studied—Australia, Canada, Germany, New Zea…

Billy Mays Dies But Was it Cocaine?

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It was sad to hear that the TV pitchman Billy Mays (age 50) died in his sleep from a heart attack. I must admit I have seen him pitching oxi-clean when I was channel surfing late at night. (Yes, I do rarely watch TV when I am not blogging.) I've always been fascinated by TV pitchmen (Sham-Wow) and how they can convince you that their product is a "must have".

So now I really must speak out against the irresponsible press release of the Hillsborough County Medical Examiner that states cocaine was a contributory cause of death for Billy Mays. His autopsy showed coronary artery disease and hypertension.

He did not have active cocaine in his system at the time of death. Cocaine metabolites were found on a toxicology screen and these metabolites can remain for 30 days in some tissue and up to three months in hair.

We know that cocaine has inflammatory effects and vasoconstrictive effects...both of which are bad for the heart and other vessels. Cocaine can also cause sudden…

Malignant Hypertension Effect on the Eye

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Ever wonder what the doctor is looking for when she shines the light into your eyes, up close and personal?
This is what she sees if the patient has severe hypertension. The retina shows blurring of the optic disc (in the middle left) and the white areas are called "cotton wool spots". The blurry part at the bottom is a partial retinal detachment. The patient's blood pressure was 220/150.

Preparing for Flu

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The hospitals I work in are gearing up for the flu season. The H1N1 (Swine) flu is on everyone's radar and we just don't know if we will be slammed with patients. Preparedness is the name of the game and nurses, doctors, infection control experts and risk managers are coming together to make sure policies and protocols are in place before we are hit with emergencies.

Here is what we know now. H1N1 flu is still present across the globe and in the United States, 477 deaths have been reported. This is not unlike regular flu. We do know that this strain is especially virulent in pregnant women and hospitals are particularly concerned about protecting them from infection.

The instant screening tests (rapid influenza diagnostic tests) are not able to distinguish novel H1N1 flu from other seasonal flu, nor can they provide information about sensitivity to drugs. The tests for confirming H1N1 flu take weeks and are not readily available in clinics or hospitals.

Hospital employees …

Obama Considers Insurance Co-ops

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All it took was ranting crazies talking about "death squads" and the Obama administration is caving on health care. No public option..no health care reform. The idea of a "health co-op" is unproven anywhere in the world. There is no model to tell us how it would work, how it would deliver care or how much money it would cost.

The healthcare industry loves the idea of co-ops and says it would provide the competition needed for real choice. Well guess what? We already have competition between insurers. We have Blue Cross, Anthem, Blue Shield, Aetna, Cigna, United Health Care and hundreds of others to choose from. Do we need more choices that we cannot afford? Will the co-op be required to take the people with pre-existing conditions? How would a co-op hold down costs?

With the world wide embarrassment of thousands of people lining up in Los Angeles for free health care, you would think the white house could sail through true reform. Was it audacious to hope t…

Fix Medicare

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Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to "cognitive, diagnosing, talking" physicians makes the idea of expansion untenable.

May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief...22 pages for a change of address. It is now mid-August and I still do not have the "approval" for my addr…

Universal Health Care

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Gallup Well -Being States

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A Gallup poll is done each year to rank the best and the worst states for population "well-being". The well-being index score is an average of of six sub-indexes which examine life evaluation, emotional health, work environment, physical health, healthy behaviors and access to basic necessities. They interviewed more than 170,000 adults over age 18. This "first half of the year" report is a precursor to the annual report. Maybe it isn't too late to make changes and get your well-being up.
Americans in Hawaii and Utah continued to lead the nation in well-being in the first half of 2009, with the two states having switched places since 2008. West Virginia and Kentucky maintained their status as the states with the lowest well-being.
Four of the top 10 scoring states -- Iowa, North Dakota, Kansas, and Minnesota -- are in the Midwest. As in 2008, many of the states with lower Well-Being Index scores are located in the South. Nevada is the only Western state in th…

Will Obama Cave on Health Care?

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Healthcare reform is heading downhill fast as Obama starts to cave on some essential principles. He is a smart guy, with smart advisors, but the watered down version of reform that Americans may be getting will be disappointing at best and possibly a financial disaster for the American people.

Unless the government is able to control costs, health care reform will be a failure. The Administration is showing willingness to cave on two critical aspects of reform: controlling drug costs and having a "public option". Big Pharma is exerting massive pressure to disallow price negotiations and it looks like Obama may just go along with this extortion to get them to support the plan. George Bush struck the same deal with the pharmaceutical giants when Medicare enacted the Part D drug coverage (ie: no ability to negotiate price) and that was a huge bonanza for Big Pharma. Their bonanza means sky rocketing prices for all of us.
The public option is also loosing steam as the insurance l…

Are Americans Stupid?

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I like to see the best in everyone, but when I follow some of the "town hall" meetings on health care reform, I have to ask... Are Americans really stupid? What is with the recent town hall meeting in South Carolina where an elderly man stood up and told his Congressman to "keep your government hands off my Medicare."

Huh? Buddy, I got news for you. The government is the "single payer" for your Medicare benefits. The government already decides what it will pay for or not. The government already has a bizarre formula for reimbursing doctors and hospitals. Every young worker under the age of 65 is paying every month for your Medicare so you can go to any doctor or hospital you want.
Mr. Ignorant, I have a question for you; "Do you want to give up Medicare and buy some insurance on the open market, like the rest of us suckers?"

I flipped on Fox news last night (Yikes!) and watched a rally in San Diego. Someone said health care reform would ma…

Does Lumigan Work to Grow Eyelashes?

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Last year I blogged about a new FDA approval for Lumigan (Bimatoprost) ophthalmic solution for glaucoma to be used as a safe way to grow eyelashes. I thought the readers of EverythingHealth would enjoy seeing if it really worked.

You be the judge..the before photo shows eyelashes (with mascara, of course) before using Lumigan. The 2nd photo shows eyelashes after 6 weeks of use. The manufacturer states it takes 8 weeks for full benefit.

Nurses Assaulted at Work

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Who knew that being a nurse could be a health hazard? A study published in the Journal of Nursing Administration shows that violence against nurses working in the emergency department is at an all time high. A 69 question survey of nurses showed that 25% of them had been assaulted at work more than TWENTY TIMES in the past three years. Almost 20% had undergone verbal abuse over 200 times during the same period.
Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence.
OK folks, this is just unacceptable. Nurses in emergency departments work damn hard. They are doing triage to determine who is sick and who just "doesn't have a doctor" to see the pink eye. They deal with blood, vomit, lice and trauma.
Every day at work brings interaction with drunks and mentally ill patients. They assess patients who are "…

Omega 3 Fish Oil Benefits the Heart

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I continue to write blogs about the benefits of Omega 3 FFA fish oil and I'm doing it again. A new review published in the American Journal of Cardiology shows that fish oil supplements benefit almost everyone. This includes people with heart disease and atrial fibrillation as well as healthy people with no problems.
The researchers from Ochsner Clinic in New Orleans reviewed all published studies of Omega 3 FFA. The most compelling evidence for cardiovascular benefits comes from four controlled trials of almost 40 000 participants. These patients were randomized to receive Omega 3 Fish Oil EPA with or without DHA ( both ingredients are found in supplements) in studies of primary prevention, after MI (heart attack), and most recently with heart failure. They found it prevented death from heart disease. The benefits were seen in sudden death and subsequent heart attack events.
So how much Omega 3 fish oil should a person consume? Dr. Lavie, the lead researcher said,
"If somebody …

Awesome Toilets- Why Don't We Have Them?

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The toilet is one of the most important inventions for good health and comfort. But, except for pulling a chain vs. pushing a handle...not much has changed in the last 100 years in the United States. Since it is a device that is used by 100% of us several times a day...you would think it would be a technology ripe for innovation.

Leave it to the Japanese. They have a loo that can do all of these things for the user:

* Cleanse “front and back” with three separate streams of water
* Dry “front and back” with air blowers
* Warm the seat
* Automatically put down the seat (a feature cleverly dubbed the “marriage saver”)
* Illuminate itself with a programmable nightlight
* Monitor medical conditions by preforming urine tests
* De-ionize the air to remove odors
* Play a soothing waterfall or birdsong soundtrack “to drown out embarrassing noises.”

If you are into saving the environment (...and aren't we all?), the new toilet means you don't need to squeeze the Charmin as much and they are be…

Health Care in Other Countries

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I was reading the comments to an article in the New York Times(please don't go out of business,) about getting sick on vacation and I was struck by the people who travel abroad and need to access emergency health care. There were 92 comments from readers about their vacations and what happened when they got sick.

The people who got sick in the USA talked about the expense of "out of network" fees or how long they waited in urgent care or emergency departments. About 90% of the comments were about getting sick in countries that have a single payer health system and how great it was.

Several comments had experience with Denmark health care; "Yes, in Denmark there are doctors on call who come to see the ill. He prescribed an antibiotic, said that if I didn’t improve he would hospitalize me, and left. No charge! I improved, my daughter took the ferry to Denmark, and we spent time visiting relatives. I was 65 at the time and never felt so sick before or after."

In Ca…

Prison Tennis

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I spent this morning on the "yard" at San Quintin Prison, playing tennis with the inmates. The prison has a tennis court, built right in the middle of the yard with hundreds of inmates shuffling about, shooting hoops, playing dominoes, working out or just milling about.

The guys who play tennis are a remarkable bunch. They are serious about their game, play whenever they can during the week and are really happy on Saturday morning when authorized "outsiders" come to play with them.

We play round robin; first team to 4 wins and a new foursome takes the court. They seem to have an understanding among themselves about who plays when. It is competitive but, believe it or not, very gentlemanly. Everyone is encouraging, with lots of high-fives and there is no cheating or bad line calls. The best part is when I am not playing, I am sitting on the bench with the guys, just chatting.

The tennis players in San Quintin are without attitude or posturing. Some do yoga or go t…

Animal Diseases

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Pregnancy Q&A

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If you are pregnant, ever knew a pregnant woman, or ever want to be pregnant...these questions and answers should be very useful. (Thanks to Raymond for the laugh)

Q: Should I have a baby after 35?
A: No, 35 children is enough.

Q : I'm two months pregnant now. When will my baby move?
A: With any luck, right after he finishes university.

Q : What is the most reliable method to determine a baby's sex?
A: Childbirth.

Q: My wife is five months pregnant and so moody that sometimes she's borderline irrational.
A: So what's your question?

Q : My childbirth instructor says it's not pain I'll feel during labour, but pressure. Is she right?
A: Yes, in the same way that a cyclone might be called an air current.

Q: When is the best time to get an epidural?
A: Right after you find out you're pregnant..

Q : Is there any reason I have to be in the delivery room while my wife is in labour?
A: Not unless the word 'child support payment' means anything to you.

Q: Is there anythin…