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Showing posts from 2010

New Years Resolutions for Doctors and Patients

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Below is an updated re-post of a blog from a few years ago.  I liked it then and I like it now.


#1 Doctor: Resolve to let patient speak without interruption and describe their symptoms.
Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15 minute visit.

#2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend calls from the answering service, patients or nurses.
Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling and to use nights and weekend phone calls for emergencies only.

#3 Doctor: Resolve to exercise a minimum of 4 times a week for better health.
Patient: Ditto

#4 Doctor: Resolve to train my staff and model excellent customer service for patients.
Patient: Resolve to understand that getting an instant referral, prescription, note for jury duty, letter to my insurance from the doctor is not…

Top 10 Articles Read by Doctors

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Now that the end of the decade is near, we are hearing and reading about "the top this and that" from music to fashion to political downfalls.  Medscape has their own top 10 articles that were read by physicians on their site.  I find it interesting to see what my colleagues plug in to when they are not seeing patients.  The only surprise to me was the Brain Tumor "risk" because I thought that was settled years ago!  I'm not surprised about number 2 or 3.  Everyone I know is trying to survive in some way.

Here are the highlights from the Medscape Top 10for physicians in 2010:
Brain Tumour Risk in Relation to Mobile Telephone Use
Is it safe to take that call? Trashed on the Internet: What Should You Do?
Does a physician have any recourse if patients post a bad review on an Internet rating site?Six Ways to Earn Extra Income From Medical Activities
Physicians are seeking ways to create more revenue. These activities may bring in additional profit.Physician in Whist…

Chewable Contraceptive

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Just in the nick of time before this decade ends, the FDA has approved the first low-dose chewable birth control contraceptive. 

The daily chew will be marketed by Watson Pharmaceuticals, Inc.   Fred Wilkinson, executive vice president of Global Brands said "We believe this product is an important addition to the oral contraceptive category, and that its characteristics will make it a desirable choice for women."

I have to ask myself...why?

Most birth control failures occur because the woman forgets to take the pill.  Will a chewable be more reliant?  Is it aimed at gals who just love chewing gum?  I don't get the concept.

Marketing for this breakthrough will begin the in the second quarter of 2011.

Henrietta Lacks and Her Immortal Cells

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If you like science, true history and an engaging story, pick up the new book by journalist Rebecca Skloot, The Immortal Life of Henrietta Lacks and prepare for a great read.  I knew nothing about the young black woman whose cells were taken back in 1951 by a scientist at Johns Hopkins Hospital and how those cells have revolutionized modern cell biology and research.

The HeLa (named after HEnrietta LAcks) cells were taken as she lay dying on the "colored" ward at Johns Hopkins Hospital of aggressive cervical cancer at age 30. Everyone who studies basic cell biology has heard of HeLa cells because they were the first human cell line to be successfully grown in culture and they are alive today.  HeLa cells were sent to researchers all across the globe and have been used to develop the polio vaccine, viruses, cloning, gene mapping and in-vitro fertilization.  Billions of the same immortal HeLa cells are used by researchers fighting cancer, multiple sclerosis, heart disease and …

Answer to Gory Medical Challenge.

(Scroll down to see the challenge)

The Answer to the gory image from NEJM is #2, Ischemic gangrene.

This patient had a 4 month history of progressive gangrene.  Untreated diabetes can lead to lack of blood flow to extremities which causes the tissue to die.  This foot will require amputation.  Readers of EverythingHealth are smart and many of you got the answer.

Audio of a Doctor in the Making

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This 5 year old has all the makings of a good physician.  Calm, reassuring, caring, and interested in dressing well.

Last Gory Medical Challenge Before Christmas

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If the New England Journal of Medicine can do it right before Christmas, so can EverythingHealth.  This shocking pic represents what diagnosis?
1.  Ichthyosis
2.  Ischemic gangrene
3. Necrobiosis lipoidica diabeticorum
4. Phlegmasia cerulea dolens
5. Pyoderma gangrenosum

Make your diagnosis in the comment section and check back tomorrow for the answer.
(Better yet...sign up on the right as a subscriber and you'll get a handy email alert for each post)

Health Care Reform Challenges

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While most Republicans believe the new health law will be repealed, the Health and Human Services Secretary, Kathleen Sebelius says "there is no going back".  Reform is in turmoil after a federal judge in Virginia ruled the individual mandate unconstitutional.  Two other federal judges of equal stature have upheld it,  so confusion prevails with policywonks and the public.

The federal mandate says all Americans must maintain health insurance.  Secretary Sebelius says, "I think discussions are likely to go forward, but most Americans find the practice of saying to sick Americans or those who may be sick or those whose children are sick 'you cannot participate in the health insurance pool' really reprehensible."  

She also said, "Instead of making health insurance more available, more affordable to an estimated 32 to 35 million Americans, repeal would make sure insurance was even further out of reach and that our costs continue to skyrocket," Sebeli…

Macular Degeneration and Lifestyle

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We now have another condition that may be prevented by eating a healthy diet, exercising and abstaining from smoking.  Age Related macular degeneration (AMD)!

Macular degeneration causes a loss of central vision and makes it difficult to recognize faces and read small print.  The macula degenerates with age and severe macular degeneration causes blindness.  Treatment is costly and doesn't work very well.

A new study published in the Archives of Ophthalmology looked at 1313 women aged 55-74 years.  They reviewed their diet and exercise habits.   Eating a "healthy diet" meant 3.5 servings of fruit and vegetables, 2.3 servings of dairy, 2.7 ounces of meet and 3.5 servings of grain a day.  Exercise habits and smoking history were also monitored.

They found a significant association between early AMD and diet, exercise and overall healthy habits.  Non-smokers who ate the healthiest diets and were the most active (only 5% of participants) reduced their odds for AMD by 71% compa…

San Francisco Gothic Merry Christmas

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My uber talented friends, Martin and Brigitta Wolman created this Christmas card.  They are the best artists!!  This is a self portrait.

Raynaud's Disease

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Thanks to modern technology (iphone) a picture is worth a thousand words in diagnosing a condition.  This young woman had been exercising outside by the Golden Gate Bridge in San Francisco (temp a chilly 49ยบ F) and when she finished her hand looked like this.  It felt numb and began stinging when she ran hot water on it.

What is seen is classic Raynaud's disease.  It is a condition that causes some ares of the body like the fingers, toes, tips of nose and ears to have limited blood circulation in response to cold temperatures.  It affects women more than men and the skin can turn blue or white or purple in blotchy areas.  It is common to feel swelling and stinging as the circulation improves (such as immersing in hot water).  An attack can last several minutes to hours.

With Raynauds, there is a vasospasm of the small blood vessels that go to the digits.  This limits blood supply which causes the skin to turn pale.  Cold temperatures are most likely to trigger an attack but emoti…

Answer to Yesterday's Medical Quiz

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The answer to the Medical Challenge was #5  Tinea.

Tinea refers to a group of infections caused by fungus. Tinea is also known as "ringworm"..even though it has nothing to do with worms.  The ringworm infection is often a well demarcated ring on the face, scalp or body.


The culture of this lesion showed Trichophyton rubrum, a common fungal species that also causes nail infection (onchomycosis) and athletes foot.  The skin infections are easily cured with 14 days of topical treatment.   Nail infections are difficult to cure.


The fungal infection "athletes foot" is also called Tinea pedis.  Topical treatment usually cures it.

Medical Challenge

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I've been too busy to blog but not too busy to keep up with the New England Journal of Medicine.  Here is your medical quiz for the week.

What is the diagnosis for this finger lesion?  Make your best guess and the answer will be posted tomorrow.  Click on the image for a better view.

1. Anthrax
2.  Cellulitis
3.  Lichen planus
4. Psoriasis
5. Tinea

Ten Commandments For the Office Christmas Party

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EverythingHealth offers sage advice to keep you healthy...both physically and mentally over the holidays.  The office or hospital Christmas party can be a treacherous place.  Observe these tips:

1.  Don't Get Toasted- A drink or two is fine and festive.  But when the booze flows freely so does the mouth and attitude.  Don't drink too much and regret (or worse yet..wonder) what you said or did with your co-workers.
2.  Don't Get Too Cozy- If you observe #1,  there will be less likelihood that you will get into trouble with that co-worker, nurse, boss, married man or make inappropriate remarks to the receptionist in the short skirt.  Remember it is still the workplace on Monday.
3.  Don't Give Bad Gifts- People will remember if your Secret Santa gift was a dud.  Do not recycle what was given to you and try to chose wisely.  It doesn't have to be expensive to be classy.  Avoid clothing and make sure you aren't giving Champagne to a Mormon.
4.  Don't Dance Craz…

Women's Health Gets an F

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The Oregon Health and Science University has published its 5th report card since 2000 and it grades and ranks the United States on 26 health-status indicators for women.   In 2010, not one state received an overall "satisfactory" grade for women's health and just two states (Vermont and Massachusetts) received a "satisfactory-minus" grade.  Overall, the nation is so far from meeting the goals set by the U.S. Department of Health and Human Services that it receives an overall grade of "Unsatisfactory".

The National Report Card uses status indicators to assess women's health:
Women's Access to Health Care Services (medically under-served area, no abortion provider, no health insurance and first trimester prenatal care)Wellness  (screening mammograms, colorectal cancer, pap smears, cholesterol)Prevention (leisure time physical activity, obesity, eating 5 fruits and vegies/day, binge drinking, annual dental visits, smoking)Key Conditions (coronary…

Just follow the Money for Cardiac Stents

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History repeats itself again with the new expose' in the New York Times about the Baltimore Cardiologist who inserted (at the least) 585 stents in patients who did not need them.  On one single day he inserted 30 stents!  I didn't know there was that much time even available in the cardiac cath lab but with Medicare reporting payments of $3.8 million for a two year period to Dr. Mark Midei,  I guess it isn't a surprise that he might have worked "overtime".

The Times article is pretty scathing and implicates his hospital, St. Josephs,  who treated him like a king and gave him a $1.2 million dollar salary just to be on the medical staff and bring those $10,000 cases to their institution.  St. Josephs settled with the OIG by paying a $22 million dollar fine for charges that it paid a kickback to Dr. Midei.

Abbott labs, the maker of the expensive stent, was thrilled with his excessive surgeries and showered additional millions in consulting fees and perks for the goo…

Tinnitus-Ringing in the Ears

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Tinnitus is derived from the Latin word tinnire meaning "to ring".  It is an extremely common complaint and 50 million adults reported tinnitus in the past year.  Up to 3 million people have symptoms that are severely debilitating. You would think that we know a lot about tinnitus and how to cure it but you would be wrong.  Here is what we learned from a study reported in The American Journal of Medicine.

Tinnitus increases with age until age 60-69 and then it decreases. We don't know if the symptoms improve as part of the natural history or if having tinnitus goes along with other conditions that cause mortality.  Black people and Hispanic people suffer less tinnitus than Whites.

There are significant associations between tinnitus, smoking and hypertension.  Loud noise exposure is also a risk factor for developing tinnitus.  The noise could be leisure (loud music or sports), occupational or firearm exposure.

Anxiety and major depressive disorders were associated with i…

The Sound of Music Flash Mob Dance

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The best of mobs.

Answer to Yesterday's Medical Quiz

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The answer to the strange  lesions seen on the patient in yesterday's image challenge is #5 - bleomycin reaction.  The patient was treated with intralesional bleomycin for a lesion on her tongue.  Within a week she developed painless, non-itchy hyperpigmentation on her trunk. 

Bleomycin is a medication that is used for certain types of cancer.  Twenty percent of patients treated with bleomycin have such a reaction.

What is the Diagnosis

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Here is your medical challenge for today compliments of EverythingHealth and the New England Journal of Medicine.  This 39 year old woman presented with these marks on her back.  You be the doctor.  What is the diagnosis?   Click on the image for a better view and the answer will be posted tomorrow.  (hint: 3/4 of the physicians got it wrong.  I got it right)

Save yourself from remembering to check back by signing up on the right side for an EverythingHealth email alert

1.  Arsenic Poisoning
2.  Cushing's Syndrome
3.  Pellagra
4.  Self-flagellation
5. Treatment with Bleomycin

Health Care is Not Recession Proof

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I've heard people say that health care is recession proof.  Even when the economy is suffering, people still get sick and need service.  The current recession is entering the 3rd year and it has finally caught up to the health industry.  The latest Bureau of Labor Statistics reports that there were 16 mass hospital layoffs in October, up from 10 in September.  Mass layoffs involve 50 or more employees and in the first 10 months of 2010,  128 mass layoffs occurred.  The Bureau projects 12,349 initial claims for unemployment benefits, which surpasses the number in 2009.

What causes mass layoffs?  The recession and unemployment has reduced demand for elective procedures and reduced reimbursement from government programs (Medicaid and Medicare).  Charity care has also increased and hospitals are adjusting to a lower bottom line by eliminating their most costly item...employees.

Physicians, too, have noticed a decrease in patients in the office.  Doctors who previously had a long wait …

Vitamin D Controversy

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I have written before about the value of evidence based medicine and the need for doctors to alter their practice as new evidence comes in.  But I am totally thrown off by the new IOM report about Vitamin D and Calcium.  The report is 999 pages long.  Let me repeat that, dear readers...999 pages. (Available for purchase for $53.96)

The Committee was asked to review current data and make a recommendation about appropriate dietary intake of Vitamin D and Calcium. I will give you the cliff notes.  They report that most Americans and Canadians are getting just about enough Vitamin D and Calcium in their diets and sticking with the recommended 700 mg to 1,300 mg a day of Calcium is just fine.  For most people, 600 IUs of Vitamin D is enough for bone health but those age 71 and older may need 800 IUs.  These levels are easily reached through a healthy diet without the need for nutritional supplements, according to the researchers.

Talk about confusion!  Over the past 5 years I have read num…

Good Health Simplified

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You can't do anything about your genes but here is the formula for good health...simplified:

0           Cigarettes
          Servings Fruits and Vegetables a Day
10         Minutes of Silence or Relaxation a Day
30         Body Mass Index below 30
150       Minutes of Exercise a week    


You knew this already...but are you really doing it?

Rabies 101

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Rabies is a virus that causes neurologic encephalitis and is almost 100% fatal.  Since 2000, 31 cases of human rabies have been reported in the United States.  Seven of them were acquired from exposure abroad (Phillippines, Ghana, El Salvador, Haiti, Mexico and India).  Rabies is mainly contracted from an animal bite or saliva from an infected animal.  The most common animals are dogs, bats, coyotes, raccoons and skunks.  The average incubation period between exposure and illness is 2-7 weeks but symptoms can first occur after 3 months.

If  Doctors don't suspect rabies, it can be difficult to diagnose at first and once symptoms occur it is 100% fatal.  Symptoms may include anxiety, loss of feeling in an area of the body and loss of muscle function.  Fever is low grade and the patient is restless.  As the infection develops,  drooling, difficulty swallowing and convulsions occur.  Hydrophobia (aversion to water) is common.  Death occurs as quickly as one week.

The only treatment f…

The Turkey Speaks

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Health Care Reform Cannot be Stopped

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Now that the Republicans have taken over the House, they are calling for repeal of The Patient Protection and Affordable Care Act (ACA).  They are calling it a "bad product" and a "monstrosity" and the airways are full of pundits telling the American people that they intend to "take back our country."  But what would repeal of the bill really do?

Overturning ACA would cause 32  million Americans to forgo insurance.  It would deregulate the insurance industry and cause those children that are on their parents plans (until age 26) to be dropped  like a hot stone.  The part that went into effect today about mandating that insurance companies spend 80-85% of your  premium money on the insured would be reversed.  Children would not be covered if they had preexisting conditions (active now) and the practice of denying coverage for adults with preexisting conditions would continue if the law is repealed.  Increased funding for primary care physicians and nurses …

Total Knee Replacement in Younger Adults

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The surgery that replaces the knee joint rose by 66% in American age 65-84 from 1997 to 2007.  And in Americans age 45-64, the rate tripled in that time.  The technology has improved and more surgeons are willing to perform this operation in younger people and the public has a greater familiarity with the procedure and its results.

We don't know if more patients age 45-64 are getting osteoarthritis or if the rise in sports injuries is driving it.   With the baby boomers now reaching Medicare age, it is anticipated that the knee replacement rate will continue to soar.

Total knee replacement is a big surgery.  Some have referred to it as "precision carpentry".  The recovery period is 4-6 weeks and the full recovery takes about a year.  For older, retired people who are more sedentary, this disability time is not such a big deal.  But for working adults, it consumes a lot of time.  The surgery is usually not done until the patient has tried all of the other treatments but st…

Gastroenteritis and Hypertension

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There is provocative new research from the British Medical Journal this week. They have made a strong connection between EColi infection and subsequent development of hypertension.  I'll try to break it down here into the "cliff notes" but to read the entire study go here to BMJ.

We know that most hypertension diagnoses have no etiology (cause).  We also know that in the U.S. escherichia coli 0157:H7 (EColi) infections cause 50,000-120,000 gastroenteric illnesses annually. (commonly known as food poisoning).  We also know that there are receptors on the kidney for toxins and exposure can cause both renal and vascular injury causing severe and subtle nephron (kidney cell) loss.

This study followed 1977 adults from Walkerton, Ontario, Canada after the town suffered from a municipal water system contamination with EColi and other bacteria.  Acute gastroenteritis was reported by 1067 participants. The researchers followed all the participants of Walkerton annually and exclud…

Answers to Derm Quiz

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Scroll down to see the photos and here are the answers. If you cant see the images in the previous post, click on "EverythingHealth" and you'll see the entire blog.

#1 - Actinic Keratosis - these dry crusty bumps are on sun damaged skin and can be either flat or raised in appearance.  They occur after long periods of sun exposure and damage.  They are not life threatening and can be treated with freezing (cryosurgery), excision or chemical peels.

#2- Basal Cell Carcinoma- this is the most common type of skin cancer and can usually be cured by removing it.  They also occur in sun damaged skin.

#3- Solar Lentigo- This is a large freckle caused by the skin damage from UV radiation (sun).  They are also called sun spots or liver spots or age spots as they occur in people over age 55 after years of sun damage.

#4 Squamous Cell Cancer-This is the 2nd most common skin cancer and it also occurs with sun damage. Men are twice as likely to have SQ cancer.  Most are curable and the…

Dermatology Quiz

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Let's see how many of these common skin lesions you can identify.  The answer will be posted tomorrow.
Match the diagnosis with the images:
Basal Cell CarcinomaSolar LentigoSquamous Cell Carcinoma Actinic Keratosis   

Medical Updates for Older Adults

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New clinical trials and published research is giving us information on how to improve health in elderly patients.  Here are some brief points from The Cleveland Journal of Medicine that were surprising to me:
Each year 30% of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important.  Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls.  A better dose is 1000mg a day in people who consume a low-calcium diet.  Exercise boosts the effect of influenza vaccine.The benefits of dialysis in older patients is uncertain as it does not improve  function in people over age 80.  We don't even know if it improves survival.  Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene and dressing) after starting treatment.Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease …

Micro Loans and Your Health

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Research has shown that giving to others can lead to a healthier, happier and longer life.  Generous behavior reduces depression and risk of suicide in adolescents.  Volunteerism on the part of older adults significantly reduces mortality.  Giving to others enables people to forgive themselves for mistakes; a key element in well-being.

One way to have a lot of fun on the internet and get a health boost while doing so is to log onto a cool site called Kiva.org.  For as little as $25.00,  ordinary people like you and me can be part of the world-wide micro-loan community.  Kiva's mission is to connect people, through lending, for the sake of alleviating poverty.

I have made 14 Kiva loans and I got to pick the recipients.  By viewing the photos and reading the bios, I wait until a person "speaks" to me.   I like loaning to women because I know that when women are able to earn money, they spend it on their children's education and it benefits the entire village.  This morn…