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Showing posts from March, 2010

Why Medical Care Costs So Much

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The cost of medical care is high because the body is complicated and doctors and patients hate ambiguity. The cost is high because a missed diagnosis can lead to death and a large lawsuit. The cost is high because we have many specialists that view the body in tiny pieces and want to feel 100% correct about their piece. Let me give you a real life example:

My patient, Rick is a brilliant attorney. He has insulin dependent diabetes and heart disease and he takes good care of his health. He pointed out that his lower leg (around his shin) was red and swelling and then forming a painless hard lump. The exam showed a little redness, a tiny puffiness and a small firm lump in his leg tissue. I ordered some blood tests to make sure his diabetes was under control and to look for infection. Because I couldn't put a name on it and I was unwilling to say "Let's watch it, I don't think it is anything serious", I told him to ask his dermatologist , who he was seeing a…

Ground Beef is Unhealthy and Contaminated

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I am a bit obsessed this week with Celebrity Chef Jaime Oliver and his mission to reform the way Americans eat. I watched his new ABC show where he tries to reform the school lunch program in North Carolina where 50% of the town is obese. It is really a great show and it's great to see this type of "reality" TV rather than the usual fare. In honor of eating healthy, I am re-posting a blog from last year. It is worth repeating and here it is:

It takes a lot to shock me, but the article in today's New York Times about E. coli in ground beef is truly eye opening. I want you to read the entire article but here are some scary highlights and facts that show our meat sources are not safe for consumption:A single portion of hamburger meat bought at most supermarkets is not from meat run through a grinder. It is an amalgam of various grades of meat from different parts of many cows and even from different slaughterhouses.There is no federal requirement for grinders…

Eating Healthy is High Cost

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I watched a good documentary called "Food, Inc". It was nominated for an Academy Award . The promo says you'll never look at dinner the same way and they are right. Since I am a fan of Michael Pollan and have read "Fast Food Nation", I was already one of the healthy food fans, but seeing how agriculture and farming has changed over the last 40 years was still a shocker.

There is no doubt that high calorie, sugar laden processed foods is contributing to serious health issues in America. And 10 billion animals (chickens, cattle, hogs, ducks, turkeys and lambs) are raised on factory farms under inhumane conditions.

So when I went to the grocery store today, I made a conscious choice to ask if Safeway had any grass fed beef. I am making a healthy stir-fry for dinner. The answer was "No", so I journeyed over to Whole Foods. I bought one lb of sirloin. The cost was a whopping $16.43.

I have to ask myself why grass fed beef should be so much more exp…

Don Berwick to Head CMS

President Obama likes to shake things up. He has named Dr. Donald Berwick to head the Medicare and Medicaid Agency known as Centers for Medicare and Medicaid Services (CMS). This is a huge government agency with a budget of over $800 BILLION a year. That is more than most countries in the world. Dr. Berwick would be a major force in implementing the new health laws and changing Medicare to be more efficient and cost effective.

The average person probably doesn't know who Don Berwick is, but he is a big name in the Health Care industry. A pediatrician by training, he is the president of the Institute for Healthcare Improvement (IHI) and is a national leader on quality and patient safety. By telling stories that people can relate to, he is a transformational leader for reducing hospital errors and reducing variability in care.

Here is a quote from Dr. Berwick at the 2004 IHI meeting;
"I'm losing my patience, not with the people in healthcare, but with the system itself.…

Corporate Hall of Shame Award

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Thanks to reader m.scott for alerting me to this weeks Corporate Hall of Shame winner. Blue Cross and Blue Shield of Texas is the winner for it's egregious denial of care for a 10 day old baby who was born with a congenital heart defect. Coverage for surgery to treat transposition of the great arteries was denied for...are you ready for this....a "preexisting condition". Both of the Houston parents had previously purchased coverage for their two other children but were denied for the new baby.

Denial of care for children will not be allowed when the new Health Reform laws go into effect. Until it begins, it is business as usual for Blue Cross and Blue Shield of Texas.

New Approved Treatment for Dupuytren's

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I did a blog on Dupuytren'scontracture last year that got a lot of interest. There are a lot of men out there with this condition and, apparently, many of them are readingEverythingHealth. I mentioned a new biologic drug that was being developed as a non-surgical treatment for Dupuytrens. At that time, it was still in testing phase and not available for use.

The product, collengenaseclostridiumhistolyticum (Xiaflex) has now been approved and will be marketed by AuxiliumPharmaceuticas, Inc. It is injected directly into the palpable Dupuytren's cord, followed by a finger extension procedure 24 hours later to help distrupt the contracture cord.

The company plans to market Xiaflex to physicians experienced in hand injection procedures. The most common adverse reactions were fluid buildup, swelling, bleeding and pain in the injected area. No serious allergic reactions have been reported.

Are You Fat?

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If you are wondering if you need to lose weight click here to calculate your body mass index (BMI). I am surprised that it applies to both men and women, especially considering the larger muscle mass of men, but it is an eye opener.

Health Care Reform Bill 101

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Well, it is an historic day as health reform has finally passed. Yes, it is a watered down bill that leaves much to be desired but...it is a start. After months of stops, starts, rhetoric, fear mongering, empty promises and long, heated debate, many Americans are not sure of what just passed. It will have different effects on different people and many of the provisions are delayed until 2014. Here are a few features of the new bill:

Insurers will be prohibited right away from excluding children with pre-existing health conditions. Adults will have to wait until 2014 to be assured of coverage.Health plans will have to provide immunizations and other preventive health services for children and adolescents.Insurers cannot charge higher insurance premiums for woman and maternity care is covered.
Most US citizens and legal residents must purchase "minimal essential coverage" for themselves and their dependents, either through the employer or exchanges that will sell policies t…

"She Have AIDS"

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I can't get the stories of Haiti out of my mind.

A patient showed up at the Port au Prince hospital ward with a massive left sided paralysis, an obvious stroke. This 48 year old woman had collapsed the day before and was now accompanied by her three grown daughters, who were most attentive and worried. I examined her in the bed with other patients and families gathered around. (There is no sense of privacy and even an exam seems to be everyone's business in Haiti). One daughter spoke broken English but I had a good translator that helped me get the information I needed.

It was a sad story. They had been on the 5th floor when the Earthquake hit. They fell straight down and dad was killed. One of the children had a crush injury to his leg and the entire remaining family was now "on the street". Just surviving must have been such a strain. Then...mom has a massive stroke.

As I was examining the patient further, one daughter handed me a quickly scrawled note. It re…

Answer to Medical Challenge

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Yesterdays medical challenge answer was Herpes Zoster (aka: shingles). Shingles is caused by the varicella-zoster (chickenpox) virus which lives in the nerve roots and can become reactivated later in life. The blistering eruption can be painful and one distinctive finding is that it rarely crosses the midline of the body. Each nerve has it's own "dermatome" distribution and the infection follows that nerve pattern.

It is recommended that people over age 60 receive the Shingles Vaccine (Zostavax) to prevent the activation of Shingles.

More Haiti Images

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Reviewing the images of our Medical Mission to Port au Prince, Haiti brings back haunting memories.

#1 - 2 Dramatic collapsed buildings..there are thousands like this

#3 This man was outside of the emergency tent, lying alone and unattended

#4 Families stayed with hospitalized patients, sleeping on cardboard on the floor. With no homes to go back to, we had no problem giving them shelter. They supplied food for the patient and emptied the bed pans outside in an open ditch. There was absolutely no privacy for anyone and they were only able to get a few hours sleep at night

Medical Challenge

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Here is another medical challenge from the New England Journal of Medicine. Make your diagnosis and the answer will be posted tomorrow.

1. Chemical Burn
2. Cicatricial pemphigoid
3. Epidermomycosis
4. Herpes Zoster
5. Squamous Cell Carcinoma

Haiti Medical Relief - Continued Need

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(note family is caring for the patients)


It has been two months since the disastrous earthquake in Haiti and the medical need is still dire. I just returned from a week in Port au Prince with a 17 person team of doctors and nurses to work with Partners in Health. We worked at the University Hospital, the only State hospital in this city of 3.5 million. What did we see?

We delivered medical care in tents like MASH units. There is one standing concrete structure housing about 50 patients and other tents being used for ER, ICU and Pediatrics ICU. Another tent is Surgery and TB ward. Our group staffed the nights on the Med Ward (we called it the catacombs), ICU and Pedi ICU. We worked 14 hour shifts and saw the most unbelievable filth, diseases and resilience of the Haitian people. We had no running water and that means no toilets too. We had 100% surgical infection rates. We chased mice out of patient's beds and shared our food and water with people who had none. We brought med…

Haiti Medical Relief

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The January 12 Haiti earthquake killed over 200,000 people and The United Nations reports nearly 1.3 million people are now homeless. The devastated capital of Port-au-Prince is home to 762,708 of them, living in squalid tent camps without proper sanitation. Officials have worried about "donor fatigue", especially with the Chile earthquake. But the situation in Haiti is so much worse than Chile because of the lack of a functioning government.

On Friday morning I will be leading a team of doctors and nurses who will fly to Port-au-Prince to work with Partners in Health (PIH) and provide medical care to the victims of the earthquake. We don't know exactly what to expect or what the working conditions will be like.

The need has moved beyond the initial trauma and surgery to general medical care and pediatric care for the millions of survivors. Sutter Health deployed an initial team to work with PIH right after the quake and now they are asking for more help. It is gre…

Healthy Comfort Food

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Comfort food is usually home made and carries some emotional significance with it. During times of stress or illness people often turn to "comfort foods" to feel better. Most everyone has a favorite comfort food and comfort foods are not necessarily one's favorite food. Ask yourself...what is my favorite food? Then ask "At the end of a long day, when I'm tired and stressed or sick in bed, what food would I like a loved one (mom) to fix for me?

Comfort foods are often fattening or unhealthy...macaroni and cheese, chocolate cake, fried chicken, chocolate pudding. Foods that are high in carbohydrates and sugar are often connected to childhood and make you feel homey and good. And different cultures have different comfort foods. Rarely is yogurt or a handful of almonds a comfort food in any culture.

There is nothing wrong with a fattening comfort food. The key word here is "comfort". If it elicits a fond memory of good times, it is comforting. …