Friday, July 30, 2010

Sun and Surf

I'll be blogging from a vacation site. (If I have the time and creativity).  Nothing too exotic this year...can you guess where EverythingHealth will be?

Thursday, July 29, 2010

Bystander CPR Saves Lives

Nearly 450 people die each day of sudden cardiac arrest. Many times the bystanders, who witness a person collapse don't know what to do. They are afraid they will hurt the victim or they feel nervous about doing traditional Cardio-pulmonary resuscitation (CPR) with mouth to mouth breathing and chest compressions.

New information is published in the New England Journal of Medicine that shows hands-only CPR is potentially a lifesaving option to be used and it can improve the chance of survival equally as well as traditional CPR. This study confirms other reports that bystanders can save lives by doing chest compressions in adults and children who are not breathing. The two studies from NEJM compared the outcomes of victims who collapsed and onlookers gave either chest compressions alone or were instructed by emergency telephone operators to give traditional CPR. They found no difference in survival rates.

Other studies have shown that children who receive bystander chest compression CPR are 3 times more likely to survive than those who receive no help.

Because onlookers are more likely to administer chest compressions and it is easier to execute, it is important that everyone know how to do it. The compressions need to be deep on the sternum (lower breastbone) at 100 times a minute. Do not stop until the emergency personnel arrive.

I am still haunted by the image of a man who collapsed and immediately turned blue in a shopping mall when I was a young teen. I knew he was dying and the bystanders (including me) just watched. I didn't know about CPR then. I compare that to the runner who dropped dead of a heart attack in a Bay to Breakers Race when I was running as a medical resident. I administered full CPR in the Panhandle of Golden Gate Park until the paramedics arrived and administered cardiac shocks before transporting him to the hospital. He survived.

Knowledge is everything!

Monday, July 26, 2010

Irritable Bowel Syndrome From Structural Brain Changes

Irritable bowel syndrome (IBS) is a common disorder that affects women twice as often as men.  It is commonly seen in a general medicine practice.  It is thought to be chronic and involves cramping, abdominal pain, gas, diarrhea and constipation.  An old term for it is "spastic colon".   It is one of those frustrating conditions where we "don't know what causes it" and that means doctors often say it is caused by stress or hormones or food intolerance or the immune system. Because it can be associated with depression and because it comes and goes, a variety of different medications are used to treat the symptoms.

Well, surprise!  New findings reported in Gastroenterology, show that there may be structural changes in the brain that cause the gut to react and cause IBS.  The researchers at UCLA and Canada's McGill University used brain scans to compare brain anatomy of 55 women with moderate IBS vs. women with no symptoms.  They found thinning grey matter in specific areas of the brain.  Three areas of the brain were involved in affected women, areas associated with pain inhibition, emotion regulation, attention and processing of information on organ functioning.  They found changes in the brain that have a role in intensifying pain and reductions in areas which have a role in suppressing pain.

In IBS, the brain may be amplifying pain signals it receives from the bowel.  We know that different patients have different thresholds for pain and this study demonstrates anatomical brain changes that might account for it.

Finding an organic component to IBS helps validate what patients have been experiencing and may lead to new treatments for the disorder.

Sunday, July 25, 2010

The Pesticide Dirty Dozen

The Environmental Working Group is a non-profit focused on public health.  We know that the long term consequences of eating chemicals from pesticides used on our foods is damaging to our health.  The EWG analyzed data from the FDA and  found that people who eat five fruits and vegetables a day from the dirty dozen are eating 10 pesticides a day.  We want people to eat more fruits and vegetables, but NOT to ingest more chemicals.  Rinsing reduces but does not eliminate pesticides.   What is the answer?  Rinse completely and buy the following foods organic when possible.

The Dirty Dozen:
  • Celery
  • Peaches
  • Strawberries
  • Apples
  • Blueberries
  • Nectarines
  • Bell Peppers
  • Spinach
  • Cherries
  • Kale/Collard Greens
  • Potatoes
  • Grapes (imported)
Summer is a great time to visit farmers markets.  Fortunately stores like Safeway are now stocking organic fruits and vegies.  Start with the dirty dozen and do your body a favor.

Got an iPhone?  Check out this site and download the shopper's guide to pesticides app.

Friday, July 23, 2010

Caffeine is OK for Pregnant Women

The American College of Obstetricians and Gynecologists have issued a statement that moderate caffeine consumption (<200mg/day - about a cup of coffee) does not increase a woman's risk for miscarriage or preterm birth.  The review of recent studies was published in Obstetrics and Gynecology and should reassure women about drinking coffee when pregnant.

Caffeine does cross the placenta but there was no difference found between the moms who drank caffeine while pregnant and those who did not.

If you wonder how much caffeine is in certain drinks or foods, click here.

One fact the study did not mention is that many women have a natural aversion to coffee when they are pregnant.  Maybe nature knows best.

Monday, July 19, 2010

When a Professional Turns His Back

A few weeks before Christmas, Eutisha Rennix, a pregnant restaurant worker,  collapsed while working.  She started having a seizure and her co-workers were screaming for help. There were two EMT workers in line at Au Bon Pain shop in Brooklyn and they refused to help.  They told on-lookers to call 911 and they walked out of the store after picking up their bagels, presumably because they were on a coffee break. An ambulance was called and the 25 year old woman and her baby girl died shortly afterward.  She is survived by a 3 year old son.

A spokesman for the FDNY said members "take an oath to assist others whenever they are in need of emergency medical care. It is their sworn duty."

That was the last we heard about that horrific story until today.  Jason Green, the EMT who refused to help, was fatally shot near a New York City nightclub last night.  Police believe the shooting was unrelated to the coffee shot incident.

There is no question in my mind that  those of us who have a skill that can potentially save lives, should never be "on a break" in life.  See my prior post on Good Samaritans and the risks involved.  I also wrote about helping a man on a flight I was on.  Surprisingly, not every health professional feels this way and apparently these paramedics felt their coffee break was sacrosanct time.

Altruistic behavior is found throughout the animal kingdom and is thought to have a genetic link.  Are we hardwired for altruism or for selfishness?  One study showed that altering a single gene in a species of bacteria turned resource "cheaters" into cooperative organisms.  And environmental stress promoted a genetic change that favored cooperation.

It is a complicated subject and I've never seen a study on health care professionals and their Good Samaritan or altruistic tendencies.  It would be interesting to see if people act in ways that are congruent with their views on being a Good Samaritan, or if they chose to take their coffee and leave when the chips are down.

Sunday, July 18, 2010

The Most Amazing Flower in the World

This Agave Century Plant has the most amazing flower in the world.  I've been photographing the initial bloom spike since early June.  The plant takes about 15-20 years to finally put out a flower. Because so much of the plant's energy goes into this amazing bloom, the plant dies afterward.  But in nature's amazing way there are new daughter plants spreading from the original to keep the species going.

Tequila is made from a different species of the Agave Plant.

Saturday, July 17, 2010

How to Recognize a Competitive Medical Student

This cartoon is from a clever medical student blog.  I love finding out what medical students in 2010 are up to,  and reading about their struggles brings back my own nostalgic (read: horrific)  memories.  This cartoon of a Med School Gunner shows me that not much has changed and this type of student is still with us. 

(thanks Doc Cartoon)

Friday, July 16, 2010

19th Century Obesity Cure

I really really want to know what the treatment is that this "regular practicing physician" will send to the patient to reduce the surplus flesh. "Eat as much and as often as you please" and no "bandaging or tight lacing."  Bring it on!

(click on image to enlarge)

Thursday, July 15, 2010

The Answer

The answer to yesterday's medical challenge is...(drum roll)...insect bites.  Many of you diagnosed correctly.  We don't know what type of insect caused the reaction because mosquito and chigger bites can look the same with red, indurated wheals.  The fact that they were on the exposed skin, and not under clothing gives a clue to insects too.

The photo here shows one of our nurses in Haiti with hundreds of mosquito bites on her arm.  We took malaria prophylaxis so all is well.

Wednesday, July 14, 2010

What is the Diagnosis?

This 24 year old patient had the onset of these very itchy lesions on both upper arms.  She takes no medication and has no other medical problems.  She had just returned from a vacation where they had lots of outdoor dining.  She recalls eating shellfish and strawberries.  You are the doctor.  Make a comment and tell us what is the diagnosis?  Can it be treated?

The answer will be posted tomorrow.

(Case and Image from ConsultantLive)

Monday, July 12, 2010

Tips for Men Using Viagra

One of my journals, Mayo Clinic Proceedings,  (I read every night to keep up with the latest medical information) contained some clinical pearls that I wanted to pass on to my men readers who take medication for erectile dysfunction (ED).  They reported on a healthy 67 year old male who took 2 25mg doses of Viagra (sildenafil) but still did not get erections.  He was frustrated and inquired about other treatments for ED.

The article reported that patients often take Viagra and other phosphodiesterase type 5 inhibitors (Cialis, Levitra) incorrectly. To be effective, Viagra must be taken on an empty stomach at least one hour before intercourse. Research has shown that approximately half of patients who don't respond to Viagra will have success when they take it properly.  The dose can go up to 100mg but there is no need to increase the medication until the patient learns how to take it.

So there you have it.  Take it on an empty stomach at least 1 hour before sex.

Wednesday, July 7, 2010

Obama Makes Don Berwick Head of CMS

In a slick move, President Obama appointed Donald Berwick, a pediatrician, to the top post at CMS (Centers for Medicare and Medicaid).  I am happy about this because Dr. Berwick is eminently qualified and has been a leader in the quality and safety movement and patient protection for decades.   With his focus on quality and his passion for improving health care, he is the right person at this time to lead CMS.  He has been endorsed by the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association, AARP,  the AMA and the American Association of Family Physicians.  He is non partisan and three former directors of CMS (who served under Republican presidents) support him.

Why did Obama appoint him, rather than take him through the confirmation process?  It is because the Republicans vowed to block his nomination through extended hearings and use politics to keep him out.  Medicare has been leaderless since 2006 and urgently needs reform.  Medicare is a mess and must be fixed before health care reform can occur.

Yes, Berwick is a proponent of health regulations that "weigh public welfare against the choices of private consumers".   Those are fighting words to those who are against health reform and who are happy with the status quo.  Don Berwick doesn't sugar coat the problems our nation is facing and he believes in a system where decisions are transparent - and the people who make them are accountable. 

That sounds pretty good to me.

Tuesday, July 6, 2010

Doctor Sues for Lousy OnLine Ratings

I must say I think Dr. Kimberly Henry, cosmetic surgeon,  has made a big professional mistake.  She has filed a lawsuit to stop online reviewers from badmouthing her on the Internet.  She is seeking injunctions against at least 12 reviewers from sites such as  and  Dr. Henry claims libel and defamation, invasion of privacy and interference with prospective economic advantage and is seeking $1million in general damages and $1million in special damages, etc etc etc.

Now I don't know Dr. Henry, nor do I know of her plastic surgery technique.   I don't know who the disgruntled patients are or if they are unfairly targeting her.  What I do know is that the Internet is here to stay and there is no place to hide if you do not provide excellent customer service.  I was curious and checked and there is a new complaint placed today, so I don't think this publicity is helping her.  It will bring more angry patients out to comment, I'm afraid.

A similar case was filed last year by a dentist in San Francisco, Gelareh Rahbar, who filed a case against a patient who wrote a negative review on  The case was thrown out by the judge and Rahbar was ordered to pay $43K for the patient's legal fees.  Anti-SLAPP (strategic lawsuits against public participation) laws provide some protection for online commentators as a preservation of free speech.

I wrote about medical rating sites back in 2007 and in 2008 and those posts have proven to be correct. (Reading my old posts is rather interesting and I agree with myself all over again!)  I know some physicians feel it is unfair that angry patients can say whatever they want and there is no rebuttal.  But if a surgeon has that many disgruntled patients who would take the time to comment, there might just be a problem.   Customer service can dwindle if no one in the office has medical coding certification.  And let's face it, those sites are anonymous and I know of doctors who post their own "good" ratings.  It swings both ways.

I feel sorry for Dr. Kimberly Henry because no one likes criticism and public critique is especially hard to swallow.  But bringing it even more public with a lawsuit (that may be hard to win!) is just throwing oil on the fire.  Better to spend that time and effort satisfying patients and asking them to post great comments to counteract the bad.

Monday, July 5, 2010

Top Ten Things Going through Isner's Mind


Did you see the mental and physical strength these player's demonstrated during the historic tennis match?  It shows just how important the mind is.  RESPECT!

Saturday, July 3, 2010

Rare Condition of Lizzie Velasquez


Lizzie Velasquez is 21 years old and lives in Austin, Texas.  She suffers from a rare condition that prevents her from gaining weight, even thought she eats up to 60 small meals and consumes between 5,000 and 8,000 calories daily. 

She was born premature at 2 lbs. 10oz and remained tiny as a child.  She has a syndrome that prevents her body from gaining weight and putting on body fat.  She is blind in one eye and weights just 60 lbs.

Doctors do not have a name for her condition as it is extremely rare.  She is part of a genetic study being conducted at the University of Texas and the closest doctors can come to a diagnosis is that she might have a form of Neonatal Progeroid Syndrome that causes accelerated aging, fat loss from the face and body, and tissue degeneration.

Lizzie hasn't let a lack of a diagnosis affect her life.  She just wrote a book and wants to share her story with others.  She has her own website here.  What an inspiring young woman!

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...