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Showing posts from August, 2010

Katrina Racial Violence

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I read an article in the New York Times about the post hurricane violence in New Orleans after Katrina and the stories that are finally emerging about vigilante white people, including police, who threatened and murdered innocent blacks.  These accounts, so many years later are difficult to believe and several police officers have finally been indicted in various cases.

It takes me back to the post flooding of New Orleans and my work there as a medical volunteer.  I wasn't writing a blog then, but I wrote about it later.  One of the things I have never mentioned or written about was the story one survivor told me when I was taking care of him at the refugee center in Baton Rouge. 

The patient was a young black man in his 30s who was displaced and was with his uncle at the Center that served as temporary housing for about 5000 victims.  He left his home as the waters started rising and was walking shoulder deep through the murky water.  People were left to fend for themselves and, …

Humane Farming to Prevent Salmonella Infected Eggs

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More than a thousand Americans are ill from egg contaminated Salmonella and it has forced a recall of 1/2 billion eggs and increased scrutiny of the safety of eggs.  The Centers for Disease Control and Prevention have tracked the contaminated eggs to two Iowa facilities, one with over 1 million chickens.  It turns out that less than 200 big companies supply 95% of the eggs in the United States. Wholesalers and distributors routinely repackage the eggs for sale under other names, like Albertsons or Wholesome Farms.

According to National Public Radio, the Iowa egg producer is part of the DeCoster family business who has run large hog and chicken operations.  They have faced a number of complaints and charges including employment discrimination, environmental violations, federal immigration charges and animal cruelty charges against their chickens.  They paid millions in fines to settle the charges.

There have been nine studies published in the last five years that show higher rates of Sa…

Weight Loss Requires a Major Change in Lifestyle

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I know it is not politically correct to look at what other people buy at the grocery store, but as a physician I just can't help noticing.  Some baskets contain huge containers of soda pop, Doritos, frozen pizza and other packaged goods.  I'm not surprised because at the end of every isle is a display case that offers the giant soda for 89 cents or the Doritos on special for $1.29.  With this type of marketing it takes a strong person to resist the "bargain".

Yesterday the woman in front of me (overweight, middle age) had a strange assortment of goods that she probably thought would help her lose weight.  She had several "weight watcher" type meals, diet drinks, power bars, and lots of "light" items..."light butter", "light crackers", "light yogurt", "light ice-cream". 

Folks, this will not work.  Eating this way will not help her lose weight.  She needs to make dramatic changes to drop the pounds. 

Recent …

Answer to Medical Challenge

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The answer to yesterday's image and patient case was #3-Ludwig's angina.  Ludwig's angina is an infectious process involving the submental (chin), Sublingual (under tongue) and submandibular (under the jaw) spaces. The bacterial cause is usually strept.  It can rapidly progress and is considered a medical emergency because it can affect the breathing and airway.

The term angina means "strangling".  Whilhelm Fredrich von Ludwig first described the condition in 1836.

Aren't we all smarter now?

Medical Challenge

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This weeks Medical Challenge from the New England Journal of Medicine is a tough one.  This patient had been treated with penicillin for a toothache the day before.  You be the doctor.  What is the diagnosis?

1. Acute parotitis
2. Angioneurotic edema
3. Ludwig's angina
4. Penicillin allergy
5. Peritonsillar abscess

The answer will be posted tomorrow.

Communication Gaps Between Doctors and Patients

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In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.  If that isn't enough, when the researchers queried the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients "understood their diagnoses at least somewhat well".  I would call that a pretty significant communication gap!

Ninety percent of the patients said they received a new medication and didn't know the side effects.  Although 98% of physicians thought they discussed their patient's fears and anxieties with them, only 54% of patients thought they did.

The researchers from Yale University School of Medicine and Waterbury Hospital concluded: “Significant differences exist between patients’ and physicians’ impressions about patient knowledge and inpatient …

Osteoporosis Testing with DXA

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One of the good things that has come out of the Affordable Care Act (the name for Health Care Reform) is that the payments to providers who do DXA screening for osteoporosis will increase immediately from Medicare and Medicaid.  Unfortunately these increased payments expire at the end of 2011.  To show how crazy the Medicare payment policies are, in 2006 the DXA service was reimbursed at $143.00.  Now the fee for the same  CPT code 77080 is $45.00 and it will increase to $98.00.  So the increased payment now is still only 70% of the payment in 2006 and there is no guarantee it won't be ratcheted down again.

The cost of a new DXA dual energy Xray absorptiometry machine is about $35,000 and the life span is about 8-10 years.  Training for employees, space and variable costs to run the program are added to this.  A patient's access to this test depends upon where they live.  In large metropolitan areas, most hospitals offer DXA testing.  But it doesn't take advanced math to s…

Top 10 U.S. Pharmaceutical Sales

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The top money makers for the U. S Pharmaceutical Industry might surprise you.  These are not necessarily the most prescribed medications (although some of them are) but they are the top products in terms of sales in 2009.  The revenues were in $ Billions:
Lipitor  -      used for high cholesterol                 $7.5Nexium  -    a proton pump inhibitor for reflux     6.3Plavix   -      a blood thinner                                 5.6Advair Diskus-   used for asthma and COPD            4.7Seroquel -    used for bipolar disorders                  4.2Abilify   -     used for bipolar disorders                  4.0Singulair-     for asthma and allergies                    3.7Actos     -     for diabetes                                      3.4Embrel  -      injectible for rheumatoid arthritis     3.3Epogen  -     injectible for low red cells                 3.2All of these medications are used on a chronic basis.  One month of Advair inhaler can cost $150 - $200.  Lipitor can cost betwee…

Don't Wait After Miscarriage to Get Pregnant Again

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About 15-20% of women who know they are pregnant will have a miscarriage.  The loss of a pregnancy before 20 weeks is considered a miscarriage. Many women suffer grief and shock after a miscarriage and fear there is something wrong with them or that they did something to cause it.  But the reasons for miscarriage are usually not known.  Women are often told to wait "a few months"  to get pregnant again to let their bodies recover.

A new study published in the British Medical Journal looked at over 30,000 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant again.  They found that women who conceived again within six months were less likely to have another miscarriage or problem pregnancy.  They were even less likely to have a cesarean section, preterm delivery or infant of low birth weight.  These women were more likely to have an induced labor.

The researchers wrote, "Women wanting to become pregnant soon after a miscarriage sho…

Are Teens Overmedicated?

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It is summer camp season for kids and well run camps require a medical history and record of prescription medications that the child is taking.  One prestigious camp for teens (ages 11 to 19 - average camper is 16) in Southern California had 153 residential teenagers last week.  These kids come from California and other states across the U.S.  Fifty percent come from out of state and a number of campers each week are international.  OK, so far so good.  Healthy teens getting together for a week of learning and fun.   Here is the shocker!

I was amazed to learn that almost 25% of these kids are on prescription medication.  Can it be that we are over medicating teens?

I am not counting birth control pills in this count. (All sexually active teens should be on the pill or another reliable form of birth control).  I'm also leaving out medication for asthma, allergies, or acne. The medications that 23% of the teens took were:
AdderalAcyclovirAmbienFluoxetineLamictalLexaproNaprosynProzacS…