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Showing posts from October, 2010

Medical Marijuana

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When I was an Intern I took care of an elderly gentleman who was dying of lung cancer.  Mr. Washington had spent much of his life as a sharecropper in the deep South.   Mr. Washington was alone without family and his cancer had spread to his bones and his brain.   He no longer had a wife and his grown son had died several years ago. He had stopped eating and was just skin and bones.  I could see that he had once been a robust black man.  It was pretty clear that this would be his last admission to the hospital.  If I knew then, what I know now, I would have pushed for him to be in a hospice program.  But I was just an Intern and I didn't know much at all.

I had a full caseload and many patients coming and going each day.  The workload for Internal Medicine was extreme and I worked my first 35 days without a day off.  Mr. Washington was my favorite patient.  He was elegant and charming and polite.  He cared more about me and my education and my state of mind than his own.  It was c…

Happy Halloween

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Red Yeast Rice Supplements for High Cholesterol

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People are always on the search for "natural" ways to stay healthy and reduce cholesterol.  Chinese red yeast rice supplements have been touted as a natural, safer way to lower cholesterol compared to statin medications.  The yeast that grows on a particular type of rice contains a family of substances called monocolins, which lower cholesterol by inhibiting cholesterol production in the liver in the same manner as prescription statin drugs.  Some studies have shown as much as a 15% drop in cholesterol.

All of this sounds good until you dig a little deeper.  Supplements are not regulated by the FDA and a new study in the Archives of Internal Medicine showed that different brands of red yeast rice supplements showed dramatic variation in levels of active ingredients.  Furthermore some contained toxic manufacturing byproducts.

The researchers analyzed capsules from a dozen different manufacturers.  They found the consistency was far from standard, even thought they all were la…

The Man with the Eyeball Tattoo

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There seems to be no end to stupidity and this man from Toronto, Canada is right up there at the top for crazy ideas.  He actually tattooed his eye by injecting the sclera with ink.  It took 40 injections of ink to complete the color transformation.  Despite the painful appearance, the eye can be easily anesthetized (numbed) so the needle does not hurt.

Despite the fact that this is reported as the "first" eyeball tattoo, I did a little research and other body manipulation fans have done the same thing.  All we can do as physicians is give people the scientific facts.  Here it is:

This type of body modification is extremely dangerous and could lead to blindness.

Thanks to KM for the tip

What Caused This Woman to Faint?

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Dear Dr. Brayer;
My mother, age 66, fainted while she was at work.  She was taken to the emergency room and was evaluated for hours, including a CT scan of her head.  They could not find a reason and sent her home.  Could it have been a stroke that didn't show up?  
Thanks, Heidi

Dear Heidi,
The medical term for fainting or sudden loss of consciousness is syncope.  It occurs when the blood flow to the brain is not adequate to supply oxygen and glucose and fainting can occur after only 5 seconds of hypoperfusion.   It is actually pretty common and even after careful evaluation, no cause can be found in 60% of cases.

It would be rare for a stroke to cause syncope and they do not usually go together.  A patient might have a brain hemorrhage that would cause a severe headache followed by a loss of consciousness, but that is different from a simple faint and those patients do not spontaneously wake up.  Strokes usually cause sudden weakness on one side of the body or face and a severe …

First Do No Harm

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One of the ancient principles of medicine is Primum non nocere, the Latin phrase that means "First, do no harm".  It means that sometimes doing nothing is a better decision than doing something that might cause more harm than good.  It is an ethical precept for physicians, but it becomes harder and harder to adhere to as more and more exotic tests and treatments are at our disposal. 

But just because we can do tests or surgery, doesn't mean we should.  Looking at the whole patient; their lifestyle, beliefs, support system and activity level, should be part of the analysis and decision.

There are so many ways and times in treating patients, that doing nothing can be the best decision.  A prime example is Mr. Leon Sanit who is 97 years old.  Mr. Sanit lives in Los Angeles and plays tennis every single day at 11 A.M.  He was diagnosed with bladder cancer and doctors recommended surgery that had a 50% chance of extending his life.  Here is a guy with an active life,  playing…

Cholera in Haiti

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I still follow the aftermath of the Haiti earthquake closely and have continued contact with our Haitian interpreters that I met this year on the Sutter Health Helps Haiti medical mission.  Our physicians and nurses worked in St. Marc, (three hours north of Port-au-Prince) at St. Nicholas Hospital, the epicenter of the new Haitian Cholera outbreak.  Boston based Partners in Health (PIH) runs the hospital there and the villages surrounding the area had been drinking water from the river, that is presumed to be contaminated.   Reports are that the 200 bed St. Nicholas Hospital is overwhelmed with the influx of patients and other areas of Haiti are also showing cases.

The news of the cholera outbreak is not a surprise to me, considering the sanitation problems.  At this writing, over 3,000 people are reported to be sick from Cholera and over 200 have died.

What is Cholera?  Cholera strikes poor countries, where water sources are contaminated and public sanitation is compromised.   The bac…

How Do You Hide $100 From a Doctor?

How do you hide $100 from a surgeon?           Put it in the patient's chart, next to the lab. How do you hide $100 from an orthopedist?           Put it in a text book. How do you hide $100 from a neurosurgeon?           Tape it to his kid. How do you hide $100 from an OB/Gyn?           Tape it to the patient's head. How do you hide $100 from an internist?           Stick it under the patient's bandage. How do you hide $100 from a radiologist?          Give it to the patient. How do you hide $100 from a cardiologist?           You can't. How do you hide $100 from a plastic surgeon?           You definitely can't.
Compliments of The Happy Hospitalist

How Not to Raise a Baby

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I seem to be on a baby theme.  Here are Baby Dont's.  Remember to be safe with Baby.

Should You Share a Bed With Baby?

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I've watched the pendulum swing back and forth on the wisdom of mom sharing her bed with a baby.  The American Pediatric Society has come out against the practice, because of a higher incidence of Sudden Infant Death.   But nearly half of all British moms sleep at times with their baby and 1/5 share a bed regularly during the first year.


According to a British study published in Pediatrics, the value of breast-feeding should be considered before advising mothers not to share  beds with their infants.  The results showed that mothers who shared a bed with their newborns were better educated and of a higher socioeconomic status, and that those whose children routinely slept in their beds during the first 15 months of life reported a significantly greater incidence of breast-feeding.

"Both cross-sectional epidemiological and sleep laboratory studies showed close links between the frequency and duration of breastfeeding and the practice of bed sharing," writes Peter B…

Cool Medical Apps

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The best thing about the iphone and ipad are the cool apps.  I am learning about new ones all the time but here are a few Medical Apps that I like and I think they are all free.

Lose it!  This is a great app for dieters.  It is easy to use and intuitive and you can track your caloric intake and exercise.  Just set your goal and how many calories you want to eat a day and it maps out how long it will take you to get there.EyeChart  I've never had the chance to use it with patients but it looks like it would work well.Speed Bones Lite (Quiz)For those of us who still like to test ourselves on anatomy.  Name the bones while the clock is ticking.  I do pretty well on this one!PoWorkout   A cool app that takes you through an entire fitness workout with video on how to do it right and info on what muscle groups are working.  Abs, cardio, total body.  It's all here.MPR  This app has a lot of drug information, prescribing, doses, interactions arranged by organ system or with a simple se…

Medicare Fraud

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There are few things that grind my gears more than Medicare Fraud.  These scams pop up every couple of years and I am so glad when the perpetrators get caught and arrested.  The latest is a large crime syndicate lead by Armen Kazarian, the godfather of Armenian gangsters.  More than $160 million fake  Medicare invoices were generated from 118 fake medical clinics in 25 states, said U.S. Attorney Preet Bharara.  Most of these "clinics" didn't even exist and were Mail Boxes, Etc. addresses.

As part of this fraud, Endeavor Diagnostics billed more than $1million in medical lab tests for Medicare patients.   Endeavor Diagnostics was an empty office with a desk and a fax machine in San Fernando Valley, California.  The complex operation recruited people and paid them a small fee to become a fake patient and then they would bill Medicare for services supposedly rendered.  Corrupt doctors were also part of the scam that carried out unnecessary tests on "fake" accident …

Drug Shortages in the United States

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One of our pharmacists asked me "Are we now in Sudan?"

It seems like we are a third world country because we are dealing with serious and nationwide pharmaceutical shortages for needed drugs.  Medications like Propofol (yes, the one that killed Michael Jackson) and Succinylcholine, a neuromuscular drug that is commonly used in surgery, are in such short supply that we are canceling surgeries and trading those drugs between hospitals. It is just the tip of the iceberg.  Other drugs like metoclopramide, vecuronium and even ephedrine are limited.  Every week we find a new shortage.

What the heck is going on?  Because these drugs are generic, only a few companies manufacture them.  If one stops, it creates a shortage that is not easy to rapidly correct.  In the case of Propofol (used in anesthesia and even for conscious sedation in emergency rooms and for colonoscopies), two of the three manufacturers stopped making it and that left only one to supply the entire market.   The sit…

Get Healthy Compliments of Uncle Sam

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It makes my blogging life easier if I can just direct readers to a cool site compliments of....drumroll...the U.S. Government! 

This site, called Smallstep Adult and Teen,  is filled with great health, eating and exercise tips.  Check it out and click around a bit.  Don't ya' just love the internet?

Positively Quit Smoking

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I hold my breath when I walk into the hospital and see a small group of people in the "smoking area" puffing hard on cigarettes. The hospital (and other office buildings) are smoke free, but that doesn't mean everyone has stopped smoking.  They just have to stand out in the fog or the cold like lepers.  I know in other parts of the country, smoking is more tolerated and even more smoking occurs. Unfortunately, after declining for a few years, the number of smokers in the U.S.  has now remained stable at 21%. About 438,000 Americans die each year because of tobacco use, the CDC said. The agency estimated that for every death, there are 20 people living with a tobacco-related illness.

A study was just published that showed U.S. smokers are exposed to higher levels of cancer-causing compounds than smokers in other countries.  The researchers compared the levels of nitrosamines in cigarette butts and dangerous metabolites in smoker's urine and found the levels were sig…

Internal Medicine Poem

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I am frequently asked:  What is Internal Medicine?  The answer: "I am the doctor for adults" or I am the primary care physician", just doesn't seem to cover it.  I think this poem from the Journal of American Medical Association (JAMA) does:

Today I Saw

diabetes in a brown pantsuit
recently widowed, bringing her daughter
for the first time.

Bladder cancer still working
full time after surgery
with two sons to get through college.

A stroke crying and embarrassed
to be unmanly since his release
from the hospital.

A health care checkup squeezed in
before her insurance runs out.
Downsized out of a job.

High blood pressure out of control
from the stress of a daughter
raped at age sixteen.

Recurrent breast cancer smiling.
Thin but happy to be leaving on her first cruise.
To her I say bon voyage.

Barbara Fleming-Phillips, MD
Lexington, Kentucky

Flossing Toothbrush

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Being the world famous popular blog it is, EverythingHealth gets lots of solicitations to place ads, promote books, authors, medical supplies, drugs and other websites.  The answer to most of these requests is "Thanks, but no-thanks".  I like to keep the blog pure and you know that my advice is not tainted by outside influence. (Also known as $$$$)

But since October is National Dental Hygiene month, I took SoFresh Oral Care up on their offer to try their flossing toothbrush.  After my last visit with the dental hygienist, I knew I needed all the help I could get.  Good dental and gum care is not just for a good smile and fresh breath.  Studies show there is a direct link between mouth bacteria and systemic diseases like cardiovascular disease (heart attack and stroke), diabetes complications, bacterial pneumonia and even osteoporosis.

Ok, enough of the background.  So I tried the flossing toothbrush and the OraSweeet tongue cleaner and I liked it a lot.  I gave one to my mom…

Why You Should Get Enough Sleep

1915 Anti-Smoking

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They had the right idea back then.  I wonder how cigarettes became so popular as the Century progressed?