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Showing posts from November, 2010

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…

Great Healthy Holiday Food Ideas

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I have permission to share these tips from MD Anderson Cancer Center with the readers of EverythingHealth.  With the holidays coming up,  these choices make sense.  Enjoy! *********************************************************************************
Making healthy food choices can be tough during the holidays, especially at gatherings where festive snacks abound But who says holiday snacks have to be high in fat and sugar?

“Many holiday foods can easily be replaced with more nutritious alternatives — without sacrificing festive smells and flavors,” says Sally Scroggs, health education manager at MD Anderson’s Cancer Prevention Center.

That’s good news because a cookie or two, a slice of cake, and a few trips to the chip and dip bowl can easily add up to more than a meal’s worth of calories.

“Most of these holiday treats are filled with empty calories and don’t provide the nutrients your body needs to reduce your risk of diseases like cancer,” Scroggs says. “Plus, they may n…

Doctors as Employees

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The days of doctors running their own offices and starting practice are coming to an end.  As this graph from today's Wall Street Journal shows, since 2005 more doctors are becoming employees of hospitals rather than owning their own medical practice.

The reasons are not that hard to understand.  Medicine has become a complex and difficult business.  Dealing with dozens of different insurance companies, Medicare,  Medicaid and the hassles of being an employer are not what doctors are trained to do.  The days of the simple medical practice with a receptionist and a well trained (smart and loyal) nurse at the doctor's side are long gone. 

Why don't doctors in the U.S. have electronic medical records, as does much of Europe and other developed countries?  They cannot afford to capitalize the technology or  support the IT infrastructure.  A hospital organization can!

In my medical community only one of the recent Internal Medicine residents stayed in private practice.  And he …

Surprises Ahead

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I just like this photo!

Answer to Diagnostic Challenge

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The answer is #4 - Median rhomboid glossitis.  This condition shows a round or rhomboid shaped patch of smooth tongue that lacks both papillae and taste buds.  It is usually located in the midline.  It is thought to arise from an embryologic defect but it doesn't usually cause problems nor does it require treatment.

This Weeks Diagnostic Challenge

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This Weeks Diagnostic challenge from the New England Journal of Medicine is a good one.  What is the diagnosis for this unusual looking tongue?  Answer will be posted tomorrow so make your best guess. (click on the image to enlarge and get a better view)

1.  Atrophic candidiasis
2.  Erythroplakia
3.  lingual thyroid
4.  Median rhomboid glossitis
5.  Tertiary syphillis


Smarter Medical Care

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The internet is a wonderful place to get medical information when and how you want it.  You may not be interested in the topic of "Coumadin" until you or a family member is prescribed the drug.  What does it mean when your father tells you his doctor wants to do a "laparoscopy" or that your mother has a "venous thrombosis"?  It is important to get your medical information from a reputable source that is not filled with advertisements and gimmicks.  That is why I recommend Smarter Medical Care.

Smarter Medical Care was started by a San Francisco Hematologist named Dr. Robert Rodvien in memory of his wife, Rayna, who died of ovarian cancer.  It contains over 65 podcasts dedicated to patient information that is easy to digest and free of commercial bias.  It is an easy site to navigate and it addresses medical topics directly and compassionately.


Smarter Medical Care is a good site to bookmark and come back to when questions need answering.  So far Dr. Rodvi…