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Showing posts from 2011

Seven Tips for Healthy 2012 Planning

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As we welcome a new year it is an opportunity to re-evaluate, consider the coming year and make intentions for improving our health and sense of well being.  EverythingHealth sifts through the latest medical literature and evidence to offer these proven recommendations for staying on top of your game.
If you are 50 or older and haven't had a colonoscopy, schedule one in 2012.  It's time!  Go online and check your Body Mass Index (BMI).  If you are too high, plan and execute on that diet.  (contact me for a diet coach referral if needed)Get rid of sugar and soft drinks.  Stevia is a natural sweetener that is safe and yummy.  The average American eats 160 lbs of sugar a year. Break the sugar habit in 2012Stop smoking. For motivation go here.Relax your mind.  Start yoga, meditative dance, meditation.  These practices have been shown to lower blood pressure and general stress.Send one thank you note a week.  That is 52 notes in 2012.  You can send it to your child, co-worker, groc…

Top EverythingHealth Books of 2011

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We at EverythingHealth love end of the year lists and we love reading.  Here is our pick for the best read Health (and everything)  books in 2011.  (not in order...all are terrific)
The Immortal Life of Henrietta Lacks, byRebecca Skloot
Cutting For Stone,  by Abraham VergheseOutliers,  by Malcolm GladwellThe Help,  by Katheryn StockettThe Checklist Manifesto,  by Atul GawandeMiddlesex,  by Jeffrey EugenidesThe Known World,  by Edward P. JonesComplications,  by Atul GawandeThe Curious Incident of the Dog in the Night-Time,  by Mark HaddonA Short History of Nearly Everything,   by Bill Bryson If you have other favorites, let us all know.

Answer to Medical Challenge

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The answer to the CT scan image medical challenge is #3, Intercostal Muscle Rupture.

The image shows subcutaneous emphysema and an intercostal muscle defect between the ribs.  the patient recovered after repair of the intercostal hernia.  Subcutaneous emphysema is air under the surface of the skin. 

It is not unusual for these muscles between the ribcage to be strained or even get small tears with sports, extreme coughing or trauma.  It is very unusual for the tear to be this extreme and affect the pleura around the lung and the lung itself.

Thanks for your diagnoses.

Medical Challenge

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For my non medical readers, this is an abnormal CT scan.  The CT scan takes a transverse image sliced through, so you are looking at the patient sliced in half transversely.  This is the chest area. I will orient you:

The whitish circle and v-shaped part is the vertebral column.  So you know that is the back.   Bone shows up whiter than organs.  The small whitish lines in a circle are the ribcage (more bone) sliced through.  Air shows up dark so the big dark areas are the lungs.  Notice there is darkness streaking on one side and not the other.  As my 16 year old would say: "That is messed up".  What ruptured to allow air to penetrate the muscle area? (click on the image for a better view)


1.  The diaphragm
2.  The esophagus
3.  An intercostal muscle
4.  The interventricular septum
5.  The pericardium

Medical professionals and others:  Make your diagnosis.  The answer will be posted tomorrow.

High Ratings for Personal Physicians

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It's time for some good news!   A study that looked at online patient ratings  about their physicians from 2004 through 2010 showed that the average physician rating was 9.3 out of 10.  That is amazingly high and shows that patients (at least the ones who posted on Dr.Score) are very content with the care they receive from their doctor.  Even though some patients will post a nasty comment about the doctor, the overall patient satisfaction is high.  Seventy percent of doctors earned a perfect 10.

The survey asked patients to rate physicians on attitude, the thoroughness of the visit,  how well the doctor communicated and how long they sat in the waiting room.  It is not a surprise that the longer patients waited, the lower was the rating.  Forty two % of doctors were primary care physicians and the remainder were specialists outside of primary care.

Patient satisfaction is finally getting attention in medicine.  More than 60% of health care organizations are using patient satisfac…

Holiday Dinner from the Boss

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Marney is bossy.  Click to read her instructions for the Thanksgiving Potluck and be glad you aren't invited.

EverythingHealth tip:  Stay out of the stores today.  Rest, play games with the kids, Take a long walk in nature with the entire family and the dog and then drink the rest of the Christmas wine.


Happy Holidays EverythingHealth

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I get a lot of pleasure out of being a health blogger and it is only possible because of you, the reader.  Thank you for visiting EverythingHealth and allowing me to keep my mind sharp by researching articles and healthy living for you to read and enjoy.

Merry Christmas, Happy Hanukkah, Happy Holidays, and may we all have a wonderful 2012, no matter where we live on Earth. 


Kwashiorkor in Northern California Means Fraud

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Is it plausible that one small hospital in rural Northern California treated 1,030 cases of Kwashiorkor within a two year period?

Before you answer that, let me explain what Kwashiorkor is.  It is a severe form of protein malnutrition...starving to death actually.  It is the type of starvation you see in African children.  It is so severe that the patient needs special nutritional support including special re-feeding with vitamins and it occurs mainly in children ages 1-4.   Adults can starve to death, but they do not develop classic Kwashiorkor.

Medicare pays hospitals a flat rate based on diagnosis codes for patients.  Patients with more severe coded illnesses get paid at a much higher rate.  Shasta Regional Medical Center, located in Redding, Shasta County, California is under the microscope for billing Medicare (our tax dollars at work) for 1,030 cases of Kwashiorkor to the tune of $11,463 for each diagnosis.  This medical center is a 246 bed facility in a town of about 90,000 pe…

Strange Compulsion

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Pica is a medical term that refers to people who eat substances that are not nutritious like clay, dirt, paper or starch.  Lithophagia is the eating of rocks or pebbles.  The Xray above is from a 48 year old homeless man who came to the emergency department with abdominal pain, constipation and intermittent blood in his stool for 2 weeks.  The abdominal Xray showed small radio-opaque pebbles and gravel that the patient admitted eating over the last 9 months.  He believed that "God might turn it to bread in his belly."  He was given the diagnosis of nonspecific delusional disorder.

The patient underwent a purge with polyethelene glycol electrolyte solution.  (It is the same solution that is used for bowel prep before a colonoscopy).  Some of the pebbles had to be manually removed under general anesthesia.  His symptoms improved and follow-up Xray showed compete removal of the stones.  Unfortunately the patient was lost to follow-up after discharge from the hospital.

Geophagi…

Osteoarthritis

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One of my patients came to see me today with severe right knee pain.  This is not a new problem, and in fact, we have been dealing with flare ups of  her osteoarthritis for years.  It mainly affects her knees and hands and today her right knee was swollen and felt like the "bone was rubbing together" with each step. She could hardly walk because of the pain.

Osteoarthritis is also known as degenerative arthritis and it is one of the most common maladies of aging joints, affecting millions of people.  The cartilage in joints wears down and inflammation causes the bones to build up spurs and small micro tears.  It affects women more than men and  the cause is unknown.  There are likely genetic factors as it tends to run in families.  Arthritis can occur in any joint but the most common are the fingers, wrists, hips, neck and spine and knees.  Stiffness (especially in the morning) and pain are the main symptoms that limit mobility.

You can see the bony changes that have occurre…

Affordable Health Care Act Provides Senior Benefits

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While the courts and politicians wrangle about the Affordable Care Act (ACA, "Obamacare"), some of the benefits have kicked in for Medicare beneficiaries.  The Act empowered the Center for Medicare and Medicaid Services (CMS) to eliminate co-payments for a number of preventative services and to cover services that were not included before.  Patients on Medicare now receive:
Bone mass measurementsCervical Cancer ScreeningCholesterol and other cardiovascular screeningColorectal cancer screeningDiabetes screeningHIV testsAnnual influenza, pneumococcal and Hep B vaccinesMammogramsMedical Nutrition therapyProstate Cancer screening.Previously Medicare did not cover screening tests or required co-pays.

It's not just seniors who have benefited from ACA.  It also allows young adults to stay on their parents' health plan until age 26 years.  These young adults do not need to live with their parents or be listed as a dependent on the tax return to be eligible.  This alone allows…

Women Don't Need As Many Pap Tests

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Women have been told they should have screening for cervical cancer with a pap test every year.  The visit to the gynecologist or internal medicine physician has been a right of passage for most young women and most are very compliant with that annual visit throughout their lives.

Well, the times they are a-changin' because new guidelines issued by the US Preventative Services Task Force and the American Cancer Society say women should undergo screening NO MORE OFTEN than every 3 years starting at age 21.  To further strengthen this recommendation, even the American Society for Clinical Pathology (those folks that read the pap smears) agrees with the recommendation.  They also recommending stopping routine pap smears after age 65 for women who have had 3 negative Pap test results in the past 10 years.  These women are just not at high risk.

So why the change?

The pap smear is a screening test for cervical cancer.  Evidence shows that more frequent screening than every 3 years doesn…

Fingernails

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Let's see how much you know about fingernails?  The arrow points to what part of the fingernail?
1.  Lunula
2.  Eponychium
3.  Cuticle
4.  Nail groove
5.  Proximal nailfold

If you answered #1, you would be correct.  The lunula is most noticeable on the thumb.



Did you know that nails on your dominant hand grow faster than nails on the nondominant hand?  As you age, nails are usually thicker and they grow more slowly.  A six month old will grow a new fingernail in 3 months.  A 70 year old will take twice as long.

Toenails take 12-18 months to regrow.

Photo and info credit to Medscape




Unhealthy Food at Childrens Hospitals

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A study published in the journal Academic Pediatrics reveals that 93% of California children's hospitals offered unhealthy food to outpatients, visitors and staff in the cafeteria and snack bars.  Said another way, only 7% offered healthy food.  What did these foods consist of to be called "unhealthy"?  Try fried food, sweetened beverages, burgers and lots of sugary sweets.

The study found that 81% of the cafeterias placed high-calorie, high-sugar items like ice cream right by the cash register, a well known marketing plan to tantalize and increase selection.  Forty four percent didn't even offer low calorie salad dressing and fewer than 1/3 had no nutrition information.

Health care workers, like the rest of America, suffer from increasing obesity.  One study showed over 54% of nurses are overweight and both stress and shift work can contribute to unhealthy eating and weight gain.  If the cafeteria offers high calorie food, it is no surprise that obesity will prevail…

Don Berwick Says Medicare is Wasteful

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I was thrilled when Dr. Don Berwick took over as head of the Center for Medicare and Medicaid Services (CMS).  It was a politically charged appointment and the GOP wasn't standing for his type of medicine.  He would have never been confirmed and now he is saying goodbye to Washington.  Dr. Berwick admits Government is more complex than he realized and said "Government decisions result from the interactions of many internal stakeholders-different agencies and parts of government that, in many cases, have their own world views."  Ya think?

He also said the GOP criticism of him and his policies was "purely political, a world of sound bites" and that they "completely distorted his meaning."

Berwick reflected on his 17 months in office and said these are the ways we waste money in healthcare:
1.  Over treatment of patients
2.  Failure to coordinate care
3.  Complex administrative restrictions on the health care system
4.  Burdensome rules; and
5.  Fraud

I…

Scientists and Tattoos

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A surprising number of scientists have tattoos hidden under their lab coats and these tattoos are examples of their cool geekiness.   Prof Sandeep Robert Datta has a tattoo of a twisting ladder of DNA.  The DNA message spells out the initials of his wife, Eliza Emond Edelsberg.  True love manifested through amino acids that are the building blocks of protein!!!  
Science journalist, Carl Zimmer, posted a blog at Discover Magazine and asked scientists if a tattoo like this was a trend.  Without trying, he became the curator of tattoos and a scholar of science ink.  He found out that many scientist sport tattoos of carbon atoms, DNA, ancient fish, embryos...just about anything that interests them and is meaningful.  He has published a book called Science Ink.

Body ink has been around for thousands of years.  Two hikers climbing the Austrian Alps discovered the freeze-dried body of a 5,300-year-old hunter whose skin was preserved in the ice.  He had tattoos made from fireplace ash rubbed…

Thanksgiving Idea

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Happy Thanksgiving to EverythingHealth readers.

Thanks to KM for this way to appreciate Thanksgiving.  I did it and it only took about 7 minutes.  Here's the concept:

Get a piece of paper or a word doc on your computer.  Write one thing you are grateful for for each year of your age.  If you are older, you have lots of reasons to give thanks.  Don't over think it or try to put it in order of "importance".  No-one has to see it,  but the act of giving thanks for your life is an exercise that will improve your entire being.

Have a great day and Thanksgiving weekend.






Smoking is still a Huge Problem in the U.S.

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I live on the West Coast and where is rare to see a smoker.  Because it is not socially accepted,  smokers are not out in the open.  They lurk behind buildings to take a smoke break at work and I don't even own an ashtray for friends because none of my friends smoke.  But San Francisco isn't the rest of America.   In 2010 there were 45.5 million Americans who smoke, with men smoking more than women.  Tobacco remains the single largest preventable cause of death and disease in the United States.  Each year approximately 433,000 people die of smoking-related illness.

Here are some more stats on American adult smokers.  The highest prevalence is American Indians/Alaska Natives (31.4%) followed by whites (21%).  Smoking incidence decreases with increasing education and improved economics.  By region, the Midwest has the most smokers in Oklahoma, Arkansas, Mississippi, Louisiana, Kentucky, Ohio and West Virginia (22-27%).  That is huge.

California and Utah have the lowest percentag…

Amazing Spider Animation

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This is one of the most accurate and beautiful pieces of animation I've ever seen. And I love the title: "Loom" (Warning: if you are arachnophobic you may wish to avoid but if you want to see nature at her best, the detail is amazing.)

Hat tip to Micro Voyage and the creators at Polynoid

Yoga for Back Pain

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Low back pain is one of the most common conditions to affect humans.  More than 80% of Americans experience low back pain at some time in their lives and "chronic" pain is on the rise as people live longer and get heavier.  Numerous studies have shown that doctors and patients underutilized exercise as a treatment for chronic back and neck pain even though it has been shown to be effective.  A new study was published in the Annals of Internal Medicine that showed yoga to be an effective treatment for chronic low back pain.

The study authors took two groups of patients and compared yoga to usual care for chronic or recurrent low back pain. All patients received a back pain education booklet, but the study group also received a gradually progressing yoga program delivered by 12 teachers over 3 months.  The teachers were from 2 yoga associations - The British Wheel of Yoga and Iyengar Yoga and the sessions they taught were the same.  They focused on foundational elements of yog…

Answer to Medical Challenge-Yellow Nail Syndrome

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Yesterday's Medical Challenge answer was clear to some readers and a mystery to others.  The answer was:
#4  Yellow Nail Syndrome.  Although nails can become discolored from nail polish, the medical Yellow Nail Syndrome is a sign of a serious disorder and not well understood.  It is believed to be associated with  restrictive lung disease or  (rarely) problems with lymphatic drainage channels. (good memory, Grady Doc!)



Because these nails stop growing and become thicker, they are susceptible to fungal infections too.  Those who guessed Onchomycosis were not far off.   Onchomycosis is very common and the fungus infection causes lifting of the nail from the nail bed.



Psoriasis of the nail can also cause changes that can be confused with Yellow Nail Syndrome.   Ninety-five% of these patients have cutaneous psoriasis also.

Thanks for your diagnosis in this challenging case!















Medical Challenge

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This weeks medical challenge from the New England Journal of Medicine is a hard one.  Patients come all the time with nail problems and most are easy to diagnose.  Full disclosure to my readers...I missed this one.   A couple of hints...all of the nails are obviously affected.  Click on the image to enlarge and make your diagnosis in the comments section.   I will post the answer tomorrow so be sure to check back and see how you did.

1. Melanoma
2. Onychomycosis (fungus)
3. Psoriasis
4. Yellow-nail syndrome
5.  Zinc deficiency

Good luck!


Ode to Andy Rooney

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Andy Rooney, the broadcaster with a wry look at life, has died at age 92.  He worked up to the end after delivering his 1,097th commentary on life.  Andy Rooney had a knack of picking a topic that no-one had thought about, comment on it and listeners would say "Oh yea, that is so true".  He touched a nerve in modern American society.  Here are my Andy Rooneyisms:
Why do we have foods like "Go-Gurt"?  Is it so hard to eat yogurt that we need to make it faster?  Does squeezing it into your mouth from a tube save time?  Have you ever been late to something because you were "eating yogurt"?  When did we end up with 700 TV channels?  How did that happen? And why, when I'm watching the news, do I have to see a streaming commentary about different news across the bottom of the screen?  Aren't the 700 channels enough?  Do we need to be seeing several things at one time on each channel?  What happened to elevator operator jobs?  There was a time when someone …

Follow Up on 1991 Gulf War Veterans

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Remember the 1991 Gulf War between the United States and Iraq (aka: "Operation Desert Storm")?  A new study has been published in the American Journal of Epidemiology that assessed the health status of 5,469 deployed Gulf War veterans compared to 3,353 non deployed veterans.  At 10 year follow up, the deployed veterans were more likely to report persistent poor health.  The measures were functional impairment, limitation of activities, repeated clinic visits, recurrent hospitalization, perception of health as fair or poor, chronic fatigue syndrome illness and post-traumatic stress disorder.

From 1995 to 2005, the health of these veterans worsened in comparison to the veterans who did not deploy to the Persian Gulf.  A study done in the United Kingdom that compared Gulf War veterans to UN peacekeepers who served in Bosnia and other non-deployed Gulf War soldiers found the same thing.  The deployed veterans had significantly worse health in all realms. 

This was a longitudinal…

Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome (CTS) is common and is the result of the median nerve becoming squeezed or "entrapped" as it passes through the wrist down into the palm of the hand.  Because this is a sensory nerve, the compression causes tingling, burning and itching numbness in the palm of the hand and fingers. A different nerve goes to the little finger and the lateral half of the 4th finger so the sensation there would feel normal.  There is often a sensation of swelling even though there is rarely any true edema that can be seen in CTS.

The symptoms of Carpal Tunnel Syndrome  usually start at night when people sleep with flexed wrists.  As it progresses, the tingling and numbness can be felt on and off during the day.  It can cause decreased grip strength and weakness in the hands.

CTS can be worsened by medical conditions like rheumatoid arthritis, diabetes, pregnancy or wrist trauma.  Women are three times more likely to develop CTS than men,  and it is rare in children.  Mos…

Teens and Soda and Junk Science

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The headlines of a number of newspapers say "Soda Boosts Violence Among Teenagers."  A new study out of Harvard's Public Health Division analyzed data from 1878 14 to 18 year olds and found those who drank over 5 cans of non-diet soda a week consumed more alcohol and smoked more cigarettes.  Additionally those teens were more likely to carry a knife and exhibit violence toward family and peers.

According to the Washington Post,  "About 23 percent of those who drank one or no cans of soda a week carried a gun or knife, and 15 percent had perpetrated violence toward a partner. In comparison, among those who consumed 14 or more cans a week, 43 percent carried a gun or knife and 27 percent had been violent toward a partner, the researchers found. Similarly, violence towards peers rose from 35 percent to 58 percent while violence towards siblings rose from 25.4 percent to 43 percent."

The study was published online in something called "Injury Prevention&q…

Robots Bring Care to Remote Places

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Both in the United States and around the globe there is a mismatch between needed medical care and the doctors who can provide it.  Most physicians are located in urban areas where there are hospitals, teaching schools, lab and Xray and specialists to deal with most every medical condition.  Rural areas in the United States lack these resources and patients either do without,  or must travel far to be seen.  In developing countries there may be no services at all for hundreds of miles.  That is where telehealth can play a huge role in bringing medicine to the  people.

The "In-touch" robot is one technology that can work all over the world.  Through a simple lap-top computer a doctor and reach out across the globe and "see and be seen" by the patient and have a conversation with the patient.  The robot is mobile and can be remotely navigated from room to room (or hospital bed to hospital bed) and "visit" the patient.  A dermatologist can see the skin and re…

Kid's Allergies and Asthma

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There never seems to be enough time for parents to ask all of the questions they want of their kid's pediatrician.  And parents whose children have allergies or asthma have lots of questions and new concerns that pop up all of the time.  The American Academy of Pediatrics has published an updated guide called "Allergies and Asthma - What Every Parent Needs to Know."   This paperback should go a long way toward answering those questions and letting parents know how to deal with health problems.

This book is easy to navigate and is written in language that will be understood by the reader, yet it is not a "dummy guide" but a real source of information.   It starts with basic physiology and  explains what happens with the immune system when an allergen is encountered.  Those allergens can cause skin allergies, hay fever, food allergies, killer allergies (anaphylaxis) and asthma.  The authors advise how to identify, prevent and treat these conditions.

Childhood ast…

Ovarian Cancer Screening of No Value

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If you want to create an outcry of indignation,  just inform people that certain screening tests are of no value and do not increase time on this earth.  People love the idea that if they do all the right things and get all the medical tests at the right time, they can prevent disease ( ....uh...no, tests don't prevent anything) or catch cancer early and cure it.

The furor over the lack of benefit for men of the screening Prostate Specific Antigen test (PSA) is still being heard.  It seems everyone knows someone who was "saved" by getting a PSA and don't try to tell me there is evidence to suggest otherwise, dammit!

There is a new report in the Journal of the American Medical Association (JAMA) that confirms previous studies and shows there is no benefit for women to obtaining screening ultrasounds and Ca125 for ovarian cancer.  This is bad news because every year over 21,000 women are diagnosed with ovarian cancer.   Most of them are diagnosed in advanced stages and…