Friday, September 30, 2011

Plastic Surgeons Behaving Badly

What is it about "Patient Privacy" that some doctors don't understand?  A St. Louis, Mo. plastic surgeon is being sued by 5 patients after she posted "before" and "after" photos of their bare breasts and torsos on her website to show the benefits of their breast implants.  To make it worse, she also posted their full names with the photos and several of the women are prominent in their communities as lawyers, teachers and CPAs.  A google search of their names brings up the breast photos!

The lawsuit, which claims the plaintiff suffered shame, humiliation, embarrassment, anxiety, nervousness...etc, is for $25,000.00.  An apology and a check from the doctor are in order.

Thursday, September 29, 2011

What is Listeria?

If you have watched any news over the past week you know there is a listeria outbreak from contaminated cantaloupes that has been traced to Jensen Farms in Colorado. The CDC has confirmed 72 illnesses, including 13 deaths linked to the melons and three other deaths may be involved.  By now most of the cantaloupes should be gone as they usually last only a couple of weeks.  The recalled cantaloupes were shipped between July 29 and Sept 10.

Listeriosis is a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes.  It causes fever, muscle aching and sometimes diarrhea.  It feels like a bad flu with headache, stiff neck, confusion, loss of balance and in severe cases, convulsions.  As with many infections;  babies, pregnant women, people with weakened immune systems and older adults are more likely to have severe illness.  There are about 1,600 cases annually reported in the United States.  The largest outbreak occurred in 2002 and the culprit was contaminated turkey deli meat.

It can take several weeks for symptoms to appear so even though the contaminated melons are probably gone, we may see more cases crop up.  Listeria bacteria can grow at room and refrigerator temperatures. The illness can be diagnosed with stool or blood cultures for confirmation.

The best way to prevent Listeria infection is to thoroughly cook raw food from animal sources.  Rinse raw fruits and vegetables under running tap water before eating and avoid raw (unpasteurized) milk.  Opened package lunch meats, deli meats, cold cuts and meat spreads are risky, as are soft cheeses such as feta, queso blanco, brie, and camembert,  unless the label says "Made with Pasteurized Milk".

The CDC say that "cantaloupes that are known to NOT have come from Jensen Farms are safe to eat. If consumers are uncertain about the source of a cantaloupe for purchase, they should ask the grocery store. A cantaloupe purchased from an unknown source should be discarded: "when in doubt, throw it out.""

Wednesday, September 21, 2011

Land Mines Around the World

We must not turn a blind eye to the shocking facts about land mines and the damage they cause to civilians and our own troops.  The fact that modern warfare involves buried explosives that are completely untargeted  should shock the conscience of the world.  The number of severe wounds that affect our servicemen is on the rise and the Army's Landstuhl Regional Medical Center in Germany is filled with casualties from Iraq and Afghanistan.

There have been 79 cases of multiple amputations this year for our U.S. soldiers...more than any previous year and through July, 134 servicemen and women lost limbs.  The year is only 1/2 over!

Doctors treating the troops said there is often damage to lungs, kidneys and livers from massive blood loss and shock.  Infection is rampant and 90 solders lost genitals from the blasts.  This is despite heavyweight chaps and Kevlar underwear and ground penetrating radar systems and increased armoring of vehicles.

Twenty-five percent of the world's unexploded land mines are buried in Iraq, which has more than 20 million mines.  They were planted randomly as far back as 1960.  The Ministry of Defense is in charge of clearance and uses private companies to do the work. Land mines killed or injured an average of two Iraqis every week in 2009.  Each day over 70 people,  somewhere in the world,  are killed or injured by a landmine.

The Ottawa Treaty or "Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction", was signed by 156 Countries to eliminate land mines around the world.  The United States, Russia and China have not signed the treaty.

Shocking but true.

Tuesday, September 20, 2011

Chocolate May Benefit the Heart and Reduce Stroke

In case you missed it, I'm happy to report something that should please most everyone.  A study published in the British Medical Journal showed that consumption of chocolate (candies, candy bars, chocolate drinks, cookies and deserts) lowered the rates of stroke, coronary heart disease and blood pressure.  It seems that chocolate is good for you!

The study (which did NOT receive funding from the chocolate industry) included 114,009 people and performed a meta-analysis of the medical literature.  They found that people who ate the most chocolate reduced their risk of heart disease by as much as 37% and their risk of stroke by 29%, compared with those who ate the least chocolate.  Having chocolate regularly, rather than binging, seemed to bring the most benefit.  They did not confirm the difference between dark, milk or white chocolate, nor were they able to say what amount is of most benefit.

Before you run out and eat a chocolate decadence cake or a bag of Hershey's kisses, there are a few caveats to consider.  All chocolate may not be the same in terms of benefit and most American candy chocolate is made with high sugar and dairy fat, not cacao beans.  The extra sugar and fat may probably  reduces the health benefits of pure chocolate.  Pure chocolate has no sugar and no carbohydrates.

A meta-analysis is not nearly as good or reliable as a prospective, controlled study.  It is a review of past studies and a "pooling" of the data to come to conclusions.  Because the studies are not consistent, there is no way to tease out  the "types" of chocolate or even what is mean by eating "higher" quantities of chocolate.  Some trends can be identified, but there is no true cause-effect with a meta-analysis.  It simply points researchers in a direction .  For these reasons, the authors recommended further research to prove (or disprove) that chocolate can actually benefit the heart.

But...until those trials are done, we can take this information and be happy that there "may" be health benefits from eating chocolate.  We already know that fats, sugar and excess calories are extremely health detrimental,  but regular consumption of chocolate with a high cocoa content might be OK.

Friday, September 16, 2011

Cocaine Smuggler Swallowed Drugs

This CT scan reveals reddish capsules that are intertwined through out this man's intestines.  The 72 capsules are filled with almost a kilogram of cocaine.  The man was arrested in Sao Paolo, Brazil, as he was getting ready to board a flight to Brussels.  He was an Irish guy and he was taken to the hospital for removal of the baggies.  We don't know how they were removed but usually they are expelled with laxatives.

If one of the capsules ruptures it can be life threatening to the "human mule".  Last week a Colombian woman, Sorlinda Vega,  died in a New Zealand hospital after a bag of cocaine burst in her body.

Approximately 5 people a day are arrested for drug smuggling in San Paolo International Airport.  The airport has connections to 53 countries.

Tuesday, September 13, 2011

Doctors Improving Quality

I spent the day today with 60 physicians and nurses at a symposium focused on quality improvement and reducing mortality from sepsis.  Sepsis (overwhelming infection) is the number 1 cause of hospital deaths and the mortality rate can be as high as 60% if the patient goes into shock from infection.  Survival depends upon thousands of independent pieces coming together in an organized way.  A patient doesn't come to the emergency department and say "I have sepsis".  He may arrive by ambulance or be brought in by a relative and simply feel weak, or confused or have a fever.

To make the diagnosis, the doctor or nurse has to be thinking sepsis is a possibility and it is critical to get the right tests and treatments within a very short time frame.  There are complicated steps that must be taken quickly and the entire hospital team (lab, pharmacy, transport, doctors and nurses)  must act in a coordinated way to treat the patient with the right tests, antibiotics, and massive fluids.  None of this happens without processes being put into place and that is where quality improvement teams come in.

It is so gratifying to see my clinical colleagues spending their precious time learning ways to improve the quality of care of our patients.  No-one gets paid to go to these conferences and quality improvement takes a lot of time and effort.  I believe our patients would be surprised to know how dedicated we are to improving hospital care and when a patient with sepsis is discharged to resume their normal life, how much teamwork went into that successful outcome.

 Addendum:  Although I like to refrain from politics on this blog, I couldn't help but contrast the selflessness of my colleagues today, focusing their precious time (for no pay) on improving patient care, with the shocking Tea Party GOP debate where Texan Ron Paul and his audience supporters believe a 30 year old should die in a hospital rather than have any government funded health care.  It's every man for himself.

Monday, September 12, 2011

Medicine Prices in 1900

Click on image for a better view
This looks like a pretty good deal.  Physicians in attendance, large, well ventilated rooms and food.  Medicine and nursing by caring nuns included.  All for $7-$10.00 a week.  If that is too expensive you can opt for a ward for $4-$6.00/week.

Of course, you will likely be prescribed arsenic and be bled via a slice in your arm vein.  Enemas and purgatives are the treatment of the day.  And the guy next to you on the ward will be coughing with tuberculosis.

Friday, September 9, 2011

Sjogrens Syndrome Slows Venus Williams

U.S. Open 2010
I was lucky enough to see Venus Williams play her first professional tennis match when she was a teenager.  It was obvious she was something special and her coach-father said "If you think she's good, wait until you see her little sister." (Serena Williams).

Venus and her sister, Serena have dominated women's tennis over the past decade but she is currently sidelined with a diagnosis of Sjogrens Syndrome. (pronounced Show-grins).  It is a chronic auto-immune disorder where white blood cells (immune function cells) target the body's moisture-producing glands.  Symptoms include dry eyes, dry mouth, extreme fatigue and joint pain.  Sometime it co-exists with other auto-immune diseases like thyroid disease or rheumatoid arthritis.

Symptoms can wax and wane and getting the right diagnosis can take time.  I can imagine Venus going to her doctor and complaining of fatigue and dry mouth.  Considering her athletic schedule, she was probably told to get some rest and fluids.  The diagnostic key should have been the degree of fatigue that plagued her for years, coupled with the dry eyes and mouth.  Often the mouth is so dry, taste is affected and the lack of saliva can produce dental caries.

Although a blood test can reveal antibodies that go along with Sjogrens, some people have the disorder without showing blood abnormalities.  Sjogrens and other auto-immune diseases are complicated and diverse and the symptoms can flare up and then remit.  There are many "home remedies" that patients swear by, but the best place to start is with a rheumatologist who can both make the diagnosis and prescribe treatment to block the antibodies and relieve symptoms.

Venus believes she will return to tennis, and I would bet on her.  She is a major talent; graceful, athletic and fun to watch.

Wednesday, September 7, 2011

NSAIDS May Increase Risk of Miscarriage

A new study of more than 52,000 pregnant women in Canada shows that miscarriage rates were more than twice as high for women who took a nonsteroidal anti-inflammatory drug (NSAID) compared to women who did not.  The study, published in the Canadian Medical Association Journal reported that women who used prescription NSAIDS for just 4 days during early pregnancy had an increased risk for miscarriage.

These medications are commonly prescribed for pain,  cramps, headaches and fever and can be bought over the counter as Advil, Aleeve or Ibuprofen.  We have thought they were safe in early pregnancy but this study shows that may not be the case.   Of the women who filled a prescription for an NSAID in early pregnancy, 7.5% suffered a miscarriage compared to 2.6% of those who did not fill a prescription.  Prescriptions filled were Diclofenac, Naprosyn, Celebrex and Ibuprofen.  The researchers controlled for other miscarriage risks like diabetes, depression, rheumatoid arthritis, lupus and untreated thyroid disease.

One problem with the study is that it only looked at prescription NSAIDs and women who were taking over-the-counter NSAIDs might not have been counted.  Also, filling a prescription does not mean the woman took the drug.  They also noted that about 15% of the women who did not have miscarriages got prescriptions for anti-nausea drugs, compared to about 3% of the women who miscarried.  It appears that morning sickness protects against miscarriage.  Or the drug that treats morning sickness is protective.

So what is a woman to do?  First of all, if you are pregnant and have taken an NSAID, don't worry.  This study was not perfectly done and there may have been other factors involved besides NSAIDs.  (The miscarriage group had higher rates of anxiety and depression).   Also the odds of having a healthy baby were far greater than a miscarriage.

If a woman is not yet pregnant, she would be advised to take Tylenol (acetaminophen) for pain relief instead of a NSAID.

Monday, September 5, 2011

Foods that Lower Cholesterol

All physicians recommend dietary (lifestyle) changes for patients with high cholesterol (aka: hyperlipidemia).  But this dietary advice which focuses on low fat intake is often confusing for patients and physicians can be pessimistic that it will even work.  Many rush into prescribing statins because we know they will "get the numbers down".  New evidence published in the Journal of the American Medical Association (JAMA) shows that diets high in plant sterols, soy protein, viscous fiber and almonds was more effective than a low fat diet  in reducing cholesterol after 4 weeks.

The researchers called the cholesterol lowering foods a "dietary portfolio".  They included soy protein, sticky types of fibers like oats, barley and psyllium, vegetables, nuts and plant sterols.  These plant sterols work by blocking the absorption of cholesterol in the small intestine.  Fruits, vegetables, nuts and seeds have plant sterols as does some of the new enriched margarine found in the grocery store.  In this study, when these foods were included in the diet, serum LDL-cholesterol was reduced by 28-35%.

They compared this regimen which included two counseling sessions with more intensive treatment, a low fat diet and multiple office visits.   The reductions were the same whether the participants received few or many counseling sessions but the  "dietary portfolio" participants had greater reduction in LDL levels.  The benefit was greater than the low-saturated fat diet group, irregardless of the number of counseling sessions.

A previous study found that a dietary portfolio featuring plant sterols, soy protein, viscous fiber and almonds was just as effective in reducing LDL cholesterol and CRP (C-reactive protein) as a low-fat diet plus Lovastatin.

This study further suggests we can successfully use simple dietary changes and avoid prescribing Statins to reduce risk of cardiovascular disease.  Diet changes really do work and incorporating plant sterols is easy to do.

Sunday, September 4, 2011

Summer Fresh Tomato Pasta

The farmers market in my area is bursting with fresh tomatoes now.  If you are lucky, you have tomato plants that are producing fruit.  Here is a healthy way to use tomatoes that your family will love.

Summer Fresh Tomato Pasta

Serves 4-6
6-8 tomatoes chopped
5 tbs extra virgin olive oil
Juice of 1/2 fresh lemon
1 chopped clove garlic
1/2 cup chopped fresh basil
Salt and pepper
1lb spaghetti pasta
1/2 cup grated Parmesan cheese

In a large bowel mix the tomatoes in the olive oil. Add lemon juice, basil, salt and pepper.
Cook the spaghetti al-dente in a large pot of water
Drain pasta and immediately toss with the tomatoes.
Top with cheese and enjoy

EverythingHealth tips:
  • You can make this recipe even more healthy by adding 1 cup of chopped zucchini
  • Olive Oil and Canola Oil are the only cooking oils you will need in your pantry.  Both are heart healthy
  • If you are dieting or want to avoid the 225 calories in 1 cup of spaghetti, substitute spaghetti squash (only 40 calories/cup)  for a really healthy dish.
  • Tomatoes have the highest content of Lycopene of any fruit or vegetable.  Lycopene acts as an anti-oxidant in the body and helps fight cancer and heart disease 
  •  Tomatoes should not be refrigerated as they loose their consistency and flavor.  Keep them in a cool place and eat as soon as you can after picking

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