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Showing posts from December, 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…