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Showing posts from October, 2011

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…

Male Circumcision

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Male circumcision has been practiced for cultural and religious reasons since ancient times and it is estimated that about 1/4 of the world's men are circumcised.  It is a controversial topic and the debate about medical benefits of circumcision has not been fully resolved.   The Journal of the American Medical Association (JAMA) has recently published three randomized trials from Africa that demonstrated  adult male circumcision decreases HIV acquisition in men by 51-60%.   That is a huge decrease for a virus that is ravaging the continent.  Observational studies in the United States also show such declines in heterosexual circumcised men.

In addition to HIV, male circumcision has been shown to reduce other STDs.  Herpes and HVP contagion were reduced in men and the female partners of circumcised men had a lower risk of bacterial vaginosis and trichomoniasis.   Since STDs are a significant problem in the United States, there may be societal benefits for male circumcision.

Opponen…

Doctors Charging Add On Fees

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My telecom bill is pretty high when you take the basic rate and then add on "additional bundled services ($4.99)", "Internet Services ($7.00)", "Additional Voice Service ($25.72)", Taxes, surcharges and fees ($10.47), "911 fee ($.24)" and "other charges and credits ($2.99).  One way doctors could deal with their declining incomes (down 7%-25% adjusted for inflation depending upon the specialty) is to mimic the phone company.  Just add additional fees and taxes to their charges.

How about:
CLIA lab compliance fee
Electronic medical record maintenance fee
business tax fee
Medical license renewal fee
DEA fee
State mandated pain management course fee
State mandated end of life course fee
Hospital Med Staff application fee
Continuing Medical Education fee

Get the point?  The cost of doing business keeps escalating as does the number of mandated regulations.  Other businesses can adjust by raising prices or charging add on fees.   Physician…

Calming

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Answer to Medical Challenge

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The answer to the Medical Challenge this week is #3 - Graves' disease.

The skin changes seen on the lower legs are typical of Graves' dermopathy.  The skin has a leathery texture, thickening and fissuring.

Graves' disease, named after the Irish doctor Robert James Graves, who first described it in 1835 is caused by an overactive thyroid gland.  Thyroid auto-antibodies stimulate thyroid hormone synthesis and secretion and the thyroid gland grows into a goiter.  (A goiter can occur with an overactive or underactive thyroid or even a normal functioning gland)  The hyperthyroidism causes tremor, hyperactivity, heat intolerance, weight loss and insomnia.  The eyes can bulge out and tear excessively and this is called Graves' ophthalmology.

Graves' disease is an auto-immune disorder and it is more common in women and in people with a family history of endocrine disorders.  Treatment consists of inhibiting the production of thyroid hormones, either by radioactive iodine th…

Michael Jackson's Doctor

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The 2nd degree manslaughter trial of Dr. Conrad Murray, the doctor who attended Michael Jackson at the time of his death June 25, 2009,  is now underway in LA.  The testimony that is taking place is certainly revealing of the last day of Mr. Jackson's life.  Michael Jackson died of an acute Propofol overdose and the toxicology report also revealed Valium, Lorezepam, Versed, Lidocaine  and Ephedrine in his system.  There were no illegal drugs.

Propofol is used as a powerful anesthetic and is given intravenously.  It is not a drug that would be used outside of a medical facility or hospital.  Versed (Midazolam) is also a drug that is used for conscious sedation for procedures in hospitals.

Dr. Conrad Murray is a cardiologist and served as Michael's personal physician.  He was trained at Meharry Medical College and did post graduate work at Mayo Clinic and Loma Linda University Medical Center in California.  He studied Cardiology at my alma mater, University of Arizona, and he wa…

This Weeks Medical Challenge

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Avert your eyes if you can't stand this weeks Medical Challenge  from the New England Journal of Medicine.  Click on the image for a better view.

This Patient is being treated for an endocrine disease.  What is it?
1.  Acromegaly ("giantism")
2.  Cushing's disease (excess cortisol)
3.  Graves' Disease (hyperthyroidism)
4.  Hashimoto's thyroiditis (a thyroid disorder)
5.  Type 1 diabetes

  The answer will be posted tomorrow so post your diagnosis in the comment section, smarty pants!

(In case you wondered...I did get it right.)

scintillating scotoma

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Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate is flashing, sparkles.  Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century  by a Dr. Hubert Airy who had migraine headaches.  The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain.   The scotoma affects both eyes and closing one or the other does not make it go away.  Sometimes the term "ocular migraine" or "retinal migraine"  are used to describe this phenomenon but these involve only one eye, not both.  The terms are often …

Bedside Manners Worth $42 Million

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A Chicago couple believes doctors should have good bedside manners and they have ponied up $42 million dollars to teach it.  Matthew and Carolyn Bucksbaum have donated to the Bucksbaum Institute for Clinical Excellence at the University of Chicago.  They made the donation for their own personal physician to lead it and say he's the kind of doctor students should emulate.  They were motivated to make the donation after Carolyn had a bad experience with an arrogant doctor who dismissed her illness and never apologized.

Large medical groups measure "patient satisfaction" with the physician and the medical office.  Doctors who are very good clinically can have horrible scores because of bad bedside manner.  There are many consultants who will come into an organization and "teach" better rapport.  And it is a well known fact that doctors with good communication and interpersonal skills get sued less...many times less or not at all!

Are empathy and interpersonal skil…