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Showing posts from April, 2012

Aging skin bruising

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It is not uncommon for a friend or relative to corner me with a worried look on his face and ask me about bruising on the arms or legs.  It is one of the more common concerns of patients in the office too.  People are worried that it is a harbinger of leukemia or some other blood disorder.  "Look at my skin.  These spots just appear for no reason.  What are they?"

What I'm seeing is the natural effect of aging and sun damaged skin.  The medical term is "Senile Purpura"...a term I actually hate and pronounce "sanili purpura"  just to make it sound better for patients.   It is simply easy bruising that shows through thin dermis.  Many people are taking aspirin or blood thinners that make the capillaries fragile.  Couple that with the lack of subcutaneous fat and elasticity that occurs with aging and you have purplish bruises that look positively frightful.  These bruises usually appear on the forearms or backs of the hands and shins.

There is no treatm…

Love Your Body - 12 Month Challenge

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The Dangerous Choking Game

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There is a game that pre-teens are playing that has killed 82 kids since 1995, according the the Centers for Disease Control (CDC).    It is called the "choking game" and these youngsters have no idea how dangerous it is.  There are probably thousands of choking deaths all across the country that have not been reported to the CDC and countless parents who think their child committed suicide, when he might have just unknowingly been playing a game.

The choking game is not new at all.  I know about the choking game because I played it with my girlfriends as a kid too.  I hadn't thought about it for decades and we had no clue that it was dangerous and just thought we were having fun.  At a slumber party (now called a "sleep-over") one girl would hyperventilate for a few minutes and then hold her breath while another squeezed her from behind across her chest in a tight bear hug.  Within a few seconds she would black out completely and fall to the floor. 

I can…

Hidden Health Care Pricing and Costs

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More and more employed people who have health insurance are facing large deductibles so they are actually paying "out of pocket" for tests, Xrays and doctor visits.   Health care policy-makers talk about involving the consumer in the cost of care as a way to force competition and hold down prices.  But finding out how much something costs can be a herculean effort and take hours of time phoning around.   Despite a law in California that dates back to 2006 that requires hospitals to post common test prices, it is nearly impossible for a patient to find out ahead what something costs.

I gave my patient an order for a hip Xray to evaluate pain that would not go away.  Because she has a $5000 deductible with Anthem Blue Cross insurance, she knew that she would be paying for it.  She spent hours calling local hospitals to compare prices and became more frustrated and confused as time went on.  She was told they couldn't look it up without a code.  She was asked what hospital…

Red Meat Linked to Death

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Advanced warning: meat lovers are not going to like this. 

A well done study published in the Archives of Internal Medicine as shown that red meat consumption is linked with an increased risk of total death, cardiovascular death and cancer death.  Yup...death!  That goes further than what we knew before about red meat connection to heart attacks and strokes.  This is the big one.


This study looked at two large studies that contained 28 years of follow-up data:  The Health Professionals Follow-up Study and the Nurses' Health Study.   The researchers excluded subjects that had a history of CVD or cancer at baseline or left more than 9 study questions blank.  They ended up with 37,698 men and 83,644 women.   

They found some interesting things.  Both men and women with higher intake of red meat were less likely to be physically active and were more likely to be smokers, drink alcohol and have a higher body mass index (fat!).   Additionally, those with higher intake of meat had lower…

Lepromatous leprosy

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The answer to yesterday's diagnostic challenge is #2.  Leprosy.

 Most of you were correct.  The patient's face had multiple nodular lesions that coalesced into plaques.  After 9 months of multidrug treatment the skin infiltration and weakness in the left eyelid had diminished.

Leprosy is caused by the bacterium, Mycobacterium leprae.  It is not very contagious and has a long incubation period before symptoms begin.  The lepromatous type causes large bumps and lumps and is the most severe. 

Effective medications exist to treat leprosy, which is also known as Hansen's disease.  Usually different antibiotics are used together.   It is important to diagnose the disease early so treatment can limit damage and disfigurement.

What is the Diagnosis?

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Today's diagnostic challenge is from The New England Journal of Medicine and it is pretty straight forward.  Click on the image for a better view and make your diagnosis.  Check back tomorrow for the answer.

1.  Granulomatosis with polyangitis
2.  Lepromatous leprosy
3.  Neurofibromatosis type 1
4.  Sarcoidosis
5.  Tertiary syphilis

Don't be shy.  Post your guess in the comments section.

Doc Groups Identify Unnecessary Tests

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When nine prestigious Medical Specialty Groups get together and identify tests that are unnecessary and wasteful, it is time to take notice.  In a rare effort, each specialty identified 5 tests and procedures that do not add value and that may be unnecessary or overused.  In all, 45 tests and procedures were listed as part of the ABIM "Choosing Wisely" campaign, a multiyear initiative that aims to reduce the waste in medicine and increase dialog between patients and physicians. 

What are some of the 45 tests and procedures we should not do?

From The Academy of Allergy, Asthma and Immunology:
IgG and a battery of IgE  and other unproven allergy skin tests.Antibiotics for uncomplicated sinusitis (only .5-2% are bacterial infections)Inhalant or food testing or extensive diagnostic tests for chronic itching/hives. From the American Academy of Family Physicians:
Xrays or MRI scans for low back pain within the first 6 weeks. (unless exam points to red flags).Dexa bone scans in wome…

Doctors Coat Helps Focused Attention

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A recent study in the Journal of Experimental Social Psychology found that wearing the white coat of a doctor caused the person to focus and pay more attention.  Wearing the white coat of a painter or other occupation didn't have the same effect.  The scientists call this enclothed cognition: the effects of clothing on cognitive processes.

The experiment was done with 58 undergraduates who wore either a white lab coat or street clothes.  Those who wore the lab coat made half as many errors on incongruity trials than those who wore regular clothes.  In a 2nd experiment, they randomly assigned 74 students to either wear a doctor's coat, wear a painter's coat or see a doctor's coat.  They were given tests for sustained attention and those who wore the doctors coat found more differences and had more heightened attention than the other two groups.  Further experiments also showed that the students who wore the doctor's coat had improvement in attention.

It appears tha…

The Supreme Court and Health Care Act

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The Nation is anxiously awaiting the ruling of the Supreme Court on the Health Reform Act (Accountable Care Act..aka: Obamacare) which will be announced in June.  The 6 days of hearings were unprecedented in their partisan tone and we got a good idea of how the justices will vote.  But no-one can truly predict how it will turn out until the last minute.  Each one has already rendered a private decision and the next two months will be for counterarguments and more deliberation before the final decision.

The justices can overturn the entire law, which would nullify many important health provisions that have already taken effect.  For example, 2.5 million young adults under the age of 26 could lose insurance coverage through their parents' plans.  Patient safety improvements that are already in effect would be reversed.  Preventive care goes away and  value based purchasing has just begun under ACA and could be reversed if the act is struck down. 

The justices could strike down the…

Toxic Sugar

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I watched "60 Minutes" tonight and it reinforced my evolving understanding that refined sugar is toxic for the human body.  Dr Lustig, a pediatric endocrinologist at UCSF, was interviewed along with other researchers and the evidence strongly confirms just how bad sugar is for us.  We know about its contribution to obesity and diabetes, but now research shows sugar raises LDL cholesterol, the culprit in heart attacks and stroke.  To add to the "sugar is toxic" message, research also shows that certain cancers have sucrose receptors and sugar makes cancer grow.


You may be saying, "Hey, refined sugar has been around for centuries and it was never a problem before. What's the big deal now?"

 The big deal is just how much sugar and high fructose corn syrup are hidden in our foods and the vast quantities that are now consumed.

 According to Whole Health Source, in 1822, the average American ate the amount of sugar found in one 12 ounce soda every 5 days. …