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Showing posts from January, 2012

EverythingHealth Anniversary

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Thank you to loyal blog follower, KM, for this cute pic.  EverythingHealth is now getting over 4,000 page views a day from all over the globe.  That is just amazing to me and I have met so many wonderful bloggers over the past 5 years. I am fascinated by the power of the internet and how readily information can be found.

My goal of providing credible, up to date information without commercial content has guided me throughout these years.  I often forget my old posts until someone reminds me...then I am surprised all over again.  Researching and writing this blog keeps me on top of my game.

Thank you for visiting EverythingHealth.  Sign up on the right side for an alert and you will get a link for each new post.

Romney Should be Proud of Massachusetts Health Care

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I don't understand why Mitt Romney is running away from the Massachusetts health reform that was enacted in 2006 under his reign as Governor. They are in their 6th year and by any standards it can be considered a success.

The plan included Medicaid expansion, subsidized private health insurance, a health insurance exchange, insurance market reforms and requirements for individuals and employers. Is the fact that the Federal Accountable Care Act (Obama-care) has many provisions of Mass. health reform the reason Mr. Romney and the GOP want to bury it's success?

Oh, you didn't know it was a success?  How strange...

Let's look at the plan and what it has done for the citizens of that State. Insurance rates did not sky-rocket and employer-sponsored insurance is still strong. Access to health care remained strong and there were reductions in emergency department visits. Hospital stays declined and there were improvements in self-reported health status. Since the ac…

Heavy Menstrual Bleeding

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Heavy menstrual bleeding is common and 10% of all women experience it in their reproductive years.  Women who are NOT in menopause and who have heavy bleeding that occurs during their regular cycle usually have a benign reason for the bleeding.   Fibroids and endometrial polyps are common causes of heavy bleeding periods.

Menorrhagia is the medical term for abnormally heavy periods.  This bleeding is often associated with severe cramps.  What is considered heavy?  Soaking through one or more sanitary pads or tampons every hour for several hours or needing to wake up during the night to change protection is heavy.  Bleeding for longer than a week or passing blood clots is abnormal also.  Menorrhagia should be evaluated by a physician to rule out polyps, bleeding disorders and other medical conditions like pelvic inflammatory disease, endometriosis or thyroid problems.

Once reversible causes have been excluded, most women respond to treatment with oral contraceptives to regulate hormon…

Migraine Headaches and Oral Contraceptives

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Women who are taking oral contraceptives (Birth Control Pill) and develop new migraine headaches or increased severity of headaches after starting the Pill should be told to discontinue the Pill.  Women with migraine who use oral contraceptives are at a 2-4 fold increased risk of ischemic stroke compared to women who have migraines and are not on the pill. 

The risk of a young woman having a stroke is very small if she is not a smoker.   Smoking increases this risk and women who smoke should not take the Pill because it increases the risk of both heart attacks and strokes.  Even the low dose oral contraceptive is not completely safe in smokers. 

A  woman under age 35, who does not smoke and has longstanding migraine headaches without "aura" may be prescribed OCPs because the risk of stroke is small in this group.  New migraine, however, is an indication to stop the pill and use another form of birth control.

A Novel Approach: Ask the Primary Care Doctor

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The government, academics and policywonks are always in the process of "redesigning" health care.  Patients with increased health care needs are considered "complex" and these patients consume the major health resources (translate: "money").  In fact 65% of total health care expenditures are directed toward the 25% of patients with multiple chronic conditions.  Eighty percent of Medicare spending is on patients with 4 or more chronic diseases.  For the first time a study has been done and published in The Annals of Internal Medicine  that actually asks primary care physicians (PCPs) what defines patient complexity.  Who better than the treating doctor to answer this question?

The researchers asked 40 primary care physicians to rate the complexity of 120 of their own patients and to document the characteristics associated with complexity.  Over 1/4 of patients were described by the doctors as "complex".  The doctors were not told what defined &q…

The Many Faces of Psoriasis

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This 26 year old female noticed that her nails had been changing over a 6 month period.  Note the small pits and separation of the nail plate from the nail bed.  This lifting is called onycholysis.  There is only one disease where both of these findings are seen together and that is psoriasis.

Most people think of psoriasis as a skin disorder with patchy silvery plaques that form on the elbows, arms, knees and back.   But it is a genetic condition that can also affect the nails and 1/3 of patients develop psoriatic arthritis.  It is actually a very common disorder with wide variation in skin, joint and nail involvement.   The condition can come and go and there are a number of treatments to control symptoms, but no cure.

Psoriasis is not contagious and you cannot "catch" it.  The National Psoriasis Foundation conducted a survey of patients with psoriasis in 2008 and 71% said psoriasis was a difficult problem for them with self consciousness and embarrassment about the condi…

Bone Mineral Density Tests

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The recommendations for when and how often women should be tested for osteoporosis with bone density testing (DXA Scan) has been vague.   Many women are tested in their early 50s when they go through menopause with follow up tests as frequently as every year.  Others break a hip without ever being tested.

 A new study published in The New England Journal of Medicine states that bone loss develops slowly and women who have a  normal test when they are 65 do not need to be retested for 15 years!  Even women who show some bone loss can wait many years before they are tested again, according the the study authors.

The study followed 5,000 women over age 67 for over 10 years.  These women did not have osteoporosis at the beginning and they found fewer than 1% of women with normal beginning bone density developed osteoporosis over the next 15 years.  Only 5% of women who started with mild bone loss developed osteoporosis.

This study points to the fact that we have been over testing normal …

Skin Conditions With Aging

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Patients often have growths or skin changes that they wonder about.  After examining them, in many cases I say "happy birthday"...it's a manifestation of getting older.  Aging leads to a number of skin and hair changes and when you add the effects of sun, smoking and the environment,  the changes can be profound.
Over time the epidermis thins and by age 60 the dermis is 20% thinner than before.  It is even thinner in areas that have been exposed to the sun.  But even skin that has not been exposed to ultraviolet radiation has 50% fewer mast cells and reduced blood flow, not to mention diminished elastic fiber and collagen.

Pictures are worth a thousand words so here are some to show the changes.
Fine and deep wrinkles are evident on this face.  Thin skin around the eyes causes bags and drooping of the eyelid.


Actinic Keratosis are benign, dry, reddish, crusty lesions that appear on sun exposed ares like the face, ears, hands, chest and arms.  Sometimes a biopsy is needed…

Haiti Remembered

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This is the 2nd anniversary of the terrible Haiti Earthquake that measured 7.0 on the scale. The disaster killed 316,000 people and displaced 1.5 million more.  Even now more than 500,000 people are still in makeshift shelters and only half of the aid pledged for reconstruction has been spent. 

My organization sent medical teams and supplies to the disaster zone and our doctors and nurses continue to support a hospital with teaching and supplies.  I led a team of dedicated caregivers to Port-Au-Prince where we served under the most austere conditions.  Supplies were non existent.  There was no running water in the hospital and the magnitude of the health problems required infrastructure that was not there...and still is not there.  

The following is a reprint of a blog I did on 3/20/2010.


I can't get the stories of Haiti out of my mind.

A patient showed up at the Port Au Prince hospital ward with a massive left sided paralysis, an obvious stroke. This 48 year old woman had coll…

Patients Owning Their Medical Records

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Traditionally, the patient chart stayed in the doctors office and rarely did a patient get a glimpse of anything in the record.  Photocopying the chart is expensive and no physician would let a chart leave her office because the record must be held safely for a minimum of 7 years.   Now more and more offices are doing away with clunky paper charts and electronic medical records are becoming the norm.  With electronic portals, is there any reason a patient shouldn't have access to their own medical record?

A study published in the Annals of Internal Medicine reported that up to 97% of patients queried thought the ability to have "open visit chart notes" was a good thing.  Doctors weren't quite so eager.

The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits.  But the patients overwhelmingly wanted to see the notes and were not worried about being …

Nail Trauma Paronychia

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My patient welcomed in the New Year by doing a midnight 21 mile run through the streets of San Francisco.  It was a clear, crisp night and what a healthy and invigorating way to celebrate New Year's Eve!  The next day, however, her 2nd toe looked like this.  It was throbbing and tender to the touch.  She did not remember any specific trauma.

By the looks of the photo, it is a paronychia, an infection around a fingernail or toenail.  This infection is probably the result of repeated trauma as her foot struck the ground and the top of the nail struck her shoe.  A little bacteria (staphylococcus) was able to take hold in the skin as it broke through the protective cuticle.

Because she is healthy, without diabetes or other immune problems, I advised frequent hot water soaks to increase blood flow and (hopefully) promote natural immune healing.  If the swelling worsens or pus appears, it can be cured by excising it to drain.  Topical antibiotics are of no use and rarely are oral antib…