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Showing posts from February, 2012

Dark Spots in Eye and Skin

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I must admit, being a physician, I notice unusual skin changes where ever I go and I'm fascinated with the variety of conditions I see.

 Thanks to the Captain of our snorkeling trip in Hawaii for allowing these photos of his congenital condition called Nevus of Ota. (Originally described by Ota and Tanino in 1939). As you can see, there is a gray or blueish patch on the skin around the eye and hyperpigmentation on his sclera. This is in the distribution of the opthalmic and maxillary branches of the trigeminal nerve and consists of increased pigment producing melanocytes. Because he works in the sun, the pigmentation is probably more noticeable.

 This condition causes no problems. Ninety percent are unilateral (one side only) as is his. There is a slightly higher incidence of developing melanoma, but that is rare and it does not affect his vision. Another condition called ocular melanosis looks the same but does not involve the skin. BTW...the snorkeling and whale watching …

Overuse of Cardiac Stents

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One of my patients is in the hospital in another city (where he lives part of the year) after suffering a GI bleed.  He had a black stool, had lost blood, was quite anemic and experienced weakness and chest tightening before he came to the ER.   In the emergency room his Cardiologist was called and admitted him under the cardiology service.  When I called the Cardiologist to identify myself as his Internist, he told me the patient was getting a transfusion and he wanted to do an angiogram to see if his prior stents were open and possibly put in more stents. 


What?  Stop right there.

The patient has chronic renal failure,  has low blood counts, was quite stable with no symptoms, was receiving a transfusion and the cardiologist wants to put in stents?  There are so many things wrong with this story I wanted to scream.

First of all, the workup should first zero in on the GI tract and find out why the patient had lost blood.  He was not experiencing any chest pain or tightness once he rec…

Blogger Break

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EverythingHealth will be taking our own advice and renewing the spirit and soul for the next week. 

Check out the links on the right side for great blog reading and be sure to check back for more exciting health news in a week.  Aloha!

Avoid Obesity and Let Babies Eat With Their Hands

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Babies who feed themselves with their fingers chose less sugar and were less likely to become obese than spoon fed babies, according to a study in the British Medical Journal Open.  It was a small study based on recollection, but the findings were still interesting and give us clues about how children self regulate food.

When babies start eating solid food, parents often offer sweetened baby food or little sweet "treats", thinking babies will prefer that.  In fact, the babies who self fed chose carbohydrates like toast, pasta or potatoes and the spoon fed babies went for sweets when given a choice.

Parents worry about  providing a balanced diet and also worry if a child is eating too much of one item.  Studies show, however, that self feeding babies will actually take care of their own nutrition if all options are provided like fruits, vegetables, proteins, and iron rich foods like hard-boiled eggs or strips of meat.  Pureed baby food is often filled with added sugar and s…

First Aid for Car Crashes

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A big crash happened right in front of me today while I was at a stop light.  The sound of crunching metal and screeching brakes is truly frightening and it was clear help would be needed.  I crossed the intersection and parked my car and ran across the street to see if I could help.  Surprisingly, the man driving the car that was hit was not hurt.  The young woman in the car that struck him was on the side of the road sitting on the curb and profusely bleeding from her nose and face.   She appeared to be in shock.

What do you do in a situation like this?  The first thing to do as a first responder is to keep calm yourself.  Quickly assess who needs assistance first.  Do not move victims unless they are in a dangerous situation.  If the victim is conscious ask simple questions:  "What is your name?", "Are you in pain?" "Do you know the date?"  While you are doing this, make sure someone else is calling 911 for assistance.  If other people are around,  in…

Alternatives to Komen Foundation

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Sometimes my fellow health bloggers get it so right...the best thing I can do for my readers is steer them to another blog.  And that is what I am doing.

The Blog That Ate Manhattan is written by Dr. P. and she did a great job of pointing out that we can still donate to the fight against breast cancer, now that the Komen Foundation has shown their true political leanings.  That debacle will certainly be a classic case study in how you can shut down a money-making brand in one day.  First it was a wrong decision by the board of directors, followed by their silence in the face of an internet storm.  Wasn't anyone paying attention to the "Arab Spring"?  The power of the people is strong.

Ah, but I digress.

Check out TBTAM and see how many other choices are out there besides fake pink.

Social Network Medicine is a Bad Idea

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I like social networking as much as the next person and as an "early adopter" medical blogger no one can accuse me of not being dialed into "The World Wide Web" or "The Facebook".  But my embracing of mobile health stops when I read about a new start up that was mentioned in the New York Times  this week.  HealthTap is a concept that I hope doesn't make it.

HealthTap is a start-up based in Palo Alto, Calif (where all good start-ups are born) and consumers can post health questions  that are answered by physicians who log on.  After this free medical advice is given,  the readers can click the agree or thank button and the most popular doctors get a "Doogie Howser Award" or a "Dr. Healthcliff Huxtable Award."  Just writing this makes me feel so cheap!

What is the  point of all of this?  I am not really sure.  There are social network features on the site and maybe they will develop games and quizzes.  There are phone numbers and ma…

Polio Survivors

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Poliomyelitis is a contagious viral disease that affects nerves and can lead to paralysis.  Most people under the age of 50 don't know that polio was once an epidemic that killed and paralyzed millions of people between 1840 and the 1950's.  It was one of the most feared infections world wide. Modern polio vaccination has almost wiped out the disease.

It is rare for physicians in the  United States to see the effects of polio and most will never encounter it in their career.  There are reported to be about 450,000 polio survivors in the U.S. who have some disability from prior polio infection.

My patient (now in her 70's) was kind enough to allow these photos of her left arm paralysis from polio she contracted at age 9.  Her story is amazing.  She was kept bedridden in  a "crippled childrens home" in New Jersey for over a year.  During that year every one of her children roommates died.  She did not attend school and even though she could walk, she was kept in b…

Concussion Management

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It's football, soccer and ice-hockey season and that means concussions.  Concussion is a mild traumatic brain injury that is the result of a blow to the head. It is so common that over 1 million visits annually to emergency rooms are for concussions.  And most people don't even go to the emergency room so it is estimated that 3 times as many occur as are reported.  Sports related activities and accidents are the main cause of concussions in children and adolescents.

Concussions can be difficult to recognize and there is no specific definition or test that can diagnose it.  Clinical judgment and specific symptoms after an injury define concussion.  The patient does not need to lose consciousness and the symptoms can come on gradually but usually appear immediately or shortly after the injury.   Headache, dizziness, balance disturbance and disorientation are the most common symptoms.   Cognitive defects can occur like confusion, delayed verbal responses, difficulty concentratin…