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Showing posts from June, 2012

Incense and Bath Salt Intoxicants

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I've been hearing about kids ingesting bath salts and incense to get high for the past year.  I had never heard of this before.  These synthetic legal intoxicating drugs (SLIDs) have come on the scene and have increased in popularity.  Who would want to snort bath salts or smoke incense?   What the heck are these things?

Although they are sold as bath salts and incense to avoid FDA regulation, they are really powerful psychoactive drugs that can have intoxicating effects.  They are sold over the counter at quick-marts and on the Internet.  Herbal incense products affect the cannabinoid receptors in the brain just like marijuana (THC).  Although they differ in chemical structure from natural occurring cannabinoids, they affect the same receptors and can be stronger than THC with potential for overdose and severe toxic effects.  Some of the effects reported by emergency departments and poison control centers were agitation, anxiety, dysphoria, elevated blood pressure, hallucination…

What if Health Law is Overturned?

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The Supreme Court is likely to rule on the 2010 Accountable Care Act (ACA-Health Insurance Reform-Obamacare) this week and it will be the most important decision this court has undertaken. The court could strike down the entire act or rule that the individual mandate is unconstitutional.  Washington and policy makers are buzzing with possible scenarios depending upon what the court does.  Here are a few of those:

First let's look at Medicare.  The ACA changed the formulas that Medicare uses to pay providers and it will be increasing reimbursement for primary care.  It baked in financial incentives for doctors and hospitals that achieve quality benchmarks.  The Centers for Medicare and Medicaid pays out 100 million medical bills each month according to the new pay scale.  What will happen if the law is overturned?  Will it go back to 2009 pay?  Will pay be frozen until the House Ways and Means and Senate Finance Committees can meet and decide?  No-one knows.

The Health care law a…

Herpes Zoster

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Yes, you smart readers.  The answer to yesterdays challenge is Herpes Zoster, AKA: shingles.  Grady Doc was most precise with Herpes Zoster Ophthalmicus.  (involving the eye and optic nerve).  Note that the lesions do not cross the midline as they remain in the nerve distribution.

Treatment with antiviral medication is effective if started within the first 48 hours of symptoms.



Diagnostic Challenge

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Here is this weeks diagnostic challenge where readers of EverythingHealth can test their diagnostic skill.  This man had a mild headache, fatigue and tingling sensation, followed by this weepy rash.  His right eye also became blurry.  What is the diagnosis?  In this case I am not giving you any multiple choice answers.  Just make the diagnosis.

The Answer will be posted tomorrow.  Good luck

Image from consultant360

Manipulating Gift Giving

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A court appointed official that oversees copper heiress Huguette Clark's estate wants the money back.  It seems this elderly, eccentric multimillionaire showered her private nurse with $28 million in real estate, jewelry, checks and other gifts.  The nurse, Hadassah Peri made a salary of $131,000/year in addition to the "gifts".  Her immediate family received another $3 million.  Other nurses and doctors that cared for her received more than $4 million and she even paid one doctor's malpractice insurance.

Mrs. Clark was frail and reclusive and died at age 104.  Her lawyer and accountant have both come under scrutiny for their management of her affairs and their own large gifts bestowed by this woman.  They were both suspended by a judge from further overseeing her estate.

Huguette Clark was the daughter of a wealthy Montana senator who mined copper, built railroads and founded Las Vegas.  She spent the last 20 years of her life in two Manhattan hospitals, finally d…

Overused Tests

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The American College of Physicians (ACP) is committed to promote high-value, cost-conscious medical care.  They make the point that some treatments are expensive but offer great value, while others may be considered inexpensive and offer little value.  Price (cost) does not equal value. (for more on this read my post on price and quality)

One area where overuse is common is in testing or screening tests.  ACP published a consensus that named 37 commonly overused diagnostic procedures and treatments.   You may be surprised about what they are and here are a few:
Annual lipid screening for patients not receiving lipid-lowing drugs or diet therapyScreening low risk people for Hepatitis B  (If you don't have unsafe sex or use IV drugs you are not at risk)Screening for colorectal cancer in adults older than 75 or with a life expectancy of less than 10 years (Yes, lots of doctors do colonoscopies on demented folks in a nursing home or 85 year olds)Ordering chest Xrays for hospital patie…

Calcium Supplements and Heart Attack

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Many patients who have been advised to supplement with Calcium (especially women for bone protection) were thrown for a loop by the study in the British Medical Journal that linked calcium supplements to heart attack.  Here is what the researchers found:

They studied 24,000 German and European patients ages 35-64.  Using questionnaires, they quizzed them about their vitamin and mineral supplements.  They also tracked their health for 11 years, looking at heart attacks, strokes and death.  (These studies can be easily done in countries with Socialized Medicine because everyone has health coverage and electronic records!!!)

They found that the intake of calcium supplements did not affect the risk of stroke, either protection or causation.  But the people who took calcium supplements daily were 86% more likely to have a heart attack than those who didn't use any supplements.  Dietary calcium caused no problem, it was just the supplements.

What should we make of this study?  Dietary …

Risk of Suicide with Antidepressants Over Estimated

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When the US Food and Drug Administration issues a black box warning, it is usually to alert physicians of a serious side effect of a drug.  That warning is highlighted in all of the package material of the pharmaceutical and is a big deal.  For years, the SSRI antidepressants have carried a black box warning that the drug might cause suicide in children and adults.  This warning was there despite the fact that no actual suicides occurred during the drug trials but patients did experience suicidal thoughts and behavior.  I remember hearing about lawsuits against psychiatrists when medication was prescribed and it was thought to have contributed to suicide attempts.

A new meta-analysis study has been published in the Archives General Psychiatry that analyzed 9185 patients who took Fluoxetine (Prozac) and Venlafaxine (Effexor).  These included 7517 adults, 960 geriatric patients and 708 youths.  Contrary to the black box warning, they found that these medications decreased suicidal thou…

How to Cut Risk of Heart Disease

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Which of the following measures will cut a patient's risk of heart disease by 50%?

1.  Losing weight
2.  Stop Smoking
3.  LDL-C below 100 mg/dl
4.  Blood Pressure below 120/80 mmhg

If you said "Stop Smoking" you would be correct.  Does that surprise you?  We hear about blood pressure control, cholesterol control and getting weight under control but cigarettes are the biggest risk factor for having a heart attack or stroke and quitting smoking is the single most important step to reducing risk.  A 50 year old male smoker who is overweight, hypertensive, and has high cholesterol has about a 25% change of having a heart attack in the next 10 years.  If he stops smoking he can reduce that 10 year risk to 11%.

It is hard to believe anyone still smokes but according to the Center for Disease Control and Prevention (CDC) there were 43.5 million adults in the United States who smoked in 2010.  Smoking related diseases cost us all about 96 billion in health care costs annually.