Wednesday, January 30, 2013

Health Benefits of Coming Out

Sometimes we need a study to tell us what is obvious.  A new Canadian study published in Psychosomatic Medicine shows gays, lesbians and bisexuals who "come out" about their sexuality are less anxious, burnt out and depressed than those who stay in the closet.  AND they are even less anxious than straight people of similar age!

The researchers studied 87 men and women around 25 years old of various sexual orientations.  They measured stress hormone levels, 21 bio markers related to immune function and symptoms of depression and found that the subjects who were open about their sexuality were the most mentally healthy compared to those who were still in the closet.   Gays and lesbians who were honest with family and friends about their orientation no longer had to live a double-life and pretend to be something they weren't.

This study helped explain another study published last year in the American Journal of Public Health.  That one found that after Massachusetts enacted its same-sex marriage law in 2003, there was a significant drop in medical and mental health care visits by gay men.  Of course costs also went down.

It isn't a surprise that living an authentic, honest life and being open with one's values is a building block for emotional and mental health.  It is stressful to lie, hide or feel ashamed about one's self and stress hormones are released that contribute to anxiety, depression and even heart disease.  I see patients all the time that are ill because if "dis-ease" more than disease.  When we push feelings inside and don't deal with problems directly, it manifests in impaired immune systems, poor sleep, anxiety and disease.

So now we have at least two studies that show living honest, authentic lives are associated with better health.  I think we knew that all along.

Sunday, January 27, 2013

I Love My Blog

Thanks to my faithful blog reader, KM, for reminding me that I have been blogging for six years.  I can't believe it has been that long but I love being a health blogger and interacting with readers and other bloggers across the globe. 

Recent visitors to EverythingHealth have come from Indonesia, Mexico, Australia, Taiwan, Hong Kong, India, South Africa, France, UK, Germany, Dubai, Turkey, Pakistan, Costa Rica, Kenya, Italy, Brazil, Malaysia, Singapore, Philippines, Canada, Uganda, Kuwait, Poland, Norway  and of course, the United States.

Saturday, January 26, 2013

Shame on the U.S. Congress

 The U.S. Congress has an approval rating at less than 5%.  In fact, porn, polygamy and the BP oil spill rate higher than Congress.  Pakistani President Asif Ali Zardari's rating within his country in 2011 was twice as high as the U.S. Congress current approval rating.   And this was before the New York Times shined a light on their shady dealings with pharmaceutical giant Amgen that cost the American people more than 1/2 billion dollars.

Millions of dollars spent by Amgen, who has 74 lobbyists in Washington, kissing up to members of congress has come back to them in a nice gift...with a bow.  Our trusted public servants were happy to help Amgen by delaying price restraints on a class of drugs used by kidney dialysis patients.  They inserted this paragraph into the fiscal cliff bill and, behind closed doors, approved it.  The delay will cost the Medicare program (and your tax dollars) $500 million over the next two years.

Note that Senator Max Baucus (D, Montana) and Orrin Hatch (R, Utah) supported this shady transaction.  Both senators have political and financial ties to Amgen, as does Mitch McConnell, the senate minority leader, who also influenced the deal.  These three senators received substantial contributions from Amgen's PAC, $68,000 to Baucus, $59,000 to Hatch and $73,000 to McConnell.

If this isn't enough to mimic flu symptoms, Amgen had pleaded guilty a few weeks before and agreed to pay CRIMINAL and civil penalties of $762 million, the largest fine ever for a biotech company.  You would think that would make them persona non gratis on capitol hill but no...they have friends in high places!

Really Happy CEO
Amgen's CEO, Kevin Sharer's pay package is $21 million.  That doesn't include his personal use of Amgen's jet ($247,743) a car and driver and $15,000 for financial planning services.  After all, with that kind of money, you need to find lots of tax loopholes to keep it.  How a company can plead guilty to CRIMINAL activity and then get the taxpayers to pay 75% of the fine is amazing.  I guess Corporations really are "people"...special people with friends in the Senate.

The next time you wonder about the price of healthcare in this Country, think of our policymakers and how crooked and dishonest they are.  The Fiscal Cliff was a Fiscal Gift for Amgen.

Herpes Simplex

The answer to yesterday's Diagnostic Image Challenge was #2 Herpes Simplex virus infection.

  The usual mouth Herpes Simplex looks more like this:

Oral Herpes is also called Herpes Labailis or cold sores.  Herpes is a virus that can occur anywhere on the body but usually appears on mucous membranes.  Most people are exposed to the Herpes Virus 1 (hv1) by the time they are 10 years old.  The virus can lay dormant in the body and emerge at times of stress, radiation (sun) exposure, or other illness.   The symptoms can cause malaise, tingling followed by pain, swollen lymph glands and generally last about 10 days. Antiviral medications like acyclovir and valtrex are very effective for prevention and for shortening the time of an outbreak.

Friday, January 25, 2013

New Strain of Norovirus Hits

A new strain of Norovirus has hit the United States with a vengeance.  The Centers for Disease Control (CDC) reports it is from Australia and was first detected in March 2012.  The new strain is proving to be very fast spread and virulent.  It is called GII.4 Sydney.  During the last 4 months of 2012, GII.4 Sydney accounted for 53% of 266 norovirus outbreaks in the United States reported through an electronic laboratory surveillance system called CaliciNet. About  half of the new virus outbreaks resulted from direct person-to-person transmission; another 20% were foodborne.

Norovirus comes on suddenly and causes nausea, strong vomiting, diarrhea and abdominal pain.  It is highly contagious and spreads easily in closed environments like cruise ships, day care, nursing homes and military barracks.  Norovirus is most prevalent during the winter months and is the most common cause of gastroenteritis or food-borne illness. 

What can you do to protect yourself against Norovirus or other types of food poisoning?   Most importantly, washing hands with soap and water, disinfecting surfaces, rinsing fruits and vegetables, cooking shellfish thoroughly and not preparing food or caring for others while ill.

For everything you ever wanted to know about Norovirus...go here

Thursday, January 24, 2013

What's the Diagnosis?

It's time for you to play doctor (or if you are a doctor, prove your skill) by making the correct answer on the  New England Journal of Medicine Image Challenge.  What does this patient have?

1.     Hand-foot-mouth disease
2.     Herpes simplex virus
3.     Herpes Zoster virus
4.     Folliculitis
5.     Scalded skin syndrome

Click on the image for a better view and post your answer in the comment section.  The diagnosis will be posted tomorrow.

Wednesday, January 23, 2013

Top Ten Dr. Visit Reasons

Medical training programs should take notice of a new study that was published in Mayo Clinic Proceedings.  It listed the top ten reasons why people see a doctor.  Keep in mind these were people who lived in Rochester and Olmsted County, Minnesota, but I suspect the conditions are not too different across the United States.  As I review the main reasons patients visit me, it seems like they got the list right.  Here are the conditions that  bring people to visit the doctor:
  • Skin disorders
  • Osteoarthritis and joint pain
  • Back problems
  • Cholesterol problems
  • Upper respiratory conditions (not including asthma)
  • Anxiety, depression and bipolar disorder
  • Chronic neurologic problems
  • High blood pressure
  • Headaches and migraines
  • Diabetes
They found that most of these chronic, non-acute problems were not age or gender related.  Half of the study population had a skin disorder like acne, cysts or dermatitis.  Among children and teens the main problems were skin, joint problems and upper respiratory conditions.   Patients over 65 showed  up with high blood pressure, cholesterol problems and ...again skin disorders.

All of these problems should be handled in a primary care office.  With the shortage of primary care doctors, however, we can expect health care expenditures to continue rising if these common problems are taken to specialists.  In my community it is difficult to find dermatologists who will see "skin disorders" and most do not accept any insurance.  They are happy to deal with cosmetic dermatology and biopsies but not routine dermatologic conditions.

Most orthopedic specialists are not interested in dealing with osteoarthritis, back pain or joint problems that do not require surgery or arthroscopy. 

With less than 2% of medical students expressing an interest in primary care medicine it will be interesting to see where the bulk of patients will be getting their care in the future.

Friday, January 18, 2013

Cough Lasts Longer Than Patients Think

It's winter and that means lots of viral colds, influenza and bronchitis. A new small study was published in The Annals of Family Medicine that addresses what we doctors already know...the cough following an illness often lasts for weeks after the infection has cleared.

The researchers surveyed almost 500 patients by phone.  They found that people expected their cough to clear up in about 7-9 days if they had a 100.5ยบ fever and a cough with mucous.  The researchers then reviewed 17 published studies that showed the average cough actually took 18 days to subside.  That is almost three weeks!

Most coughs are caused by viruses,  even though over 50% of patients with acute cough are prescribed antibiotics.  We are uncovering more and more about the way antibiotics affect normal gut flora and also create resistant organisms so overuse is a real public health hazard.  As patients understand that coughs can go on and on and do not signal the need for more antibiotics, the better off we will be.

What can  you do if you have a lingering cough after a viral infection?  Taking a cough suppressant, especially at night so you can get good sleep is critical.  Cough lozenges can also help through-out the day.   If there is a wheezing, asthma component, a bronchodilator inhaler will help with the cough.  Natural cough suppressants can also help.  Theobromine, a substance found in chocolate was found to suppress cough so hot cocoa may help.

Here is another concoction that has been found to suppress cough:

1/4 tsp cayenne pepper
1/2 tsp ginger
1/4 tsp cloves
2 T. honey (or to taste)
2 T. water
1 T. apple cider vinegar

Take 3 tsp. when needed.

Saturday, January 12, 2013



   I know what it's like
  to serve time under
  a sentence without 
    possibility of parole.

       To be given a diagnosis
  by a man in a white
  coat sitting high and
  mighty on his stool.

    No empathy in the 
sentencing, just
             You have broken the law
       of normal, you have

        such-and-such disease.
  Period.  A sentence
       and nothing more.  No
     semicolon.  No dash.

Would it kill him
       to be a bit more open-
         ended, to say I'm sorry,
  to touch my hand?

Adam Possner, MD
      JAMA, August 15, 2012

Wednesday, January 9, 2013

The Danger in CT Scans

The United States is higher in its use of  computed tomography (CT)  scans than any other industrialized Country.  There were about 3 million scans done in the U.S. in 1980.  By 2007 that number had risen to 70 million.  A number of articles published in medical journals over the past few years have reported that  excess radiation delivered by these scans will cause cancer deaths in some patients they were meant to help.  One study from The National Cancer Institute estimated there would be about 29,000 future cancers related to scans done in 2007 alone. Experts have estimated that as many as a third of all imaging exams do not help the patient or contribute to better outcomes. Let me repeat that:

Experts have estimated that as many as a third of all imaging exams do not help the patient or contribute to better outcomes. 

Do patients understand the risk of CT scans?  A new study from the University of Washington showed 1/3 of people getting a CT scan didn't even know the test exposed their body to radiation.  They also underestimated the amount of radiation delivered by a CT scan.

A CT scan delivers a mega-dose of radiation - as much as 500 times that of a conventional X-ray.

Patients, especially children, who have multiple CT scans are naturally at higher risk from excess ionizing radiation.  In medicine we find "incidentalomas" all the time.  If I get a Chest-Xray on a patient that I suspect of pneumonia, it might also show a small blip that cannot be explained.  The recommendation from the radiologist may be to follow up with a CT scan.  It takes clinical judgment to weight the risks versus the benefits of getting that scan.  Perhaps the better choice is to deal with the infection and repeat the Chest X-ray in 3 months and see if it is still there.

Because CT scans are painless, usually covered by Medicare and Insurance (at high $$ cost), protect physicians from "missing something" and facing malpractice risk, and are often recommended to follow-up on an "incidentaloma", it is an overused test. 

The CT scanner is a great advance in medicine and the ability to image the body in transverse sections and visualize organs and the brain has been truly life-saving.  But patients should know and understand the risks.  Here are some ways the patient can get involved:

  • If a doctor orders a CT scan for a child, the parent should ask the technician to use pediatric-appropriate settings.
  • Do not let a doctor or institution repeat a scan that was recently done (if you get 2nd opinions or are seen at a different place).  All scans can be electronically shared, even via a flash drive if needed.
  • Ask if a "low-dose" scan is appropriate.
  • Try to avoid using the Emergency Department for health care.  Your chances of getting a CT scan for a headache, car accident, stomach ache, pelvic pain or kidney stone is extremely high if you go to an ED.  The doctor wants to cover all possibilities (even those that have low probability) in a short period of time.  Bingo:  order the CT scan.
  • It's OK to ask, "How could the test result change my (or my child's care), if at all?" 
  • It's OK to ask,  "Can you recommend an alternative, such as an ultrasound or MRI, that doesn't involve radiation?"
Understanding risks and benefits makes everyone healthier.

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...