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Showing posts from April, 2013

Poison Oak

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As the weather heats up and people are hiking and walking animals outdoors, we physicians start seeing the results of a contact dermatitis known as poison oak or poison ivy.  Some of the tell-tell signs for diagnosing this condition is the severe itching, patchy redness that is in certain skin areas only and also notice the linear streak on the top back area of her neck.  That is a classic rhus dermatitis (poison oak) appearance as are clusters of  fluid filled blisters.

Poison Oak is a leafy shrub that grows wild on the West coast.  Poison Ivy grows on the East coast as does Poison Sumac.   It commonly grows like an ivy vine and as summer rolls on the pointed leaves turn orange color.
The rash is caused by a toxic substance in the plant called urushiol.  Brushing against it or touching an object that has brushed against it (dog fur, shoe laces, backpacks, clothing, hats) can cause an extreme allergic reaction.  Like any allergic response, the symptoms get worse with each successive…

Health Care Reform Confusion

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If you think you are confused about ObamaCare and what it will mean to you and your family, you are not alone.  Confusion is rampant and open enrollment for the health exchanges is supposed to start October 1.   Yes that is a mere 6  months from now!  Despite this looming date, the various States still don't know what they will be offering and doctors and hospitals also have no idea how it will work.  There seems to be no plan on how to get the word out to the uninsured public.
Most uninsured people don't even know they will have new insurance options under the Affordable Care Act.   If you have insurance now through your employer, not much will change.

Here are some basics that we do know:

The exchanges will start covering patients on Jan 1, 2014.  Each state will have its own exchange for people who don't have employee coverage.  There will also be a plan for small businesses to offer to employees.  The vast majority of people who have health insurance from their jobs w…

Answer to Image Challenge

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The answer to yesterday's diagnostic challenge is...drum roll...
# 3.  Psoriasis.

The scattered reddish, scaly, indurated papules on the lower back and buttocks are psoriasis.  The acupuncture needling of the skin produced trauma that caused Koebner's phenomenon and subsequent psoriatic flare.  This is a rare event and it was treated with a steroid cream.

Thanks for your guesses.  This was a hard one.

What is the Diagnosis?

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Today's image challenge from the New England Journal of Medicine is a tough one.  Full disclosure - I missed it.  (bragging rights: I usually get about 99% right) 

This patient had acupuncture to the area and developed these lesions.  What is the diagnosis?
1.  Herpetic whitlow
2.  Nummular eczema
3.  Psoriasis
4.  Ringworm
5.  Scabies

Click on the image for a closer view and make your diagnostic guess in the comment section. The winner gets a free subscription to EverythingHealth.   Check back tomorrow for the answer! 


Fake Drugs

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Unfortunately many of the drugs that enter the United States (and other Countries) are fake.  Research shows that more than half of the drugs sold by online pharmacies may be fake. Globalization of the pharmaceutical manufacturing industry and distribution system is contributing to the problems of false and substandard drugs. 

And low and middle-income countries are the hardest hit by these falsified drugs.  Many patients in these countries are forced to buy their medications from poorly regulated markets and some of the drugs they buy are useless...or even worse, toxic.  Substandard drugs in developing countries have contributed to the emergence of drug resistant malaria and tuberculosis.

More and more people in the United States are buying medications on-line, hoping for a price break from the exorbitant cost of pharmaceuticals.  The best way to ensure that you are dealing with a reputable pharmacy is to verify it with the NABP (National Association of Board of Pharmacies) Verified…

Meat and Heart Disease

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We have known for decades about heart disease and the effects of red meat and saturated fats being a cause of elevated cholesterol.  But we've also known that is not the whole story and now surprising new research is pointing to gut bacteria and the actual chemical that is produced by meat as the culprit for heart disease. 

Carnitine is found in red meat and is also used by body builders as a supplement for energy.  Researchers have found that in the intestinal tract, bacteria convert carnitine into a metabolite called TMAO and TMAO promotes thickening of the arteries.  Steak consumption caused subjects in the study to immediately produce large amounts of TMAO.  Vegetarians did not produce the chemical.

Many people who become vegetarian say that they can no longer digest red meat.  It turns out that they actually lose the ability to metabolize carnitine over time because they do not develop the gut bacteria that meat eaters have.

How did the researchers know it was the gut bacter…