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Showing posts from March, 2016

Best Practices and When Your Doctor Says No

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The American College of Physicians and the Centers for Disease Control give guidelines (known as high value care advice) to physicians based on the best current scientific evidence. Physicians try to treat patients based on those guidelines even when patients want a different treatment. Here are three that create the most problems when physicians try to do the right thing.


(No antibiotics for acute bronchitis) Acute bronchial bronchitis can last up to six weeks with a    purulent or dry cough. It is one of the most common out-patient diagnoses we see. More than   15 excellent scientific studies show no benefit in treating with antibiotics and a trend toward       adverse complications when antibiotics were used.        All Primary Care physicians and Emergency Department physicians experience the constant request for Z-Pac throughout the winter. "It helped my friend, family, kid." "It's the only thing that works for me." It is hard to see a suffering patient wh…

Zika Pandemic - Early 2016

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The Zika virus was first discovered in a rhesus monkey in 1947.  The Aedes species of mosquito transmits the Zika virus as well as dengue and yellow fever.  This mosquito is found in tropical and subtropical regions around the world. Since Brazil reported Zika virus in May, 2015, infections have occurred in at least 20 countries in Central and South America.  And now, in 2016, it has pandemic potential with outbreaks in the Americas, Africa, Pacific Islands and Southeast Asia.

It's important to know that  80% of Zika virus infection cause no symptoms at all.  The rest have just mild fever, rash and muscle/joint pain.  There is no effective treatment.   But we are seeing other serious effects like congenital neurologic malformations and microcephaly in Brazil and French Polynesia.  Brazil has had 4000 cases of suspected microcephaly in 2015, a 20 fold increase since 2010.  Evidence of the virus has been found in the placenta and amniotic fluid of mothers and in the brains of fetu…