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Showing posts from May, 2008

Positional Vertigo - Common and Treatable

One of the most common ailments I treat is Benign Positional Vertigo. The patient usually feels awful, off balance and with the room spinning for no reason. It can occur suddenly and dramatically when he gets out of bed and cause vomiting and unsteadiness when walking. The episodes can be continuous or in brief episodes that are worse as the head is moved. A good neurologic exam and absence of any one sided weakness or facial droop can cinch the diagnosis without expensive testing or scans. I look for nystagmus ( rapid involuntary movement of the eyeball) when I turn the patients head from side to side. Over time the nystagmus stops.

You would think that treatment for such a common and miserable condition would be taught in medical school. There are very effective office treatments called canalith repositioning procedure or Dix-Hallpike maneuver or Eply maneuver. Each has slight variation and involves a series of specific and timed positions for the head that restores the eq…

A Cup of Cocoa Helps Diabetes

Time for health news that is warm and fuzzy!

A new study reported in the Journal of American College of Cardiology shows that a big mug of hot cocoa can reverse vascular dysfunction in patients with diabetes, suggesting a therapeutic potential of cocoa in this patient population.

Prior studies have shown that flavanol-containing foods, including cocoa, certain fruits and vegetables, tea, and red wine, have beneficial effects on LDL oxidation, platelet aggregation, insulin sensitivity, endothelial function, and blood pressure. These researchers show that the reversal of diabetic endothelial dysfunction with cocoa is comparable to intermediate- and long-term interventions using exercise and various medications, including insulin, pioglitazone, ACE inhibitors, and statins. They also found that over time the good effects persisted. Even if cocoa could enhance lifestyle and medication benefits in diabetics, it would be significant in how we approach this diabetes epidemic.

This study was not…

Popular Music Influence

I like popular music, along with all genres like R&B, hip-hop, classical and golden oldies. The pre-teens and adolescents that I know are fixated on Rap and don't listen to much else. The influence of Rap music is world-wide, not just the United States, and the entire rap subculture has permeated the world.

The Archives of Pediatrics and Adolescent Medicine published a study that looked at popular music and references to substance abuse. I am not surprised at all by their findings but seeing it in print was a bit of a wake-up.

The authors analysed 279 of the most popular songs of 2005 according to Billboard magazine. They used coders (funny to read about coders for anything other than medicine) who collected portrayals of substance abuse.

Of the 279 songs, 33.3% portrayed substance abuse with an average of 35.2 references per song-hour. The rap songs had the most references at 77%. Pop music had 9%.
Surprisingly, country songs talked about substance abuse with 36% referen…

Bloggers Love Comments

Happy Memorial Day Weekend to readers of EverythingHealth. If you are from another country, I wish you a wonderful weekend also and hope you are having nice weather!

We bloggers love comments. It tells me that you are reading the blog and that what I have written stimulates you in some way...either good or bad. It is also a way for readers to add information or share an idea.

Due to recent spam in my comment section, I have added a word verification to cut down on electronic spam. I think it is pretty easy to use (I've done it on other blogs when I comment) so give it a try by commenting on this. Don't worry, your comments cannot generate spam to you.
Thanks for reading and please visit again soon.

Exercise Your Brain

(Homer Simpson's brain)

I have a big birthday coming up so aging is on my mind. Having things "on your mind" is good because the brain benefits from being stimulated.

The story that you are born with all of your brain cells and you use only 11% of your brain throughout your life is wrong, wrong, wrong. Brain imaging research with PET scans and fMRI scans show all areas of the brain are stimulated with different activity. The entire brain is used in an active person.

We also generate new nerve cells (neurogenesis) throughout our lives and maintaining mental acuity is what we all strive for, right? One question scientists are asking is "Are mentally sharp people more engaged socially and with more stimulating activities, or does staying involved create better functioning brains?" What comes first? Studies have shown that people who exercise have improved cognitive function. It may be the result of improved blood flow, neuro hormones and neurogenesis from exer…

Suicide by Self Burning

The New England Journal of Medicinereported on the tragic plight of women in Afghanistan that causes women to burn themselves as a means of suicide. The United Nations Development Fund for Women reports that 70-80% of female Afghanis are forced into marriages and more than half are married before they are 16 years of age. Women have an 84% illiteracy rate and average 7.5 births per mother. Only 14% of those childbirths have a skilled attendant present and the country's maternal mortality is 2nd in the world.

Afghan women are forced into early marriage to settle conflict between families or tribes and it is routine that these women suffer abuse from their husbands and in-laws. There is no recourse for women who are abused by their husbands and suicide, by pouring gasoline over themselves and lighting a match, is an act of desperation. According to the authors, "women and girls see this horrifying act as a means of both escaping from intolerable conditions and speaking ou…

Ted Kennedy - Brain Tumor

I wrote about Senator Kennedy's seizure yesterday and now the results of a biopsy show he has a malignant brain tumor. Unfortunately he has a glioma in the left upper part of his brain, the parietal lobe. At age 76, Senator Kennedy's prognosis is poor because gliomas, particularly in the parietal lobe are difficult to treat.

The cause of glioma brain cancer is unknown and it is not linked to smoking or alcohol. Most gliomas present with a seizure or headaches. These are fast growing malignancies and they don't spread to other parts of the body.

Google Health-a review

Google Health is officially open for business after much pre-development fanfare. It is an on-line medical record that can be added to and accessed by the patient and any entity he/she authorizes. Since the Electronic Medical Record is such a big deal, many people think Google Health will solve the problem that medical groups and hospitals have been struggling with for decades.

I checked out Google Health to see how it functions. It has good privacy policies and the patient is the only one who can authorize access. They promise not to share information with anyone else (except when required by law...remember the illegal wire taps!). It appears to be a secure site.

Information is entered easily by the patient. They have a "conditions" list that was easy for me to use but I am not sure all patients will know the medical names of their conditions. You can, however, type in the name of your condition. For example the pull down list says hypercholesterolemia but if you don&…

Ted Kennedy's Seizure

Ted Kennedy, age 76, was rushed to Massachusetts General Hospital in Boston yesterday after suffering a seizure at his Cape Cod home. The first report was that he had suffered from a stroke, but that has been ruled out. He is reportedly doing fine and has no after-effects from the seizure, although he is still undergoing tests in the hospital.

In medicine, when I hear of a first seizure occurring in an adult, the first thing to make sure of is that it is a true seizure rather than a fainting spell (syncope). A seizure usually causes loss of consciousness and it is usually followed by a short period of confusion and feeling dazed. In contrast, a person will usually awaken clear headed after a fainting spell. I presume Ted Kennedy's episode was witnessed by family or friends and that he had some type of muscle shaking or sensation that identified it as a true seizure.

Once it has been identified as a true seizure, looking for a cause is the next order of business. Causes of s…

Acute Hepatitis C from Unsafe Injections

The CDC has concluded an investigation of a clinic in Nevada that reported an outbreak of Hepatitis C Virus (HCV) in 6 people that resulted from unsafe injection procedures. Here's what happened:

Hepatitis C is a reportable infection to the health department and when 3 people were reported in 2 days it raised concern about an outbreak. It turned out that all three persons underwent procedures at an endoscopy clinic within 35-90 days of the illness onset. Three more cases turned up from the same clinic for a total of six cases.

The incubation period for HCV is 15-160 days. Hepatitis C causes liver inflammation, jaundice, abdominal pain and elevated liver enzymes. Four of the six patients required hospitalization and four had procedures within a two day period. An additional 120 persons had procedures at the clinic during the time period and they are currently undergoing testing.

Investigators observed that improper injection practices were being done at the free-standing priva…

Answer to Medical Quiz

The answer is #1 - Hyphema. This is a common condition and it looks worse than it is. Blood (from a broken vessel or trauma) layers in the front of the eye. If it pools over the sclera (white part of the eye) it looks like a bloody blotch and can be quite frightening. Like a bruise, it resolves without treatment.

For the other players - Hypopyon refers to pus. Iridocyclitis refers to inflammation of the iris (the round colored part of the eye). Iridodonesis is a quivering of the iris when the patient moves the eye. Synechia is an adhesion between the iris and the cornea.

What's the Diagnosis? Medical Quiz

Here is today's Medical Quiz compliments of the New England Journal of Medicine. This patient awoke with a very red eye that looked like blood. There was no pain and it did not affect his vision. What is the diagnosis? Click on the image for a better view.

The answer will be posted tomorrow.

I'm Off To The Big Apple

EverythingHealth will be taking a little break for the next few days as I will be in New York City. It will be a thrill to be on the East Coast and experience the great New York. For your reading pleasure, check out my favorite blogs on the right side. You will find plenty to keep you occupied until I return next week.

Answer to Medical Quiz

This was a hard one. The answer is number 5 - Keratoderma blennorrhagicum.
These foot lesions are a feature of Reiters Syndrome, which is a reactive arthritis that is often the result of a sexually transmitted disease or a gastrointestinal infection. The foot lesions occur in about 20% of people with Reiters Syndrome.

Medical Quiz - What's the Diagnosis?

This patient is a young man with abdominal pain, diarrhea and these non-itchy lesions on his feet. What is the diagnosis?
1. Dermatopathia pigmentosa reticularis
2. Lichen planus
2. Psoriasis
4. Rubella
5. Keratoderma blennorrhagicum

Click on the image for a better view. The answer will be posted tomorrow.

Screening Blood Panels - Overused, Overtested

The Annals of Internal Medicine has reported that "frequent cholesterol measurement may be misleading." There are normal variations and fluctuations in any blood test that give erroneous information and frequent checking (even annually), when a person is stable on a cholesterol lowering drug, is pointless.
Other studies have shown that the "routine" blood tests we Internists and Family Doctors order on patients are worthless. Few diseases are discovered by a blood test if the patient doesn't have any symptoms. Yet it is almost impossible to practice medicine and be seen as credible by patients if you don't order a ton of tests. Many patients would rather have the blood test and forgo the doctor visit.
This is all backwards. Somehow we have sold the public a bill of goods. Over years, medical experts have convinced patients that we can detect early disease and save their lives if only we will "do everything" possible with screening tests. We have lot…

We Love Big Cars

Denial - Not a River in Egypt

It amazes me how people can justify just about anything...despite all the evidence to the contrary. As they say "De-Nial is not a River in Egypt."

A guy I know came up to me at an event, reeking of tobacco smoke. Seriously, I had to take a few steps backward because of the odor. Because I am a doctor, he launched into a story about a study he is in at Stanford, where they are testing him for some health factors. I couldn't quite follow what the study was assessing.

What was remarkable was that they said he is so healthy that they told him not to quit smoking because if he quit, his health might go downhill. Yes, he heard them say that being a smoker has helped his health.

It is hard for me to believe the doctors at Stanford advised him to continue chain smoking. He doesn't look particularly healthy, has a smokers voice and unhealthy smokers skin. Of course I do not know his underlying health status.

We can fool ourselves about most anything if we want to. But 10,000 stud…

Women's Choice

I came across a blog that I want to share with the readers of EverythingHealth. This New York gynecologist wrote a compelling blog on why she chose her specialty. It's worth a read here at The Blog That Ate Manhattan.

McCain's Health Plan - seriously flawed

Candidate John McCain has proposed a health policy reform that will not work, and would worsen the uninsured problem in the United States. Let's take a look:

Seventy-one percent of insured people are now covered (in some fashion) by their employers. McCain proposes eliminating employer sponsored health insurance and giving tax credits to people to buy their own insurance. A family would receive a $5000 tax credit but the typical family premium is $12,000. The consumer can pay the extra $7K or go without insurance. Essentially it would remove the employer from the insurance game and let Americans fend for themselves. Have you enjoyed dealing with your insurance company thus far? How responsive are they to your phone calls or concerns about coverage? McCain says the free market would inspire competition and let those insurance companies compete for your business.
There would be no restrictions on insurers charges or coverage of preexisting conditions. Anyone who self insures today k…

Breastfeeding New Infants

The benefits of breast feeding for at least the first six months of life have been proven over and over with scientific studies. Let's face it...nature hardly ever gets it wrong. Breast milk is a perfect nutrient, contains antibodies and is easy to digest. It is also free and readily available!

A new study by the Center for Disease Control and Prevention shows that 77% of new mothers breast-feed their babies in the United States. There has been an effort to educate women about the benefits and it seems to be paying off. The stats may be a little skewed, however, because the study gave credit even if a woman breast fed for just one day. And prior studies have shown that far fewer mothers of any age breast feed for the recommended 6 months.

So there is good news, but still not great statistics for what we know is optimal infant health. I think one of the problems is how unsupportive our society is for new mothers. A breast feeding mother cannot be in public without weird star…