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Showing posts from August, 2008

New Orleans Evacuates - 3 years after Katrina

Exactly three years ago today we were glued to our TV sets watching the horror unfold in that unique American city, New Orleans. The unthinkable was entire city was under water and tens of thousands of people were stuck on rooftops, abandoned on freeways and inside the superdome in stifling heat with no provisions. It was such a shock. Within 24 hours I heeded an email call for help and found myself on a red-eye to Baton Rouge, where all flights were landing. President Bush's Air Force 1 was on the tarmac and he was doing a "good job, Brownie" photo op. The governor and Mayor were belatedly begging for help and the national guard was deploying much needed security and manpower.

Registering at the large relief command center and getting a waiver to practice medicine in Louisiana was the last organized function I witnessed. Hundreds of volunteers were streaming in, and help was needed, but there was no way to dispatch them to the needed areas. No-one…

Hospital Infections - Take Charge

Hospital acquired infections are a serious problem that the quality improvement movement is shining a light on. Each year 2 million Americans acquire an infection while hospitalized. We used to accept these rates as just unfortunate events.

From methacillin resistant staph (MRSA) to Clostridium difficile (C. diff), we now know that these infections can be prevented through rigorous precautions and awareness. Here are 12 steps you can take to reduce your risk of hospital infections.

1. Ask hospital staff and visitors (very important!) to wash their hands before treating you.
Alcohol based hand cleaners should be at every bedside. Make sure it is used.

2. Make sure the Doctor or nurse wipes the stethoscope with alcohol before examining you.

3. Ask your surgeon about his/her infection rate. He should know the answer for the
procedure being performed.

4. Beginning 3-5 days before surgery, shower or bathe daily with chlorhexidine soap. You can
buy it over the counter.

5. …

Answer to Medical Quiz

The answer is #5. Squamous-cell carcinoma (above is another image that shows squamous cell and basal cell. A biopsy is needed to confirm diagnosis).

The squamous cell lesion is exophytic and hyperkeratotic with central ulceration, features that are most typical of a squamous-cell carcinoma. Basal-cell carcinomas typically present as a papule with a pearly border. Granuloma fissuratum refers to a mass of granulation tissue. Melanomas are often flat and hyperpigmented. Seborrheic keratosis typically originates on the back of the ear.

Remember, any new skin change should be shown to your physician.

Brits Behaving Badly

One of the benefits of a bad economy and weakened dollar is that the "Ugly American" can't travel as much anymore so we can leave the bad behaviour to the British. The New York Times has a surprising (to me) article about some Brits being too unruly and not being welcome at European resorts.

Getting drunk, having orgies, crowding the emergency rooms with injuries from fighting and carousing seem to bring the term "tourist" to a new level. “When things do go wrong, they go wrong in quite a big way,” said Alison Beckett, the director of consular services.

“What we’re trying to do here is reduce some of these avoidable accidents where they have so much to drink that they fall off balconies and are either killed or need huge operations.”

It appears that alcohol is the nidus of most of the problems. Local officials say the blame lies not just with the tourists themselves, but also with the operators of package tours promising drinking-and-partying vacations, and c…

Medical Quiz - What's the Diagnosis?

Here is this weeks Medical Challenge from the New England Journal of Medicine. If you look at ears (especially on men) you will often see something like this. What is the diagnosis? (click on image for a better view) 1. Basal-cell carcinoma 2. Granuloma fissuratum 3. Melanoma 4. Seborrheic keratosis 5. Squamous Cell Carcinoma Make your guess and the answer will be posted tomorrow!

Discovered - First Photo Of Michael Phelps

Hat tip to Paul Levy, Running a Hospital blog

Grapefruit Juice and Meds

Certain medications should not be taken within hours of drinking grapefruit juice...and it appears even orange juice and apple juice may have interactions that affect the drug levels of certain medications.

The juices block absorption by latching onto an enzyme in the intestines called CYP3A4. It can cause abnormally high levels of the medication or block absorption of the medication in other instances. We have know this about grapefruit juice, but scientists now find orange juice and apple juice may have similar effects.

Here are a few of the drugs affected with grapefruit juice:
statins -(Lipitor, lovastatin (Mevacor), simvastatin (Zorcor)calcium channel blockers- diltiazem (Cardiazem, others) felodipine (Plendil), nicardipine (Cardene) nifedipine (Procardia, Adalat) nisoldipine(Sular), verapamil (Covera, Verelan)other heart drugs- (amiodarone (Cordarone, Pacerone), cilostazol (Pletal, generics) losartin (Cozaar,Hyzaar)immunosuppressant drugssedatives -diazepam (Valium), midazolam (…

Ed McMahon-Stop Whining and Suing

Ed McMahon, I have one thing to say to you:

"You don't have much talent, yet you've had a great career as Johnny Carson's sidekick, host of Star Search and pitch man for magazines. I am sorry you blew through all of your millions in Beverly Hills. It is sad to be in your senior years and realize you didn't manage your money well.
But filing malpractice lawsuits is not the way to recoup your losses. "

Ed McMahon filed a lawsuit today against Cedars- Sinai hospital (read deep pockets) and the treating physicians, not only for what he says was mistreatment, but also for "elder abuse". Why elder abuse? Because those two words get him out of the capped amount that California has placed under tort reform. His damages would be unlimited and he can rake in as much as a sympathetic jury would give him. His attorneys stand to cash in also.

He fell at a friend's home (the friend is being sued too) and he alleges the hospital failed to diagnose a broken n…

France - Patient Centered Healthcare

I saw a husband and wife yesterday who have duel citizenship...the USA and France. They travel to Paris and the French countryside several times a year (and he has that beautiful French accent!) My mouth was hanging open when I heard about health care in France. Here's what made me perk up:
His sister, who is age 70 but quite healthy, has the usual hypertension and difficulty seeing. Since being hospitalized with pneumonia, she gets a home visit TWICE A DAY from a visiting nurse to take blood pressure and load her pills into the container and make sure she is OK. Apparently the nurse and she chat, drink coffee and read the paper together!My patient went to the pharmacy with a rash. The pharmacist said "Oh that is shingles...go to this doctor" (located next door). Doctor agreed and gave RX for treatment. No appointment needed. Cost $18 Eu.No appointment needed to see your doctor. Just walk in. Very little wait and cost is $18Eu or $15Eu if you have an appointment.…

Drug Trials - Buyer (and Physician) Beware

Pharmaceutical companies often perform drug trials to prove the effectiveness of their drug by paying physicians to participate in a clinical trial and use the drug on their patients, using the trial protocols. The Annals of Internal Medicine wisely asks the question this month:

"Why would pharmaceutical companies go to the expense and bother of conducting numerous trials with private physicians and a few of their patients, rather than conduct large trials at medical centers to accomplish the same scientific results with greater efficiency?"

Dr. Harold Sox (editor and brilliant thinker) answers it: "The true purpose is to get physicians in the habit of prescribing a new drug." A secondary purpose is to get physicians to be "opinion leaders" and advocate with their colleagues about the new drug. They get paid to do so and become de facto marketers for the drug, without really being aware of it.

These drug studies are called "seeding trials" and they…

Medical Quiz - Do You Know?

This is a real Quiz and I don't have the answer.

This is a photo I took in Honduras of a woman's foot. It is resting on a wheelchair as she previously underwent a BKA (below the knee) amputation for complications of diabetes. She now had this strange, slightly ulcerated, non tender lesion on her foot for several months. You can see a smaller, less ulcerated lesion on her heel area.

I could not make a diagnosis without a biopsy. It did not appear infected, but certainly it could have been atypical TB. I also thought of necrobiosis lipoidica diabeticorum but it did not have the shiny typical features.

In Roatan there is no dermatologist nor did I have the means to do a biopsy with pathology. My final diagnosis was a pyogenic granuloma. Any ideas from you diagnosticians out there?

Rock Hard Abs

Physicians Network Site

Just like the "My-Space" social networks, physicians have their own forums for sharing medical issues and networking. The latest item from Medscape Physician Connect:

Too Heavy for CT Scanner

"...patient who is 480lbs fell from standing position and landed on his back. We attempted to get plain films of his back. Our scanner has a weight limit of 350lbs, so we could not scan the patient. My partner tried for about 4 hours to find someone with a scanner that could hold a 500lb man. The patient was signed out pending our vet school calling us back to see if we could scan him by the vet radiologist."

The comments that followed were pretty fascinating. Most were quite respectful. My favorite was from this doctor:

"It's like saying that the beer mugs are too small for the alcoholic so we should be making bigger beer mugs. Super size the MRI scanners to meet America's super size bodies. In France there are elevators that allow for 10 Europeans or 6 Americans…

Vitamin D - Higher levels linked to longer life

In the past year, I can't open a journal without seeing more and more evidence that we have been underestimating the benefit of Vitamin D on health and longevity.

Vitamin D is a fat-soluble vitamin that is naturally present in very few foods. It is also produced when ultraviolet rays from sunlight trigger synthesis in the body. Vitamin D obtained from sun exposure, food and supplements must then undergo two hydroxylations in the body to become active so it is a complicated process. A number of drugs interfere with Vitamin D synthesis also.

Vitamin D (along with Calcium) is essential for promoting bone health. But is also is important in neuromuscular and immune function and reduction of inflammation. It affects genes that encode proteins and other cells have Vitamin D receptors.

A new study from Archives of Internal Medicine reports low levels of Vitamin D are associated with cardiovascular disease, cancer and overall shortened longevity. Not only is this a big WOW but this app…

Answer-Medical Quiz

The answer is #1 osteoarthritis. The patient's right hand reveals the typical changes with both Heberden's and Bouchard's nodes and irregular deformities at the joints.

Osteoarthritis is a degenerative syndrome where low-grade inflammation results in pain in the joints. The cause is unknown and there is an abnormal wearing of the cartilage that covers and acts as a cushion inside joints. OA affects nearly 21 million people in the U.S. and it affects the hands, spine and large weight-bearing joints such as hips and knees.

Kid's Vaccinations - Now They Tell Us!

There is always lots of debate about pediatric vaccinations. The latest study from Pediatrics tells us that the needle length that has been recommended by the Centers for Disease Control (CDC) is wrong and in many cases IS TOO LONG.

The CDC has recommended needles up to 1-1/4 length, which would result in over penetration in a high percentage of babies and children, especially for injections in the shoulder. By looking at MRIs and evaluating the depth of the subcutaneous fat and muscle layers, these authors recommend much smaller needles and basing the size on the child's weight and age rather than using a universal needle length.

Isn't it amazing that this has not been studied before by the CDC? As the top regulatory agency, it is just assumed that their recommendations are based on science. Assume nothing!

I'm always gratified when actual scientific studies confirm what any mother could have told you just by common sense and sight. Don't be afraid to look at that …

A Great Diet

You too can be in peak physical shape with this diet:
Breakfast is:

— three fried egg sandwiches with cheese, lettuce, tomatoes, fried onions, and mayo
— one five-egg omelets
— a bowl of grits
— three slices of French toast with powdered sugar
— three chocolate chip pancakes
— two cups of coffee

All you need to do is follow it with the same exercise regimen as this guy!

Hat tip to Cynthia C.

Today's Medical Quiz

This week's New England Journal of Medicine challenge is good. What is the diagnosis for this lady's hand. Hint: it is common. (click on image for a better view)
1. Psoriatic arthropathy
2. Reflex sympathetic dystrophy
3. Osteoarthritis
4. Gout
5. Rheumatoid arthritis

The answer will be posted tomorrow. If you don't might learn something.

Hey, It's a full moon tonight!!

Make A Difference

A comment on my post about volunteering in Honduras caught my eye. (Actually I obsessively read all comments so keep them coming!)

The comment was:
Anonymous said...Wouldn't it be great if we all spent some of our vacation time in endeavors like this? And wouldn't we be living then with a higher purpose...and positively ...and with more motivation.... Please indicate on your blog how we might all do work here or elsewhere in little paradises like that... help lead the way for us...My reply is that you don't need to go to exotic places, or practice medicine, or be rich, or belong to an organization to make a difference. There is a great movie called "Pay it Forward" about the ripple effect of kindness and generosity. It really doesn't matter what you do. Just do SOMETHING.Make a conscious effort to do one unexpected act or favor a week for someone else. Leave a bigger tip than usual for a minimum wage worker. (And please always always tip the maid at a hote…

Embrace Positivity

I came across some words of wisdom from a guy named Omar Periu that intrigued me and so I'm sharing it here on EverythingHealth.

Most people live lives that aren't completely fulfilling because they’ve never learned to manage their minds and emotions. These are 10 rules for living a motivated life.
Condition your mind. Train yourself to think positive thoughts.Condition your body. It takes physical energy to take action.Avoid negative people. Don’t take anything that they say seriously.Always remain flexible. No plan should be cast in concrete.Act with a higher purpose. If it doesn’t serve your goal, it’s wasted effort.Take responsibility for your own results. Don’t credit luck, good or bad.Stretch past your limits on a daily basis. That’s how you grow and evolve.Don’t wait for perfection; do it now! Perfection’s the enemy of good enough.Be careful of what you eat. It takes physical energy to succeed. Hang around motivated people. The positive energy will rub o…

Fast Food-Enough is Enough

Los Angeles has taken a bold move in the battle against unhealthy eating by banning new fast food restaurants from opening in some of the city's poorest neighborhoods. The city council has issued a moratorium on new fast food for a year in South Los Angeles.

Sure there is criticism..government stepping into a free market...government treating people like children that can't make good decisions for themselves...government targeting poor neighborhoods, etc etc.

But more than 45% of the 900 restaurants are fast food chains in the affected 32-square-mile zone. There is do doubt that fast food chains (McDonalds, Wendys, KFC, Burger King) squeeze out competition. Most poor neighborhoods don't have large supermarkets with organic food or appealing vegi displays. The choices for people in poor urban neighborhoods are limited so let's face it...unchecked market forces are leading this country toward obesity, diabetes and heart disease.

Ask any mom (poor or rich) if she wants f…

He Ain't Heavy - He's My Brother

At the clinic in Punta Gorda, Roatan.

Punta Gorda Garifuna

Garifuna or Black Caribs are communities living on the Caribbean coast of Central America. In 1635 two Spanish ships carrying slaves to the West Indies were ship-wrecked near St. Vincent. The escaped slaves were welcomed and protected by the indigenous Carib Indians. Their intermarriage formed the Garifuna of today. In 1797 the British relocated all the Garifuna along with some black slaves to the island of Roatan in Honduras. From there they have spread to Belize and Guatemala. Their language and religion remain similar to those found among their ancestral peoples of the Amazon and their dances and heritage show a strong African Influence.

Many of these Afro-Caribbeans live in Punta Gorda, where the Siempre Unidos HIV clinic is located. They performed their cultural drumming and dancing for us at a fiesta the last day we worked at the clinic. Wearing traditional costumes, the men in masks leaped and danced while the women sang. It was a wonderful display of culture and histor…

Honduras Mission with Siempre Unidos

I am just back from Roatan, where I volunteered for a week at an HIV clinic run by Siempre Unidos. This is the "seldom seen" part of the island where the locals live and a good wage is $5.00/day. Honduras is the poorest of the Central American countries and has the highest prevalence of AIDS of any Spanish speaking country. Siempre Unidos California was established as a non-profit in 2005 and provides medical screening, treatment and employment to HIV patients in three clinics. Two are on the mainland and one in central Roatan island.

Along with a group of 20 volunteers, we visited the clinic in Roatan to provide medical care, bring needed supplies and work on several building projects. We also started a small jewelry making micro-industry. It offers fair wage employment to women who are discriminated against because of AIDS and have been fired from jobs. The jewelry and sewing workshops are already established on the mainland but it was a first for the Roatan clinic.

Blog Break - Off to Honduras

I'll be taking a blog break for a week as I'm off to Honduras with Siempre Unidos, a wonderful non-profit that provides HIV education, prevention, treatment and employment for Hodurans. Check back next week for a recap of the trip and more EverythingHealth. For great medical blog reading this week...check out my favorite links on the right side. Adios