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Showing posts from January, 2009

EverythingHealth Economy

More on Octuplets

Thanks to KM for alerting me to information that continues to unfold about the mother of the octuplets born in Southern California this week. It is really hard to believe...

The mom is 33 years old, unmarried and already has 6 children between the ages of 7 and 2. She has one set of twins and...are you ready for this...she lives with her parents in a 3 bedroom home. Also, the grandparents filed for bankruptcy last year.

So there will soon be 14 children and 3 adults living in the home. And, according to the grandmother, she did have in-fertility treatment for blocked fallopian tubes. That would mean that she had in-vitro transfer (implantation) of embryos.

The American Society of Reproductive Medicine considers it grossly unethical to implant 8 embryos and many experts are speaking out against fertility help at all for a woman with six children. In Germany and Italy, there is a limit of 3 embryos that can be implanted. In the U.S., there are standards but no real prohibition…

Octuplets. OMG

Eight, count em, eight babies were born to a secret mother at Kaiser Permanente Bellflower Medical Center in Southern California this week.

This is the 2nd live-born set of octuplets in the U.S. and they are all doing well, according the the hospital spokesperson. The six boys and two girls weighed between 1 lb 8 oz. and 3lb 4 oz. When you multiply that times 8...well it is a lot of poundage!

They expected 7 babies and the 8th was a surprise. I guess they all jumble up on the ultrasound.
The babies are in the newborn ICU (NICU) of course, in incubators. They will need to be hospitalized for many weeks to grow and develop. If they all survive, they will be the first known live octuplets in history.

It hasn't been disclosed, but it is likely these babies were the result of fertility drugs. It is very unusual for high multiple pregnancies to occur naturally. Fertility drugs stimulate the ovaries to produce many eggs and if they are all fertilized and implanted, it can be highly r…

Book Contest Winner

We have a winner! Thanks to all who made comments on the blog below that gave you the unbelievable chance to win a book called "Brush Your Teeth-and other simple ways to stay young and healthy"

The comments were so compelling, heartwarming and pleading that I could not select the best. So with the help of my son...we picked names out of a hermetically sealed envelope and the winners are:

m.scott and medical student L.G.

Please email me (look at my profile) and give me your mailing address and you will receive your free healthy prize book.

The staff at EverythingHealth

Special Emergency Room for Seniors

Here is something new! I've heard of special Pediatric Emergency Departments (my hospital has just opened one) because children are not just "little adults".

But now there is an Emergency Department that treats only senior citizens over age 65. Located in Silver Spring, Maryland, the ED has staff trained in geriatrics and utilizes an approach to care that is structured around the needs of older people.

Each patient has a separate, uncluttered cubicle with a comfortable chair for a family member or visitor. The mattress is thicker than usual and is designed to prevent skin breakdown. Blanket warmers and pillows are there for comfort and the department is designed as a "soothing" atmosphere with special lighting and sound proofing. There are wooden handrails for safety and large face clocks. Each bed has a TV and overhead lighting controlled by a dimmer switch. (Great idea. Hate those glaring fluorescent lights).

Most importantly, the staff is trained in ger…

Peanut Butter Recall

Dear Dr. Brayer,
My kids love PB&J sandwiches and we all eat peanut butter. I've heard about the recall and I don't know if I should throw out all the peanut butter in the house?
Marilyn Mom

Dear Marilyn Mom:
The Salmonella outbreak that has shown up in 47 states and Canada has made everyone concerned about peanut butter. The FDA has confirmed that the source of the outbreak is peanut butter and peanut paste made by the Peanut Corporation of America at its Blakely, Ga. processing plant. Because they sell to food makers, many products have been recalled including:

Clif Bars,
Kellogg Company Austin and Keebler brand, Famous Amos Peanut Butter cookies
Kroger peanut butter ice cream
General Mills Lara Bars and Jam Frakas flavor snack bars.

This is not the complete list so you should toss out any processed peanut butter snacks and don't eat any peanut butter products served in restaurants. A full list of recalled products from the FDA is here. The list is extensive!

There has be…

EverythingHealth Give Away

The blogosphere is a marketplace and I get contacted by PR agents all the time to post on my blog. Most of them I turn down as not really "worthy" of my astute readers.

This time I reviewed a book that is really VERY GOOD. It has a catchy title..."Brush Your Teeth (and other simple ways to stay young and healthy.)"

Written by Dentist Dr. David S. Ostreicher, it focuses on six fundamentals of good health: hygiene, diet, attitude, exercise, sleep and personal safety. Forget fad diets, overpriced supplements and tonics of youth. A few simple improvements can make a big difference in every one's life and this book gives you those tips. It is a good read.

So we here at EverythingHealth are having a "give-away". (The "We" is really me...I don't have a staff or crew). Just comment and tell me why you want better health and what you are looking for in personal wellness. The top two comments (judged by impartial ole' me) will receive a…

Atul Gawande and Health Care Reform

I am happy to share my Saturday morning reading with the readers of EverythingHealth. The New Yorker featured Dr. Atul Gawande, one of the most astute and interesting physician writers of our time.

Dr. Gawande makes the case that health care reform and changes in the system are never successful with a "complete overhaul". He says a master plan for change will not work because there are so many entrenched systems that are working for "some" people. We have Medicare, Medicaid, Veterans Administration, private insurance, government insurance for government workers, employer sponsored insurance and prescription drug plans.

He says we should build upon what we have got but keep striving for better and better. The first ambition, of course, is universal coverage so everyone can receive health care and no-one goes bankrupt because they get cancer.

So go get yourself a cup of tea and read this article!

Aggressive Anti-Abortion Nurse

Talk about overstepping your professional bounds. A nurse at Presbyterian Medical Services Rio Rancho Family Health Center in Albuquerque, New Mexico was sued this week after she removed an IUD from a patient without permission because she (the nurse) was against abortion.

Allegedly, the patient went to the clinic for a routine exam and asked to have the IUD string shortened. The nurse began asking the patient about her choice of contraception and then pulled the IUD out. According the the court complaint, the nurse said "Uh oh, I accidentally pulled out your IUD" She then said, "Having the IUD come out was a good thing. I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus."

The defendant nurse said, "Everyone in the office always laughs and tells me I pull these out on purpose because I am against…

California Reports Hospital Quality Data

California is breaking new ground by publishing eight hospital mortality measures so patients can determine which hospitals have the best quality outcomes. The state is using “risk adjusted” measures to better compare how “sick” a patient is and how likely they would be to die from the condition.

The eight measures include death from three medical conditions; acute stroke, hip fracture and gastrointestinal bleeding as well as five surgical procedures: coronary angioplasty, carotid endarterectomy, craniotomy, esophageal resection and pancreatic resection.

The new data offers a snapshot of the quality of care provided by over 400 California hospitals.

"This is the first time for many hospitals that they have been able to benchmark their performance on these procedures against all California hospitals," said Joseph Parker, director of the health care outcomes center for the Office of Statewide Health Planning and Development.

Of the state's 384 such hospitals, 25 performed b…

Does Personality Affect Dementia?

A new study published in Neurology suggests that the risk of developing dementia might be influenced by a person's underlying personality. People who are active, social and calm may stay mentally sharp longer than people who don't have those traits.

The Researchers from Karolinska Institute in Stockholm, Sweden used a questionnaire to determine personality traits in 506 healthy older subjects. The participants were followed for 6 years and were asked about how they spent their leisure time, the richness of their social network and how optimistic they were and how they handled stress and isolation.

They found that people who were not socially active, but were calm and relaxed were 50% less likely to develop dementia than those who were isolated and distressed. People who were extroverts (social), active, optimistic and calm had the best outcomes and lowest dementia of all.

So what is the take home message here? If you are naturally neurotic and anxious, making sure you have an…

Obama and Stem Cell Research

There is speculation on the Hill about whether President Obama (love those words) will immediately reverse the ban on stem cell research by executive order, or wait until Congress submits a bill to him that he would sign. I think it is about 50/50.

Either way, these are significant steps in the right direction after 8 years of "anti-science" and suppression of expert research under the Bush administration. Former Surgeon-General under Bush, Dr. Richard Carmona complained he was muzzled in attempts to speak out on stem cell science and other issues.

The fact that Obama is likely to be lifting the restrictions on US federal funding of human embryonic stem cell research speaks volumes about how he will govern.

Stem cell research from public funding will potentially ensure open access to research results and allow easier transition from research to development of new therapies and cures for patients with a wide range of illnesses.

In 2007, Senator Obama co-sponsored the Stem Cell…

It's Obama Day

In honor of Barack Obama I'll be wearing my shoes.

Remember Martin Luther King, Jr.

Remember Martin Luther King, Jr. (this is a repost from 2008. And worth re-reading)
Martin Luther King, Jr. (Jan 15, 1929 -April 4, 1968)

"I have a dream that one day this nation will rise up and live out the true meaning of its creed" 'We hold these truths to be self-evident, that all men are created equal."'"I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.""Now is the time to lift our nation from the quicksand of racial injustice to the solid rock of brotherhood. Now is the time to make justice a reality for all of God's children.""Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness.""History will have to record that the greatest tragedy of this period of social transition was not the strident calmor of the bad people, but the appall…

When Ear Piercings Go Bad - Keloids

Women (and men) around the world love pierced ears. But sometimes piercings can go bad. The earlobes of this 28 year old women show huge masses that are called keloids. She had her ears pierced at age 6 and the keloids started forming when she was 9 years old.

Keloids are from excessive collagen formation that occurs during connective tissue repair. They extend beyond wound margins and usually do not regress. Microscopically you find large collagen bundles in keloids. They are common on the upper body and can develop years after injury. Persons of African American Descent are more susceptible to keloids than other races.

Keloids can be treated with intralesional corticosteroid injection, silicone gel sheeting, radiation therapy with surgery, pulsed dye laser and bleomycin.

This woman wanted to keep her keloids! I guess they do make her distinctive in a bizarre sort of way!

From Consultant, Dec 2008
Photo: Clinical Dermatology: A Color Guide to Diagnosis and Therapy

Answer to Medical Quiz

The answer to yesterday's image challenge is #1. spider hemangioma.

Spider angiomas can be seen in healthy children and pregnant women. In such cases, angiomas are few in number and resolve with time or a normalization of estrogen levels. Numerous spider angiomas are more common in patients with chronic liver disease and consist of a central arteriole from which numerous small venules radiate, resembling a spider's legs. Possible mechanisms of formation include arteriolar vasodilatation, neovascularization from angiogenic factors such as vascular endothelial growth factor, direct effects of alcohol, and estrogen excess due to inadequate hepatic metabolism.

Affordable Health Insurance

EverythingHealth is featuring a guest post today from health blogger Elaine Newland.

Get Proactive to Find Affordable Health Insurance

In the midst of the most serious economic downturn since the Great Depression, Americans are hearing frightening words like "bankruptcy" and "foreclosure" with alarming frequency. What most people don't know, especially the more than 40 million citizens who have no health coverage, is that unresolved medical expenses constitute the single most prevalent reason for personal bankruptcy in this country. There are likely many things you cannot afford in the current recession, but health coverage isn't one of them.

Businesses, especially small "Mom and Pop" endeavors are looking at the bottom line for 2009 and deciding what can be cut. Benefits will likely be the first thing to go with layoffs to follow, raising the specter of an additional 40 million Americans experiencing a break in their health coverage for a period o…

What's the Diagnosis?

This 55 year old man showed up with these lesions on his shoulder and upper chest. What is the diagnosis?
1. Spider angioma
2. Hereditary hemorrhagic telangiectasia
3. Pyogenic granuloma
4. Nodular melanoma
5. Cherry hemangioma

Click on the image for a better view and the answer will be posted tomorrow!
Answer will be posted tomorrow. Click on the image for a better view.

Steve Jobs Takes a Leave

The Steve Jobs story continues to create interest and speculation as he announced that he is going to take a six months' medical leave because his medical problems were "more complex" than he initially thought.

I blogged previously about the possible explanations for Mr. Job's weight loss after he underwent a Whipple surgical procedure for pancreatic cancer in 2004. As he became more and more emaciated, the rumors flew and Apple stock price fell with investor worries about his health. He attempted to minimize concerns last week and said the weight loss was from a hormone imbalance that caused nutritional problems.

Now, less than a week later, he announced in an email to his employees: "Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple as well. In addition, during the past week I have learned that my health-related issues are more complex than I originally thought. In order…

The Shingles Vaccine

Who should receive the Shingles vaccine?

Shingles (Aka: herpes zoster) is caused by a retrograde transport of the chickenpox virus from the ganglia (nerve root) to the skin. Ten to 30% of people develop Shingles in their lifetime and most of the time it occurs in the elderly. Normal aging causes immunity against zoster to go down.

Shingles causes a discrete rash that can be painful and lasts several weeks. Twenty percent of people develop postherpetic neuralgia, a painful condition that can last long after the Shingles outbreak.

In 2006 a Shingles vaccine called Zostavax was approved by the FDA. The Advisory Committee on Immunization Practices recommends giving a single dose of the live vaccine to healthy people age 60 or older. The vaccine prevents Shingles and postherpetic neuralgia.

Some points to know about Zostavax:
It is not the chickenpox vaccine (Varivax). Zostavax is 14X more potent than Varivax.Zostavax can be administered with other vaccines (Tetanus, influenza, pneumococcu…

Physician Self Disclosure

How much should the doctor talk about him/her self?

There have been a number of recent articles in medical journals that showed when physicians talk about themselves it can be distracting for the patient. One study showed that 40% of physician self-disclosures were unrelated to the patient's preceding remarks. In another article they found that primary care physicians talked about themselves to 30% of patients and it was not effective in conveying understanding or helping patients with improved self-care.

The only purpose of a physicians self disclosure should be if it is directly related to the patient's needs. It can be a way to facilitate understanding, increase rapport and relationship, or educate.
The Annals of Internal Medicine discussed ways physicians can reveal themselves to patients that would be in the patient's best interest.

Here are some examples:
Right: "So you have a new baby! I remember that time so well. How is that going for you?"
Wrong: "I…

A Great Snack

Someday I am going to write a "healthy recipe" cookbook. Until that time, I want to share the healthiest and easiest snack I know. Believe it or is just simmered cabbage. You are going to have to trust me on this one. You can use it as a side dish or just cook it up for hungry snacking.

One head of green cabbage
Cut it into large chunks
Place it in a large pan with butter (1-2 oz) and olive oil
Add 1/4 cup of water to keep moist.
Just braise it on the cooktop and put a lid on it and let it simmer.
Give it a stir and in about 15 minutes it is done. Season and enjoy!

Leftovers can be stored and warmed up for a quick snack.

I don't know the calorie count but the only fat is the butter and olive oil. Eat this instead of a full dinner and watch the lbs melt off.

Cabbage is rich in nutrients like iron, folate, calcium, potassium, Vit C, Vit K and all of the B vitamins.

Meditate on This

Medical Challenge - Answer

The answer to yesterday's Medical Challenge is:

#3 Donating blood. This patient donates platelets on a regular basis and this time a different technician did the venipuncture. The bruised and lacerated arm is the result of blood leaking into the tissue. The treatment is first ice followed by warm compresses which allow reabsorbtion of the blood. She is doing just fine and will continue her generous donations.

Medical Challenge- You Be The Doctor

This young woman presented with a left inner forearm that looked like this. What is the diagnosis? Answer will be posted tomorrow. Click on the image for a better view.

1. Intravenous drug abuse
2. Victim of partner abuse
3. Donated blood
4. Suicide attempt
5. "Cutter"

(photo used with permission- thank you km)

California - Big State, Many Uninsured

The California HealthCare Foundation has released it's data about the health of California and it ain't good. Over the past 20 years the number of uninsured continues to rise and we have the highest number of all the states - 6.6 million uninsured citizens.

Some surprising findings:

More than a third come from families with incomes over $50K
Nearly 60% are Latino
More than 70% of children without health insurance come from families where a parent works FULL TIME.
The number keeps growing as employers downsize and drop coverage for employees.
8% of Californians purchase their own insurance
Make no mistake...if a person has no health insurance they are more likely to suffer ill health and die earlier. Children without health care perform worse in school and have higher risk of chronic disease as adults. The success of a nation is tied to public health.
"The best diagnostic test in America of a persons health is to look at the color of his skin" Don Berwick
So lets not kid ourse…

Steve Jobs Weight Loss

When fifty-three year old Steve Jobs lost a large amount of weight and did not show up for the MacWorld Expo in San Francisco, shares of Apple stock plummeted. Since he was treated for pancreatic cancer four years ago, his weight loss has made investors nervous that the creative head of Apple was facing another serious medical crisis.

Now Mr. Jobs has released a public letter that states he is suffering from a hormonal imbalance that caused the weight loss and it can be treated with simple medication. He assured the stockholders that he is well and will continue to lead the company.

Steve Jobs was treated with the Whipple procedure, a complex surgery that removes the head of the pancreas, the gall bladder, the bottom part of the stomach (antrectomy) and part of the duodenum. This part of the pancreas secretes insulin, which regulates blood sugar, as well as a number of enzymes that help with digestion.

Weight loss after Whipple is common and extreme weight loss can occur if the pati…

John Travolta's Son - A Tragedy

John Travolta and Kelly Preston are grieving the loss of their 16 year old son today. While on vacation at their Bahama retreat, the 16 year old went to the bathroom on Jan 1 and was found by his attendant, Jeff Kathrein the next day at 10 AM, after suffering an apparent seizure and hitting his head as he fell. An autopsy is planned.

The only thing that has been revealed by his parents about his health is that he was diagnosed with Kawasaki disease as a toddler. It is a disease of blood vessels and leads to inflammation and heart problems in young children but it is not a chronic condition. Kawasaki disease does not cause epilepsy. John and Kelly blamed household cleaners and fertilizers for the disease and became obsessed about his space being cleaned, John told CNN's Larry King in a 2001 interview. They used their religion, "Scientology", to cleanse his system.

There have been reports for years that young Jett Travolta suffered from autism, although the fami…

Are Americans Too Soft?

Sometimes I think Americans are too soft. How many could survive traveling almost a year in a covered wagon? How many women could give birth without an epidural? What about experiencing "restless legs syndrome" without medication or "social anxiety disorder" (shyness?) without medication? How about suffering a common cold without needing antibiotics .

It's not entirely our fault. Now that pharmaceutical and medical device companies can advertise directly to consumers, we are lead to believe that everything has a medical label and can be cured by medication or surgery. Every condition is given a medical diagnosis and there seems to be an expensive, daily dosed medication that can help.

I believe we live in a wonderful age where medical science provides benefits and cures that were never thought possible. But I also know that many "conditions" are the result of inactivity, stress, poor diet and boredom.

Do we even know what is normal anymore? We n…

New Year - 2009

My 5 New Year Resolutions. What are Yours?

Take a 30 minute walk or bike ride each dayStop eating JuJuBees and other refined sugar
Clean clutter from my life. Purge, purge, purgeSpend more time with family (less time blogging?)Stop doubt