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Showing posts from February, 2009

Injury Rates in Runners Changed by Technique

I've recently read about a technique in running called "ChiRunning". Developed from Tai Chi practice, it involves leaning forward while running and allowing gravity to help propel you in an effortless way. The runner is supposed to be loose and relaxed while running and it makes running effortless.

It sounds like common sense, but any pain that occurs while running should not be ignored as it is your body telling you that there is something wrong with your technique. Shin splints, plantar fasciitis, iliotibial band pain, back pain can all be helped by changing the biomechanics and posture when running.

In ChiRunning, they focus on the feet being hip width apart and toes pointing forward (not angled outward). They are also mindful of softening the knees and making sure the weight is not on the ball of the foot or the heels, but in the midfoot.

For the chi runners, practicing the form is what makes it work. Running slow at first and making sure you are in alignment and m…

Medical Challenge - Answer

The answer to the NEJM challenge is #2. Angiotensin Converting Enzyme.

Lupus pernio is a skin manifestation of sarcoidosis that involves the nasal bridge and cheeks. Serum levels of the angiotensin-converting enzyme are elevated in the majority of patients with untreated sarcoidosis.

Sarcoidosis is an autoimmune disease that causes inflammatory cells to clump in various parts of the body, commonly the lungs, lymph nodes, eyes and skin. It can develop slowly over years or it can appear suddenly and then disappear.

Black Americans have a higher incidence of sarcoidosis and black women develop it twice as often as black men. It usually develops between the ages of 20-40. Treatment involves immune suppressive drugs like hydrocortisone.

Now see how smart you are?

Winner of the POM contest

EverythingHealth loves to give free things away! Because we couldn't decide amongst all of the great entries, a random drawing was held and the winner is...(drumroll).... SUSAN.

Congratulations, Susan. Please contact me with your mailing address to receive your case of healthy, yummy POM. Thanks to everyone who wrote great comments. I'll try to have other contests in the future so everyone can win.

Medical Challenge - What's the Diagnosis?

The New England Journal of Medicine diagnostic challenge is aimed at physicians but anyone can play. This patient has skin lesions (click on image for a better view) that are non-tender, non-itchy and slowly growing. What lab test would cinch the diagnosis? 1. 17-hydroxyprogesterone 2. Angiotensin-converting enzyme 3. Anti-tissue transglutaminase antibody 4. Prolactin 5. Vitamin B6 The answer will be posed on Friday.

One Lousy Doctor Can Spoil a Good Day

As a comprehensive internist, I hear lots of stories from my patients about their experiences with other doctors. Some are real shockers like this one..(used with permission):

Beverly had several weeks of rectal bleeding and pain. She mentioned it at her gynecologist visit and that doctor did an exam and thought she felt hemorrhoids so she referred her to a gastrointestinal (GI) specialist for treatment and possible colonoscopy. (The patient is 50 and is due for a screening exam anyway).

Beverly saw the GI doctor who...get this...never undressed her, did no exam at all but just talked to her and told her he didn't deal with problems "below the waist". He referred her to his friend the colo-rectal surgeon. Despite no exam he gave her a prescription for nitroglycerin cream and said once her hemorrhoids were cleared up he would be happy to do a colonoscopy. She got a bill for a 99243 "consult" for $275.00. This was for no exam and him just accepting a second h…

Lead Poisoning

Dear Dr. Toni,
I have been stripping lead based paint off of old (very old) wood planks for a project I am doing. Now I'm worried about lead poisoning. Can I get it from breathing in fumes and paint dust? How can I know?

Dear Leroy:
Yes, lead poisoning occurs after exposure in the environment and lead is not biodegradable. Old paints, water pipes and even dishes can contain lead and may pose a health hazard from breathing in lead dust, drinking water from lead based pipes or ingesting it. The accumulation of lead is gradual and symptoms might include muscle weakness, headache, memory loss, pain or tingling of the extremities and digestive problems. Children are more susceptible and can have weight loss, irritability, anemia and vomiting.

Since you are working with old paint on your project, you should have a blood test to detect lead poisoning. Levels are measured in micrograms per deciliter (mcg/dL) and any level of 10 or higher is a problem. Higher levels (can go abov…

Obama Wow!

Everythinghealth loves President Obama and was impressed and inspired by his speech tonight. Some random thoughts:
He has a beautiful smile and is like a Rock StarIt seemed both Republicans and Dems gave standing ovations - no divided house (at least in public)
He was upbeat and hopefulHe loves Michelle and acknowledged herHe seemed to be the youngest person in the roomPale, male and stale (don't those guys ever retire?)He promised a lot - hope he didn't over promise and under deliver
He looks good with a red striped tieHe didn't equivocate on reforming healthcare...but how?Does anyone believe a word from Ben Bernanke? The stock market rallied."If you earn less than 250K/year, your taxes will not increase one single dime"He talked about a lot of new programs and also pledged to cut the national debt by 50% in his first term. Sounds good..maybe too good?I could listen to him talk all night.

Fat for Fuel

Biodiesel fuel is considered to be more environmentally friendly than gasoline and different sources such as algae, beef tallow and corn have been tied as an alternative form of fuel.

Dr. Craig Alan Bittner, a Beverly Hills cosmetic surgeon found a new form of fuel right in his practice. Liposuction fat! He made fuel for his girlfriend's SUV from the extracted fat of patients. Apparently he had more fat than he could use.

This doctor is under investigation by the California Department of Public Health because it is against the law to use human waste as fuel. Who knew? His fat for fuel escapades were unveiled when he was sued by several patients for letting his unqualified girlfriend assist in operations that left patients "disfigured".

The entrepreneurial doctor has left the country for South America.

Canada vs U.S. Medical Journals

The Canadian Journal of Family Practice is a bit racy compared to the New England Journal of Medicine. I guess competition for readership occurs even in the staid world of Medicine.

(Photo hijacked from Medical Jokes)

A Healthy Pom Contest

Just for fun and good health...lets have another Give-a-way, OK?

POM Wonderful is pure 100% pomegranate Juice. EverythingHealth loves that there is no sugar, preservatives, color or cheap filler juices in POM. And for you folks that want to "buy American" is grown right here in the good ole' USA.

We always promote getting your vitamins and antioxidants from real food and pomegranate juice is one of the most potent antioxidants in nature. Studies have shown improvement in cardiac health, erectile dysfunction and prostate health with daily POM drinkers.

So think about how your health could be improved by drinking POM and write a comment. The best reply will receive a case of POM. (within the U.S. only, sorry international readers)
I'll post the winner on Thursday, Feb 26.

Click on the comments and tell me why you want POM.

Cardiologists Do Too Much

My laziness in blogging today is your win as I refer you over to Dr. Rich's Covert Rationing blog.
Dr. Rich writes a provocative piece on Cardiologists and their propensity to perform cardiac caths and place stents in patients...despite the evidence that stenting blocked coronary arteries does not prevent heart attack or prolong life.

Drug eluding (coated) stents cost from $15,000 to $30,000 to place and the data shows that medication (cholesterol lowering drugs and aspirin) are equally effective in patients who have stable blocked arteries and chest pain. So why are 70% of these patients treated with stents? Read Dr. Rich's blog for an eyeopener. It gets better as you read longer and see what patients erroneously expect the stent will do for them.

You can't blame the cardiologists...they are only responding to perverse incentives that pay them handsomely for doing more and more.

It's the American Way.

Antioxidants Don't Prevent Cardiac Disease

Tip to EverythingHealth readers: Quit wasting your money on "antioxidants". The evidence is clear that Vitamin E, B-vitamins and Folic Acid do not prevent heart attack or stroke.

It's easy to see why there was a buzz about these antioxidants and why millions of people have spent $billions of dollars on these vitamins. The LDL (bad) particle of cholesterol needs to be "oxidized" to be taken up into the artery wall. People got interested in Vitamin E, which circulates in the LDL particle and thought it might be protective against oxidation. Beta Carotene also circulates so people thought it might prevent cancer and heart disease.

That lead to numerous prospective, randomized trials in both men and women in high risk and low risk populations. They took Vitamin E, Vitamin C, and beta carotene alone and in combination. There were huge trials over 5 years that showed NO BENEFIT.

We also got interested in homocysteine because high levels in the blood were associa…

Octuplet Doctor - Yank His License Now!

Dr. Michael Kamrava runs the West Coast IVF Clinic and is the doctor who has provided Octuplet mom, Nadya Suleman, all 14 of her children (under the age of 6!) Nadya Suleman, now on food stamps and welfare, spent $100,000 with Dr. Kamrava .

If that is not enough, we now find that same physician has another patient who is 49 years old and is 5 months pregnant with quadruplets.

The mother, who has two grown children, is already admitted to the LA County Hospital on bedrest and was transferred from Good Samaritan Hospital because she does not have adequate medical insurance.

The woman at 49 years old, is already considered high risk with one baby. Triplets would increase the risk of cerebral palsy by 47 times. Premature birth is almost certain with four babies.

I am happy to report that my California medical license dues, which support the Medical Board of California, are being used properly as the Medical Board is investigating Dr. Kamrava.
Dr. Kamrava, goes outside the American Society f…

The Patient With Too Many Issues

You never know if blog comments are real or not, but I choose to take them at face value. The comment from "tina" on my "I am sick" blog is worth writing about. Here's what tina said:

"hi, I have been everywhere and seen a lot of doctor's and no one can seem to help they just say it's all in my head as i continue to get worse and worse. Sometimes things are so bad i feel like i am going to pass out,my b/p goes higher and heart beats so fast i think i am going to die. The pains are so severe they knock me down and now my legs are starting too they feel like they are bruised or sunburn but they are not and my heart beats in my throat not my chest. This all started when i was 33 years old and found out i was pregnant for my last child but i am now 42 and it is worse not better they say anxiety/panic attacks but the meds did nothing except make me gain 70 pounds or more. I am lost and at my ends wits no one can help me.My symptoms included: low energy…

I'm Sick

Check back again soon. EverythingHealth will be back with news, views and health reports when the author recovers.

Doctor Suicide

No one has been able to explain why doctors, as a profession, have the highest suicide rate of any profession. Every year, between 300-400 doctors take their own lives. In the general population, males commit suicide 4 x higher than women. But the suicide rate among male and female doctors is the same. Female doctors take their lives at a rate more than twice that of the general public.

There is really very little research done on this subject and most of it is old. The most definitive study was done in 2003 and published in JAMA. It stated that undiagnosed and untreated depression is the problem and even when physicians seek help for depression, they are not treated aggressively.

Mental illness still has a stigma in our society. Doctors realize, with good reason, that if they admit to a mental health problem they could lose respect, referrals, income and even their licenses. Doctors have access to drugs that can mask their symptoms without getting help and that may make the si…

Heart Rate Is Predictor of Heart Disease in Women

Do you want a free way to predict heart attack in women? Check the resting heart rate.

The British Medical Journal (love those Brits!) has published data that shows the resting heart rate (also known as "pulse") is a good way to predict heart attack in women over age 50. Women with heart rates higher than 76 beats per minute at rest were more likely to have heart attack than women with pulse rates below 62. Race was not a variable, nor was diabetes so the heart rate was an independent risk factor. The heart rate was not a factor in stroke.

Resting heart rate is an indicator of autonomic nervous system tone. High sympathetic nervous system tone may be a marker of subclinical cardiovascular disease and it might affect other known risk factors like blood pressure, glucose metabolism or plasma lipids (cholesterol).

To check it out on yourself, sit quietly for 5-10 minutes or check it before you get up in the morning. Take your pulse for 30 seconds and then multiply that numb…

The Maasai Visit

It was so wonderful this week to see my Maasai friends from Kenya and have a reception for them at my home. This was the first trip away from their African village for many of them and they brought such magical good vibes, generosity and openness with them. They hug and touch for hello and goodbye and after gathering in a circle and chanting and singing, they blessed my home.

Led by Sironka, they perform and sell their wonderful beads to support female education, health clinics and improved standard of living for their tribe at home.

Dasche Withdraws - The Past Haunts

Tom Daschle, the "almost" head of Obama's Health and Human Services, has suddenly pulled his nomination due to investigation into his failure to pay $140,000 in income tax when it was due. (he has since made payment). Although Pres. Obama continued supporting him, Daschle gave the usual explanation of "not wanting to be a distraction etc etc."
With the support that Tom Daschle had as new head of the HHS, this resignation, along with the two others from Obama's cabinet, heralds a new day in Washington. I'm not sure it is the delinquent taxes so much as the facts that are being disclosed about the insider shenanigans in Washington and just how much $$$MONEY$$$ these "public servant" politicians can make after they leave office.

Poor Daschle (who would have been a good HHS chief) is feeling the effects of the light being shined on the last 4 years. He was on the payroll for a large law firm that represented Indian gaming, health care, suppo…

Octuplet Mom Wants Sponsorship

Thanks to KM for this link with the unfolding new information about the lady who had the octuplets in Southern California. It seems many involved with this story are against what she did, what the infertility physician did and the ethical questions it raises.

Seeing the Doctor? Bring your Credit Card

The days of the $5 or $10 copay are leaving fast. A growing number of doctors offices are now using software programs that can tell them exactly if a deductible has been paid and what the patient needs to pay at the time of the visit. Most insurance now has a large deductible..even as much as $2500 to $5000 a year. Many healthy patients don't even meet their deductible in a year so they are responsible for first dollar payment.

From the doctor's perspective, collecting this money at the time of service is good business sense. The good old days where the doctor was paid last, is long gone with primary care and even general surgery doctors closing their doors because of financial issues. The margins are very thin in many medical offices and as practice expenses rise, the need to collect at the time of service is critical.

"Bill my insurance" is a term that is going by the wayside. Since "Bill my insurance" actually means the doctor will send several bill…