Wednesday, June 30, 2010

Doctor Fakes Research and Goes to Jail

A prominent 51 year old anesthesiologist pled guilty to falsifying research on the analgesic medications Celebrex and Vioxx for post-op pain managment.  He was sentenced in Massachusetts federal court to 6 months in prison and given hefty fines to be paid to the pharmaceutical companies who financed his research and paid him to promote their drugs.

Dr. Scott Reuben just plain faked the results.  He reported in two published articles that he had treated 200 patients in a trial - 100 with placebo and 100 with celecoxib (Celebrex).  He simply made up the findings and never enrolled any patients at all.  Multiple medical journals have retracted more than 20 articles by Dr. Reuben containing faked data on a number of pharmaceutical drugs.

Besides the faked research he spoke frequently at medical conferences and continuing medical education events about using Celebrex and Vioxx in combination with other analgesics to reduce postoperative pain.  The pharmaceutical companies reimburse their expert speakers very well and he will be repaying $361,932 to Merck and $296,557 to Pfizer.

Dr. Reuben's attorney stated that an undiagnosed bipolar disorder was the cause of his misdeeds. 

6 Ways To Help Simplify Your Life

I like to pass on good tips and these six ways to simplify your life make a lot of sense.  The constant stress we feel because life is so complicated is not good for our health.  Here are six ways you can have a simpler lifestyle:

1. De-Clutter Your Home

Look around.  If you have piles of paper, too many "things" and nic-nacs laying around it is hard to think clearly and function. An open, clear space allows our minds to feel open and more peaceful.  Tackle one room at a time. Be ruthless and donate or toss everything that isn't useful, beautiful or has special memories.

2. Limit Family Activities

Try to force family members to choose only those activities that are most important.  Many of us are over-scheduled and have no time to just see "where the day will take us".   30 years ago no stores were open on Sunday and there wasn't much to do except go on picnics or just hang out with friends and family.  It is OK to "vege" and may even be good for your family's health.

3. Stop Buying Things

Although the discount stores (Target, Cosco, Marshalls etc)  bring us convenience and value, they also create consumers who just can't resist the bargains they see.  I know so many people with stuff they do not need.  Along with de-cluttering the home, you have to stop buying things in order to create a clean environment.  This may take discipline for many people but if you just stop going to stores it helps.  Resist impulse buys and only purchase what is truly needed.

4. Avoid Negative People

It is truly OK to distance yourself from people who bring you down.  Studies have shown that the attitudes of people around you, affect your attitude.  Choose positive and supportive people to hang with and avoid those toxic relationships.

5. Plan Your Meals

Take the time to make a shopping list and plan some meals ahead.  Eating fresh food rather than packaged food is so beneficial to your health and the mindfulness that comes with planning and cooking is a good thing.  Stroll through a farmers market or find a new simple recipe online and test it out.

6.  Throw away paper

If you are reading this, you have a computer.  Recycle magazines, phone books, catalogs, and extra paper that is laying around.  Put up a chalk board in the kitchen to write notes on and don't print anything from the computer unless you know you must have a hard copy.

You deserve a peaceful, stress free life.  Getting rid of clutter is one of the most important things you can do to create an environment that supports calmness.

From Miranda at Personal Dividends

Sunday, June 27, 2010

Good Lessons Come from McChrystal Debacle

General Stanley McChrystal's loose lips and ultimate downfall can teach us all some valuable lessons.  He was a career military man (West Point Graduate) who rose to the top of the heap as Commander of the International Security Assistance Force and Commander of U.S. Forces in Afghanistan.  People are scratching their heads about how a man who was in such an esteemed position could be so stupid as to publicly criticize the only three people who had the power to sack him!

First, he was on thin ice in 2009 when he publicly suggested that 30 to 40 thousand more troops were needed to "win in Afghanistan".  At that time many people thought he should be fired for insubordination for disclosing information that should have been said in private to the President.  Flash forward to the June article in Rolling Stone  where he mocked civilian government officials (including V.P. Joe "Bite-me" Biden), the Ambassador to Afghanistan and the National Securing Advisor and finally the Commander in Chief.  His frat boy attitude toward a serious war where thousands of lives have been lost was sickening to read.  And he was the Commander!

In medicine we know that communication gaps and lack of teamwork leads to medical errors and poor outcomes for patients.  The culture of a hospital organization comes from the top leaders.  If the leaders can't set a vision of "Patient Centered Care" and inspire all of the team to work toward that vision it won't happen.  And a code of conduct that lets everyone in the hospital know what is accepted and what is not, comes from the top.

Forget whether this war is right or wrong.  Forget whether you are republican or democrat.  This is not an issue that points to any ideology.  This is about character and leadership and the self control to know when to speak out publicly and when to hold your tongue.  When things are going poorly (as they are in Afghanistan), it is not the time to blame others, especially when you are the one in charge.  The best leaders praise others and take the blame themselves when things go wrong. That is true leadership.

Some have said that McChrystal wanted to be fired so he wouldn't have to take the blame for a failure.  One can only hope that his dismissal will now allow more of a spotlight to be shined on the War and what is happening on the ground.

Friday, June 25, 2010

Omega 3 FFA for Depression

A study published in the Journal of Clinical Psychiatry has shown that supplementing Omega-3 fatty acids (FFA) can significantly reduce symptoms for patients with major depression.  This study looked at 432 adult patients (mean age 46 years, 68.5% female) and randomized them to receive either 8 weeks of omega 3 FFA or placebo.  40% of the patients were also taking antidepressants when they started the study.

The results strongly showed that the patients who got the Omega 3 FFas had significantly reduced symptoms of depression compared to the placebo group.  Of interest is that patients with anxiety and depression did not improve with the Omega 3 supplements, only the patients with depression and no anxiety.

I have extolled the benefits of Omega 3 FFA supplements many times on EverythingHealth for treatment of hypertriglyceridemia and cardiovascular protection and I mentioned it for depressive symptoms also.  These essential fatty acids are not made in the body but must be consumed from food.  The average American is completely out of balance with too much Omega 6 and not enough Omega 3 in our modern diets.  Our brains and immune system depend upon essential fatty acids to function.

The next study that needs to be done is to compare Omega 3 FFA supplements with antidepressants in a head to head trial.  Until that time, clinicians could start treating depressed patients with Omega 3 supplements and see if the symptoms are relieved before they jump to antidepressants, with the caveat that anxiety disorders (which often accompany depression) were not improved with the supplement alone.

Diet: To boost your intake of fatty acids, eat more walnuts, spinach, flax seeds, and omega-3 enriched eggs.  Salmon, herring and sardines have the most Omega 3 FFAs,  but all fish supply some.

Full disclosure: I take Omega 3 FFA every day as a preventive and for good health.

Wednesday, June 23, 2010

Black Spot Poison Ivy

I love learning something new in medicine and this was a new one for spot poison ivy.   Poison ivy (also known as rhus dermatitis) is a common contact allergic dermatitis.  Like poison oak and poison sumac, the chemical that causes a reaction is called urushiol.  When this plant sap touches the skin a pruritic (itchy) red rash appears with little blisters that are often in a line.

Black spot poison ivy is the same urushiol but in humid, warm conditions it is oxidized by lactase from the skin and turns into a dark black lacquer color.  It is an uncommon presentation because usually the sap is diluted by perspiration and never turns black.

Poison ivy/oak is more common in the summer and I treat lots of cases in Northern California because it grows like a weed.  The worst cases are when someone tries to burn the plant and inhales the resin.  Treatment of black spot poison ivy is the same as regular poison ivy.  Washing the skin, clothes, and all contacts area immediately is critical.  Severe cases may require systemic corticosteroids and rebound rash is common.

(Image from Consultantlive)

Monday, June 21, 2010

Weight Loss from Activity Only Works in Thin Middle Age Women

Talk about a cruel trick of nature!  A study funded by the National Institutes of Health (NIH) and published in JAMA shows that physical activity prevents weight gain in middle-aged and older women ONLY IF THEY ARE ALREADY AT IDEAL WEIGHT.  Did you read that?  It means that the recommended guidelines advocating 150 minutes of exercise a week isn't sufficient to prevent weight gain in most middle age women.

The Harvard associated researchers assessed weight changes associated with various levels of physical activity on 34,079 women who had been followed since 1992 in the Women's Health Study.  They stratified women as inactive (less than 150 minutes a week of moderate level physical activity), intermediately active or highly active if they performed a high, strenuous level of activity.  All three groups showed similar weight gain over a mean 13 years of follow up.

Despite exercise, there was no correlation between activity level and weight gain except in the subgroup of women with Body Mass Index (BMI) below 25.  Only in those already thin women did a high level of activity prevent weight gain.

So what are we to think about this study?  First, caloric restriction is the only way to maintain or lose weight.  The health benefits of exercise have been proven over and over in thousands of studies and that is not in dispute.  But weight control demands caloric restriction, period.

I am sorry about these results. Truly I am.

(JAMA 2010;303:1173-9)

Sunday, June 20, 2010

SpaghettiOs Recalled

I know the readers of EverythingHealth would never eat Campbells SpaghettiOs but in case you know someone who does, you should know that the USDA has recalled 15,000,000 pounds of SpaghettiOs because of under processing. The recall includes 14.75-ounce cans with a use-by date between June 2010 and December 2011 of three varieties of the product: "SpaghettiOs with Meatballs," "SpaghettiOs A to Z with Meatballs" and "SpaghettiOs Fun Shapes with Meatballs (Cars)."

Consumers who have purchased those products with a plant code of "EST4K" should not eat them and should return them to the store where they were purchased for an exchange or full refund, Campbell Soup said.

More than 150 million cans of spaghettiOs are sold each year.

Being curious, I wondered what is in this American brand that was introduced in 1965?  Here is what I found:

Water, Tomato purée (Water, Tomato Paste), Enriched Macaroni Product (Wheat Flour, Niacin, Ferrous Sulfate, Thiamine Mononitrate, Riboflavin, Folic Acid), High Fructose Corn Syrup, Contains Less than 2 % of: Salt, Enzyme Modified Cheddar Cheese (Cheddar Cheese [Milk, Cheese Culture, Salt, Enzymes], Water, Disodium phosphate), Vegetable Oil (Corn, Cottonseed, Canola and/or Soybean), Enzyme Modified Butter, Oleoresin Paprika, Spice Extract, Citric Acid and Nonfat Dry Milk. One can contains 26g of sugar, 1700mg of salt, 74g of carbohydrates, 12g of protein and 360 calories.

Looking at these ingredients brings to mind the wise words of Michael Pollan , the food writer and researcher who advises us not to eat anything our grandparents wouldn't recognize.  Spaghetti0s seem to have a lot of additives that are hard to pronounce and that granny would wonder about.  It gives new meaning to "UH, OH...spaghetti Os"

Do you have any on your shelf?

Email Alerts by Popular Demand

Dear EverythingHealth readers,
Many of you have requested an email alert when new blogs are posted.  It took me awhile, but now it is easy to sign up on the right hand side of the blog.  Check it out and never miss a fascinating topic.
Thanks for visiting and reading.

Friday, June 18, 2010

Senate Approves Last-Minute Delay for Medicare Physician Cuts

Yesterday's Medicare pay cuts for physicians have been delayed in a last-minute compromise deal today by the U.S. Senate.  The agreement was passed by "unanimous consent" without a roll call vote.  (I need to go back to 8th grade Government 101 to figure out how that is done!)

The last minute agreement means that the pay cuts will be reversed.  The House of Representatives will (hopefully) pass the measure on Monday.  In the meantime, Medicare is still holding on to June claims and will pay them when everything gets approved.  These "fixes" will only last 6 months and then we will go through this again.

Thursday, June 17, 2010

The Doctor is Out for Medicare Patients

Breaking news tonight that in a last minute shocker, the Senate voted today against postponing a scheduled 21% cut in Medicare reimbursement to physicians and other health providers.  60 senators were needed to end filibuster debate and stop the cuts under Senate rules.  Fifty-six voted in favor, with 40 opposed. There was no Republican support. (And, of course, no support from Senator Lieberman, who is a Republican in disguise).   Another consequence of the vote is that tens of thousands of Americans who have exhausted their jobless benefits would not be eligible for more.  In addition, new taxes on wealthy investment managers would not be imposed, along with an increase in liability taxes on oil companies, leading Democrats to contend that Republicans were protecting Wall Street and the oil industry, according to the New York Times.

“We’re not going to give up,” said Senator Harry Reid, the Nevada Democrat and majority leader. “We know the American people only have us to depend on.”  

Medicare has been holding all claims from June until today, pending the action that was "supposed" to reverse this 21% mind blowing decrease.  Now that the vote is in, they will pay the claims retroactively at the lower rate.

This is really bad news for seniors.  Thirty one% of  primary care physicians surveyed by the AMA said they would not accept new Medicare patients if the cuts went through.  I predict much worse.   A 21% cut is the death knell for doctors who have a lot of Medicare patients.  Last month Medicare paid me $84.00 for a 99213 office visit.  That was already unsustainable and the only way anyone stays in business is by seeing other patients with better payment.  The new payment will be $66.36.   Hello bankruptcy court.

Stay tuned for an outcry from organized medicine and a flight of physicians away from the Medicare program.  The payment volatility of these government programs is leaving the health of our nation in critical condition.

Wednesday, June 16, 2010

Surgery and Radiation Therapy for Prostate Cancer Cause Lack of Ejaculation

The American Urological Association 2010 Annual Scientific Meeting was held in San Francisco.  One of the reports at the meeting dealt with the fact that nearly 90% of men who undergo radiation therapy for prostate cancer will eventually develop anejaculation (inability to ejaculate).  Additionally radical prostatectomy (surgery) is almost always associated with loss of ability to ejaculate.  It is an inevitable and well-recognized result of surgery but anejaculation after radiation treatment is less discussed.

A  study of 252 men who were treated for prostate cancer showed that 72% of men lost their ability to ejaculate after radiation treatment.  After 5 years, 89% had anejaculation.  The mean study age was 65 years.

Since both surgery and radiation therapy are likely to cause anejaculation, it is important that men know about it as they are making decisions on treatment.

Tuesday, June 15, 2010

Addiction to Tanning

According to the Archives of Dermatology, there are people who are addicted to indoor tanning.  That journal reported on a study of 421 University students in the northeastern United States.  Using self-reported questionnaires, they screened for alcoholism and substance use as well as anxiety and depression.  They also had a questionnaire about addiction to indoor tanning. 

If you are scratching your head (as I was) please know there is a medically accepted criteria known as CAGE (cut down, annoyed, guilty, eye-opener) that correlates with addiction so they used this for "addiction" to indoor tanning also.  They found that more of the kids who met the criteria for addiction to indoor tanning also had greater anxiety, greater use of alcohol, marijuana and other substances.  Depression didn't seem to go with the tanners or the non-tanners.

The researchers concluded that students who are addicted to indoor tanning may also have other addictions and psychologic disturbances.

My 2¢ is that this is a pretty absurd study and I wonder who funded it.  I have never met anyone who is addicted to indoor tanning, nor have I known any person with anxiety or a substance abuse problem who simply must be tan!  Do some researchers have too much funding and too much idle time on their hands?

Should we call this the George Hamilton Syndrome?

Doctors Offices Not Keeping Up with Online Demand from Patients

At a time when more and more patients are using the internet to research doctors, hospitals and medical conditions, there are still few physicians who utilize on-line services for patient care.  Thirty eight percent of  US adults have researched a medical problem online in the past 12 months, according to a Forrester Research Study.  The survey also showed that 26% of adults researched a specific drug and 7% looked up the quality or reputation of a doctor.  Despite this activity, few physicians interact with patients online.

In another poll reported in Modern Healthcare, 50% of patients say they would like to communicate online with their doctor or his office about clinical or administrative services.  They would like to use web-based tools to schedule appointments, access immunization records or schedules, complete screening forms or refill prescriptions.

How many physician offices offer any one of these?  Less than 15%.

It isn't a surprise to me that Doctors are so behind on implementing these patient connections.  Most physicians are still working in solo or very small groups and they have neither the time or the resources to overhaul their offices.  Communication with patients requires secure connections that are compliant with patient privacy legislation. Electronic programs require technical support and user fees.  The costs are in hard green dollars, upfront...often in the tens of thousands of dollars.  The advantages are harder to quantify.  With overhead running 65-70% in primary care offices, the dollars involved come from the doctors pocket. 

This is one of many reasons why physicians are joining hospital sponsored groups and employment situations.  Running a business with such lean margins and tough government regulations makes it hard to keep up with new technology and services.  Most doctors still practice like they did in 1950.  We can't afford the technology that patients want.  The world has moved on and medical offices just haven't  keep up.

Saturday, June 12, 2010

Eight Secrets You Should Tell Your Doctor

It is important to have an open relationship with your primary care physician because the more she knows about your health and lifestyle, the better able she is to diagnose illnesses as they come up.  You wouldn't take your car to a mechanic and not tell him that the brake is sticking.  And a human organism is thousands of times more complicated than a car.  But patients are shy. They are embarrassed. They don't want you to think badly about them.  So they often leave out important information that is critical for the physician to know.  Here are eight secrets you should tell your doctor:

  1. All of the medicines you take, including herbs and over the counter:  It is amazing to me how many times I review a med list and  even when I prompt "is that all?", I find out much later that the patient left out the birth control pill or the herb for prostate.  Everything is important.   
  2.  Smoking, drinking, drugs:  All doctors know to triple the amount a person says they drink.  If you smoke "on weekends"...admit it.  The same with recreational drugs.
  3.  Can't afford your prescriptions:  Studies show that up to 40% of patients cut their pills or don't fill the Rx. because of cost.  Tell your doctor up front. There are many generic equivalents as well as prescription assistance programs that can help.  We all know that prescriptions are wildly expensive and we want to make sure you can afford it.
  4.  How much you really exercise: We all want to exercise more but saying you exercise "regularly", when it is really a walk to the car, makes it hard to come up with a treatment plan that will really work.
  5.  Have sexual dysfunction: For men, sexual dysfunction can signify diabetes, thyroid disorders or atherosclerosis.  Tell your doctor if you can't get it up or if there has been a change in your sexuality.  For women it is even more complicated so open up that discussion.
  6.  Have a change in your bowel movements: Blood in the stool, a change in your regular habits, pain with movements are all things that should be discussed. Doctors are very comfortable talking about body functions.  We do it at the dinner table so don't be shy.
  7.  Extreme stress:  Worried about money? Having marital problems? Have a teenager? Your mental health is as important as your body functions.  Let your doctor know if you are experiencing stress as it can have major impact on your health.
  8.  See another doctor:  One patient recently told me he had "cheated on me" and seen another doctor closer to his home.  I had to laugh at this because he said it like it was a betrayal, but I was glad he felt open enough to tell me.  Coordinating care is important and knowing that tests or prescriptions have been given by another physician is critical information for us to have.
The private nature of medicine shows why it is so important to have a trusted relationship with a physician.  It is also OK to ask that some information be left out of the medical record (chart).  The medical record is not private.  Every time you apply for insurance (life insurance, health insurance, disability, long-term care) you sign a form that allows access to your medical record so protecting it is important.  Again, this is why an open understanding with your treating physician is so important.  But if you have that relationship...go ahead a be open.  It is a partnership.

Friday, June 11, 2010

Are We Overmedicating Our Kids?

One of the blogs I read by Maggie Mahar, pointed out that a new study found that 26% of kids under age 19 are now taking prescription drugs for a chronic condition. The drugs include asthma medication, anti-psychotics, diabetes, anti-hypertensives and heartburn medications.  According to the Medco study (the largest pharmacy benefit manager), the incidence of type 2 diabetes increased over 150% in children between 2001 and 2009.  Readers, that is staggering!  Children are supposed to be healthy and active and not tied to a regimen of pills.

What is our nation doing to care for our most precious citizens?  Why are 17% of adolescents (ages 10-19) now classified as obese?  Why have medications used to treat high blood pressure, high cholesterol and diabetes increased 15.2% in children?  And why are children being treated for heartburn, a condition that is associated with obesity and should never be part of childhood?

I ask these questions rhetorically.  We know the answers.  The increase in obesity can be directly linked to processed foods with high sugar content, carbohydrates and sugary soft drinks.  Couple that with lack of exercise and you get a fat kid.  Studies show that obesity leads to high blood pressure, insulin abnormalities and diabetes, breathing disorders, gastroesophageal reflux and possibly even behavioral problems.

These figures should be front page news, right up there with the awful BP oil spill and we should be just as outraged.  Most of these medications have not been tested on children and we do not know the long term consequences.  We have a huge problem that cannot be swept under the door with a prescription.  It is not the kid's fault.  It is society's fault.

We need to put health first.  The new food labeling laws associated with Health Insurance Reform is a tiny start.  We need to get sodas out of schools and out of the nations refrigerators. We need to make physical education a school requirement, not a nice extra "if we can afford it."  We need to embrace Jaimie Oliver's Food Revolution and improve school (and home) lunches.  We need to stop buying candy and pretending that packaged convenience food is "real" food.

I know readers of EverythingHealth probably already do the right things for their kids.  It will take a village approach to turn this around for our Nation.

Wednesday, June 9, 2010

Keratosis Pilaris

This photo of the arm of a 17 year old girl showing tiny red rough bumps that were not painful or itchy.  She had similar bumps on her thighs.  This common condition is called Keratosis Pilaris and it peaks during adolescence in all races.  It goes away by itself as a person ages.

We don't know the cause of this strange phenomenon.  Since it is mainly seen in puberty there may be a hormonal effect.

 There are no special tests to diagnose Keratosis Pilaris and there is no specific treatment.  Moisturizing the skin is important to soften the dryness and reduce roughness.   Topical retinoids (Retin A, Tazorac) can help to promote cell turnover and prevent plugging of hair follicles.

Image and case from Consultant Live

Monday, June 7, 2010

Extra Fees Help Physicians Stay in Practice

I was interested in an article in USA Today about the growing number of physicians, especially primary care doctors, who are boosting their revenues by requiring patients to pay new fees for services that insurance doesn't cover.  No longer is your insurance payment "all-inclusive". These fees can include annual administration fees, no-show fees, medical report fees, and extra fees for email or phone consultations.  If private practice medicine is going to survive, these fees are a necessity.

An article in the NEJM in April, showed how much time physicians spend on activities that receive no compensation at all.  It is not unusual for an Internal Medicine physician to spend an extra 3 hours a day filling out forms, refilling prescriptions, making phone calls on patient's behalf, answering questions from patients and dealing with a myriad of patient related requests.  With overhead running at 65% or above, more and more doctors are leaving practice or burning out.  The ones who can, are joining large hospital sponsored groups where they are subsidized.  These groups know that primary care is a "loss leader" for the more lucrative procedures that insurance and Medicare reimburses.

As a physician who has practiced for over 20 years (yikes!!), I can tell you that the demands of filling out forms for everything from work questions and school physicals to handicapped stickers and travel vouchers, dealing with insurance companies, reviewing tests ordered by other doctors, overseeing and coordinating patient care, talking with pharmacists, filling prescriptions and then redoing the work when a patient switches pharmacies, emailing and countless other tasks that are "FREE" make it near impossible to remain in private practice.

What makes sense for primary care?  Instead of nickle and dimeing patients, there should be an annual administration fee that covers these extras.  Just like your car insurance doesn't cover the oil change, health insurance doesn't cover the tasks physicians perform on your behalf.  How much of an annual fee depends upon the practice.  For most practices $125/year should cover the extras.

I think most would find that a small price to pay to keep their doctor's doors open.

Saturday, June 5, 2010

Start Talking - a book for Teens and Moms

Raising kids gets really challenging when they hit the pre-teen age and there are few books that really help moms understand how maintain closeness with their teen daughters.   Authors Mary Jo Rapini and Janine Sherman offer a helpful book for young girls and their moms to read individually and together.  "Start Talking - A girls guide for you and your mom about health, sex or whatever" is a welcome coaching guide for moms who really want to open the door to great communication.

In my day there was one book that every girl read called "Growing up and Liking it".  With anatomical drawings that were hard to understand and the biologic facts about your body "changing", it didn't create much of a discussion platform.  It also didn't deal with any of the real issues young girls want to hear about.  Boring!  Rapini and Sherman have exponentially raised the bar with "Start Talking".

"Start Talking" offers straight and complete answers about how your body works, feeling good and feeling fat, birth control, STD and what makes you a virgin.  They are frank about sex and why waiting is a good choice.  There is a strong focus on helping girls feel good about their bodies.  Each chapter is a different topic and has "mom questions", "daughter questions" and "conversations starters".  What does a mom do when she finds out her daughter is having sex at age 16?  It may sound young but 40% of girls have had sex by age 16 and over half by age 17.  What if your daughter is bulimic or is being bullied?  These real life problems are addressed in "Start Talking".

What I like about this book is the easy layout and the provocative Q&A that moms and daughters can read together.  It stimulates a conversation that can start in the pre-teen years and advance as a girl matures.  The book is medically correct in it's descriptions and advice and non-judgemental in tone.  Isn't that the type of open dialog we all seek to have with our children?

If you have a pre-teen or know someone who does, pick up "Start Talking" and start creating open conversations with your daughter as she matures. Studies show that teens may act like you are not part of their world, but what they really want is to talk and to have you try and understand them.  This book is a good place to start.

Thursday, June 3, 2010

More Medication Errors in July

We medical folks have always known that July is the worst time for a patient to be admitted to the hospital.  It has nothing to do with nice summer weather or staff vacations.  Although it cannot be proven, we think the answer to the mystery of July hospital errors is human...yes it's the new interns.

A new study published in the June issue of the Journal of General Internal Medicine looked at all U.S. death certificates from 1979 to 2006.  They found that in teaching hospitals, on average deadly medication mistakes surged by 10% each July.  The good news is they did not find a surge in other medical errors, including surgery or in non-teaching hospitals.

So lets break this down.  Every July a new crop of medical interns hit the wards.  Eager, motivated, and anxious to do well in their new white coats and carrying smart phones, they start seeing hospitalized patients.  Each intern is paired with a Medical Resident...a young doctor a little further along in training.  Some Residents micromanage the interns...some are hands off.  Some interns have very little supervision and have no experience in patient safety.  With thousands of medications and tens of thousands of drug interactions, I am not surprised in the surge of mistakes in July.

In my day our pockets were stuffed with little notebooks and guides to diseases.  The Merck Handbook, the Washington Manual were lugged from place to place so we could access information.  It was laborious and not very effective.  The new interns have iphones and ipads with medical information accessible through the touch of a screen.  If they order medications though a computer, there are fail safes built in to help prevent medication errors. We will see if that makes a difference.

Everyone, patients and clinical educators, needs to be aware of the "July Effect" and be extra cautious.  Interns need increased supervision and nurses and patient families need to question everything!  Hospital Pharmacists should be making rounds with the teams and double checking all orders.   The learning curve for Interns is swift.  We need to help them learn, while protecting patients.

Wednesday, June 2, 2010

Chin Slimmer

After yesterday's eyebrow post, I am on a cosmetic run. Here is a gimmick, "As seen on TV" , on which you should save your hard earned money.  The neckline slimmer claims to reverse the effects of aging without cosmetic surgery.  Simply hold this gadget to the chin area and it will exercise your neck muscles to reduce those jowls or sagging fat under your chin.  Just two minutes a day should do the trick, according to the commercial.

Unfortunately the effects of aging and loose skin cannot be reversed by jiggling the head or pressing the fat upward.  Weight loss can slim the face but sagging jowls probably needs cosmetic surgery.
Personally, I prefer candle lighting and light dimmers.

Tuesday, June 1, 2010

Desired Shape of the Eyebrow

While my Internal Medicine Journals are filled with long studies about breast cancer, diabetes and optimal doses of Vitamin D, the Archives of Facial Plastic Surgery reports on the aesthetically desired position of eyebrows and the range of eyebrow motility.  Please understand, dear reader that  I am not poo-pooing the importance of eyebrows.  We all have two and I am sure how they sit on our foreheads is of utmost importance so here are the results of the clinical trial.

The researchers took photos of 40 adult subjects in 5 poses: eyes open and eyes closed, brows elevated and brows contracted and brow positioned optimally by the subject.  (I have never thought about optimal eyebrow positioning.  My eyebrows just seem to happen.)

They found that women desired the lower border of the brow to fall just below the orbital rim at the medial canthus (the inside corner of they eye).  They liked the rim of the eyebrow at the mid-pupil area.  The men desired a lower brow with a lower tail and a less accentuated peak.  The brow peak in both women and men was just to the middle of the lateral canthus (the outside corner of the eye.)

Plastic surgeons would do well to place the brow just where men and women want it.  You wouldn't want to give a male brow to a woman.  Now I will be looking at everyone's brow line and trying to figure it out.  Medicine is a demanding profession!

What You Should Know About Prostate Cancer

When Dennis Hopper died of prostate cancer at age 74, my husband asked me "Hey, I thought prostate cancer didn't kill men and it is slow growing".  Well, he is right  about it usually being slow growing, but prostate cancer is still the 2nd leading cause of cancer death in men.  His question made me realize that there are some facts that everyone should know about prostate cancer.

Prostate Cancer is very rare in men under age 40 and the incidence increases with age.  African-American men are at higher risk and Asian and Latin men are less likely that white guys to get it.  We do not know why these ethnic differences occur.  Family history is important and men with an affected brother or father are twice as likely to get prostate cancer.  Although genes are undoubtedly responsible, there are no genetic tests that can predict it.  Some studies show obese men and men who eat large quantities of red meat and dairy products are more at risk.  A vasectomy doesn't seem to matter, nor does exercise or prior prostatitis.

Prostate cancer grows slowly and the PSA (prostate specific antigen) test or a digital rectal exam can screen for an enlarged prostate.  The PSA test can be false positive for many reasons and the only way to diagnose suspected prostate cancer is by a biopsy.  The most important marker for a cancer in the prostate is the "Gleason" score.  This grade (1-10) tells us how advanced or aggressive the cancer is.  The pathologist can see if the cells are suspicious for atypical changes or are high-grade.  The extent of the tumor determines the stage.

Once a cancer has been diagnosed, graded and staged, the confusing choices of treatment come into play.
Because most prostate cancer occurs in older men and it is slow growing, many men choose "watchful waiting".  By following PSA tests and ultrasounds we can determine if the cancer is growing.  For many men nothing more needs to be done because the cancer causes them no problems.  For younger men or men with high Gleason scores, treatment is usually surgical removal of the prostate or radiation of the prostate gland.  Radiotherapy can also occur with seed implantation of radioactive material.
Hormone therapy or cryoablation is also used less often.

The Prostate Cancer Foundation and the Mayo Clinic have  more good info if you wish to delve further.

RIP, Dennis Hopper.  I think I'll take a stroll down memory lane and rent "Easy Rider" again.  I haven't seen it for 40 years!.

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