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Showing posts from February, 2011

What is Needed for Supplements and Vitamins

With constant messages and studies that contradict each other, it is no wonder patients are confused about vitamins and what is needed to stay healthy.  While most supplements cause no harm, except to the wallet, people do sometimes forgo needed good health habits with the erroneous assumption that they are doing the right thing by popping lots of vitamin pills.  Based on current research, here are the supplements I recommend for good preventive health:

Low dose aspirin (81mg).  Although a recent study did not recommend women take aspirin as a preventive medication, there are others that show its benefit for preventing heart attack and stroke in both men and women.   A recent study reported in The Lancet showed low-dose aspirin taken for 5 years or longer reduced mortality from esophageal, pancreatic, brain, stomach, colorectal, prostate and lung cancer.  If you are over age 40, I recommend one low dose aspirin a day.Omega-3 Fatty Acid (fish oil).  The benefits of Omega 3 have been rep…

Breast Milk Ice Cream - FAIL

Say it isn't true! A restaurant in London is planning on serving breast milk ice cream called "Baby Gaga".  The expensive treat will cost £14 pounds ($23 US dollars) a serving. Where does this breast milk come from?  Mothers answered an ad that was placed online and are selling their milk to the restaurant for £15 pounds for every 10 ounces of milk.

One of the donating mothers said she believes if adults realized how tasty breast milk actually is, then new mothers would be more willing to breast-feed their own newborns.  Do moms really decline breast feeding because they don't know how good it tastes?  That is a ludicrous concept.  She also said, "What's the harm in using my assets for a bit of extra cash?"  Now that is more like it!

Baby Gaga is said to "melt in the mouth".  The recipe blends breast milk with Madagascan vanilla pods and lemon zest.  Churn it a bit and you have ice cream.  They are planning more new flavors to serve up to the…

Ex-Convict Sisters Can't Share Kidney Because of Obesity

I posted before about the bizarre case of two sisters who had spent 16 years in prison for stealing $11 from two men.  They were sentenced to two life terms in prison for the robbery until Tennessee Gov. Hailey Barbour granted Jamie Scott an early release because of kidney failure that cost the State $200,000 a year for dialysis.  He also released her sister, Gladys on the condition that she donate a kidney to her sister.

Now it seems the doctors will not consider them for transplant surgery until Jaimie loses over 100 lbs and her sister sheds 60 lbs.  Gladys also needs to quit smoking and at 4 feet, 9 inches and 184 lbs she certainly has some weight to lose.

This case is so strange on so many levels.  First of all, why should two young women (age 19 and 21 at time of sentencing) be given life for a simple robbery?  The inequities of our legal system are profound and this case proves it.  To read a bit from Jamie Scott about the conviction go here.

2nd, this shows how unhealthy prison…

Animal Testing

Medicare Scammers Busted

I am always happy when I read about fraudulent doctors, nurses and businessmen getting busted.  Medicare is, unfortunately, a program that lends itself to crooks.  The more of these crooks that get prosecuted and sent to jail, the happier I am.  Each of these busts should be made public.  This time Federal authorities have charged over 100 doctors, nurses and physical therapists with massive Medicare fraud in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, Brooklyn, Tampa and Baton Rouge.

These crooks billed Medicare more than $225 million for services that were not performed.  One Brooklyn proctologist billed $6.5 million for phony hemorrhoid removals.  He claimed he performed 10 on one patient alone.  Impossible!   Are there even that many potential hemorrhoids in Brooklyn?  A podiatrist billed Medicare $700,000 for toenail removals.  The stupid guy said he removed 20 nails on 3 toes of one patient.

Three physical therapy clinics that were run by an organized network of Russia…

White Coat Hypertension

"But doc, my blood pressure is always normal at home."  I wish I had a dollar for every time I have heard that line and I know it is true.  When some patients come to see me, their blood pressure is abnormally high (above 130/90) and this is known as "white coat hypertension."  Although it has been thought to be from anxiety about seeing the doctor, even long established patients who have no conscious anxiety can exhibit elevated blood pressure in the office.

Because blood pressure naturally fluctuates and the office visit is not a "normal" setting,  it is important for patients who have hypertension (high blood pressure) to have their own BP cuff at home.  Now that devices are automated and easy to use, everyone with hypertension should be monitoring their BP in the comfort of their own home.  I advise multiple readings over a week at different times of day.  Get a reading when resting and when rushing around.  Take the BP after you exercise and after a m…

Ganglion Cyst

At least once every quarter, for all of the years I have been in practice, I see a patient with a swelling on their wrist, ankle or foot.  This common problem is a ganglion cyst.  These cysts are located on tendons and occasionally are tender but more often just seem to develop painlessly for no reason.  The tendon sheath may rupture suddenly or slowly and allow the fluid to bulge out.  The swelling is filled with a thick gelatinous substance called synovial fluid and it can feel spongy or firm. 

Most ganglion cysts can be diagnosed just by vision and palpating it.  If they are on extensor tendons, they might bulge more when the joint is moved and disappear when it is flexed.

A majority of ganglion cysts disappear without treatment.  If it is painful, the doctor might aspirate it with a needle.  About 1/4 of patients will have a recurrence after removal and aspiration can be tried again.  Surgical removal is needed only if it is painful or causes numbness in the hand or fingers.


Health Care Costs Too Much

Almost every day I hear a story about health care that makes me cringe. (I also hear good stories about health care, but that is another post)  Today while buying a pair of shoes, the sales clerk told me how upset she was that a chest X-ray cost her $350.00.  That amount is her portion...she has insurance and the full charge was over $800.  She wishes she would have known the cost and said,  "I would have thought twice about getting it.  I had a cold that lasted several weeks and the doctor just wanted to make sure it wasn't pneumonia."

(Try as I do not to 2nd guess my physician colleagues, I do have to wonder if a chest X-ray is indicated in a healthy young non-smoker who is not sick and just has a lingering cold)

This woman went on to say, "I can't believe it.  I pay $380 a month for health insurance just for myself and I only get a pap smear once a year.  And I still got stuck for $350.00 for the chest X-ray.  My employer pays even more for my insurance so the…

Nursing Shortage Big Disconnect

With the aging of America, it is well known that there will be a shortage of registered nurses and nurse aids to take care of the population.   It is predicted that the shortage of nurses to take care of people will climb to 80,000 by 2015 in California.  California has just 653 registered nurses employed per 100,000 people.  One of the problems is a lack of qualified faculty to teach at Nursing schools.

California was forced to turn away 23,000 qualified applicants from nursing programs during 2008-2009.

And this week, Humboldt State University announced plans to discontinue the school's nursing program because of financial concerns and inability to retain nursing faculty.

Shortage of Nurses and Closing Nurse training there is a big disconnect.

Big Changes in Breast Cancer Care

I always say that medicine is a dynamic changing field and today's JAMA study on the standard practice of removing lymph nodes in women with cancer is flipping medicine on it's head.  For over 100 years, the standard practice has been to remove cancerous lymph nodes in early stage breast cancer.  It has been common practice to sample these nodes and remove them if there was any evidence of cancer, with the hopes of stopping further spread.  It made common sense and it was done by all surgeons.  Women who had their underarm lymph nodes removed often suffered complications and severe persistent lymphedema arm swelling and pain.  But it was considered the price to be paid to be cured of cancer.

The new study, which examined data from 900 women,  showed no difference in 5 year survival rates between women with lymph nodes removed and those who did not.  These results will change the way we practice medicine.

Cancer is found in lymph nodes in about 1/3 of the 200,000 women with bre…

Vote for Everythinghealth

If you are reading this, I hope you will click here and cast your vote at MedGadget for EverythingHealth in the category of "2010 Best Ethics/Health Policy Weblog".  I am honored to be a finalist and am trailing in the votes (sob!) so your support is appreciated.  Vote now.
Thank you!

The management

A Marathon a Day for 365 Days

I would not have believed it was possible, but Stefaan Engels, a 49 year old Belgian man has run his 365th marathon in 365 days.  Mr. Engels has set a new record after running 9,569 miles across seven countries.  He finished his final race in Barcelona, Spain. He ran races in the UK, Spain, Portugal, Belgium, Canada, Mexico and the U.S.

Stefaan Engels also holds the world record for completing the most "Ironman" Triathlons in a year.  He did 20 in 2007/8.

This is his second attempt at the 365 day marathon running challenge.  The first time he injured his leg.  This year he attributes his success to running a slow pace over each 26.2 mile marathon.  He averaged 4 hours per marathon day.  Four hours!!

He stated "I wanted to inspire people by showing that if I could run a marathon a day for an entire year, that anyone could run or bike a little each day or do something about their weight problem."  I would certainly say he succeeded at being inspiring.

I'm going t…

What Doctors Want Patients to Know

Consumer Reports surveyed 660 primary care physicians about what they wish their patients knew and what they faced as professional challenges.  Some of the highlights are:
Doctors believed forming a long term relationship with the primary care physician is the most important thing a patient can do to obtain better medical care.  They believe continuity is really undervalued and patients who frequently switch doctors have more health problems and spend more on care than patients who have a relationship with one physician.Doctors want respect and 70% said that respect and appreciation from patients had gotten worse since they started practicing medicine.Doctors want patients to be compliant with advice or treatment and 37% said non-compliance affected optimal care "a lot".Doctors don't think they are very effective at minimizing pain, discomfort or disability caused by a chronic condition.  Only 37% thought they were very effective, yet 79% of patients said their doctor hel…

Norovirus Stomach Flu

After spending a weekend in bed with self diagnosed Norovirus,  I thought the information would make a great post. Norovirus is a contagious virus that causes sudden onset of nausea, vomiting, headache, body ache and feeling very very sick.  It strikes 12-48 hours after exposure, either by ingesting contaminated food or water or close contact with someone who has the virus.  When you hear of a cruise ship being struck by illness or nursing homes or child care facilities...the culprit is usually Norovirus.  I have no idea where I caught it. It wasn't a patient and I seldom catch anything from patients. No one else in my family was sick. I hadn't eaten out so the source will remain a mystery.

I can tell you from personal experience that like most viruses, this one starts with body aches, headache and malaise. That viral feeling is followed by vomiting and abdominal cramping. You just feel knocked out. No reading, no blogging, nothing but misery.

Like any gastroenteritis the bigg…

Stroke Patients Stop Taking Medicine

A study published in the Archives of Neurology reported that a quarter of patients who have a stroke stopped taking their medication within 3 months of hospital discharge.  These medications were meant to be prevention for future strokes.  With 180,000 recurrent strokes occurring in the U.S. each year, that is an astonishing number of patients who stop their prevention meds.  Also,  the recurrence rate is the highest during this 3 month period so these patients are at risk of losing more brain function.  Twenty percent of the patients were taking half of the prescribed medication and 3.5% had stopped all of the meds.

We need to understand why patients who have suffered a stroke would put themselves at risk for a 2nd event.  The reasons for going off medication were multiple.  And some of them are no surprise.
Not understanding the importance of the medicationNot understanding how to take the medication or to refill prescriptionsIncreasing age and confusionFinancial hardshipToo many con…

Women Doctors are Paid Less Than Men

A new study published in Health Affairs reports that female doctors fresh out of training are paid significantly less than their male counterparts.  The gender gap has been getting worse since 1999 and is now $16,819, up from $3,600 in 1999.   Readers, we are definitely going the wrong way here!  Women doctors are being paid less than men.

The widening pay gap cannot be attributed to the specialty they choose because the researchers controlled for that aspect.   Even when they account for specialty and hours and other factors, the gap remains.  The same gap exists for women in primary care as in other specialties.  Female heart surgeons were paid $27,103 less than males.  Female ENT doctors made $32,207 less than male doctors.  The women who specialized in pulmonary disease made a shocking $44,320 less than their male counterparts.

What about practice location?  It didn't matter...women were paid less than men.  Could it be that they work less hours?  Nope, even with the same hour…

Blog Award Nominee for EverythingHealth

I am happy to announce that EverythingHealth has been nominated and is a finalist for the MedGadget blog award in the category of "Best Health Policies/Ethics Weblog" for 2010.  The other blogs in my category are outstanding and the competition is tough...but that is a good thing and I am honored to even be mentioned with these prestigious writers.

Check out some of the other categories too.  Many of my favorites are there like "other things amanzi" and my new favorite and bbb (blog best friend) "Reflections of a Grady Doctor".  I'm making my way through the others.  It is a great way to stay informed and these are the best of the best health blogs on the internet.

Please vote for EverythingHealth by clicking here.  Don't we all love an underdog?

Sex in Pregnancy is Safe

The Canadian Medical Association Journal has published a new primer designed to help physicians when they counsel pregnant women.  They note that sex during pregnancy is normal and is generally considered safe.  The authors point out that there are very few proven contraindications and risks regarding intercourse in normal pregnancy.

Pregnant women and their partners are often afraid to have sex.  Men may think they are "invading" the home of the fetus and could actually harm the baby.  In fact, the fetus is quite safe, ensconced in the uterus (womb) and the cervix (opening of the uterus) is closed in normal pregnancy.  The penis has no contact with the fetus or the uterus during normal intercourse, no matter what the position.

When is intercourse considered risky?  Only for women who are at high risk for preterm labor and for those with placenta previa because there is increased risk for hemorrhage.  Even women who have had preterm labor may safely have sex unless they have…