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Showing posts from September, 2012

Skin Rash-Pityriasis rosea

My 17 year old son showed me the strange rash that was developing on his chest and back.  It was itchy and each day seemed to be getting worse and worse.  The rash spread around his back and under the arms but spared his face and arms and legs.  After examining the pattern, I was sure of the diagnosis...Pityriasis rosea.

This strange rash occurs in the spring and the fall and mainly strikes young adults. (I did diagnose it once in a 35 yer old woman).  We think it is a virus but it doesn't seem to spread from person to person and it is usually quite isolated.

The symptoms start with a "herald patch", one larger spot that develops into a wider, pinkish, scaly rash over a week or so.  The red, raised spots can last for up to 12 weeks but usually resolve by 4-8 weeks.  As seen here, it is mainly on the body trunk.

There is no treatment for Pityriasis rosea except patience and antihistamines for itching. 

For you wordophiles- Pityriasis comes from the Greek "bran"…

Obama vs. Ryan at AARP

President Obama and Vice-pres nominee Paul Ryan went head to head at the recent AARP convention in New Orleans and addressed the group on Medicare and the Accountable Care Act (aka: Obamacare).  Their appearances were back to back.

Ryan told the audience,"The first step toward a stronger Medicare is to repeal "ObamaCare" because it represents the worst of both worlds".  He argued that the federal health reform law would "funnel $716 billion out of Medicare to pay for a new entitlement we didn't even ask for."  He also said that Romney's plan to transition Medicare into a premium support program "empowers future seniors to choose the coverage the works best for them" and is "designed to guarantee that seniors can always afford Medicare coverage."

The response from the group was lackluster with little applause and many boos during his speech, according to the Washington Post.

It was no surprise that Obama, who addressed the conv…

Reduce Your Risk of Cancer

Imagine reducing the risk of getting cancer!
There are an estimated 1,638,910 new cases of the dreadful disease diagnosed in 2012 in the United States, not including nonmelanoma skin cancers. Cancer is not just one disease but is a term that represents more than 100 diseases with different causes. The basic unit of life is cells, and cancer always begins in cells. When the normal process of cell growth and division is altered, these abnormal cells divide without control and can form tumors and invade nearby tissue. It is a frightening diagnosis to even think about for most people.
Hundreds of studies link lifestyle and “daily habits” to the risk of developing cancer, and researchers at a recent meeting of the Union for International Cancer Control World Cancer Congress 2012 reported that more than 50 percent of cancer could be prevented if people simply implemented what is already known about cancer prevention.
Some of these are lifestyle changes and some are interventions …

The Battle Sign

The answer to yesterdays NEJM diagnostic challenge was #2 - Fracture of the temporal bone.  This patient has ecchymosis (bruising) behind the left ear.  This is the classic "battle sign" that is seen with underlying trauma to the temporal bone of the skull. 

My patient had struck her head very hard on a metal cabinet...hard enough to sustain a concussion and a small skull fracture with blood that is pulled down by gravity in the tissue plane behind the ear.

These fractures heal by themselves but we need to be on guard for subdural hematoma or any change in mental functioning.

Thanks for your guesses.

What is the Diagnosis?

I love this weeks Image Challenge from The New England Journal of Medicine because I had a patient with these exact findings about a month ago.  You be the doctor and make your best guess for the diagnosis.  Post a comment and check back for the answer tomorrow.

This patient presented with hearing loss and left ear fullness.  What is the diagnosis? (click on the image for a better view)

1.  Cholesteatoma
2.  Fracture of the temporal bone
3.  Ochronosis
4.  Otomycosis
5.  Relapsing polychondritis 

Winner gets bragging rights at your next cocktail party!

The Best Jobs in Health Care

The health care sector is a good place to look for job opportunities and to plan career goals.  The workforce is expected to increase 27% through 2014, compared with 14% for all industries combined, according to the Department of Labor.  But special education is needed to enter the health work force and now CareerCast has posted the top jobs based on stress level, solid job security, work environment, training and income.  Here is how the list came out:

1.  Dental hygienist
2.  Audiologist
3.  Occupational therapist
4.  Physical therapist
5.  Optometrist
6.  Pharmacist
7.  Physician assistant
8.  Chiropractor
9.  Primary Care Physician
10. Registered Nurse

Dental hygienists were first based on a median salary of nearly $70,000/year, low stress, a job growth outlook of 38% by 2020 and a small educational investment in a two year associates degree.  They set their own schedules, work in comfortable environments and never have to take their work home!

Compare that to a Primary Care Phys…

Primary Care Payment Struggles

The way doctors bill and get paid is a byzantine process and it is no wonder the "private practice" doctor is an endangered species.  It takes a keen sense of business, a love of medicine-not money, and a sense of humor to survive.  Here is my latest story.  You can't make this stuff up....

I saw a patient in September 2001  (note the date...11 years ago).  I billed her insurance company, Employers Mutual, LLC for $185.00.  I never got paid.

Now fast forward to September 2012.  I received a document from an attorney who informs me that he is a receiver in a class action suit and $48 million in unpaid claims is being claimed.   It appears I am a Category B creditor and will receive a pro-rata share.  He recovered $16, 559, 576.88 and took $4,831,214.40 in attorney fees.

It looks like in the future (?) I may receive a check for $37.00.  No promises are given.

I remember my practice back in 2001.  I worked about 80 hours a week and never even had enough money to fund a ret…

Bedbug Bites

The answer to yesterday's medical diagnostic challenge is #1 - Bedbug bites.  Bedbugs frequently attack exposed areas of the skin and are attracted to humans' high body temperature.  Cutaneous (skin) reactions to bedbug bites are characterized by erythematous (red) or "hive-like" papules.  Lesions observed in a linear or cluster formation are typical. 

This patient's bites responded to treatment with topical glucocorticoids.

What is the diagnosis?

'This is a great diagnostic challenge from The New England Journal of Medicine.   Let's see if you can make the diagnosis.

1.  Bedbug bites
2.  Dermatitis herpetiformis
3.  Ecthyma
4.  Guttate psoriasis
5.  Lichen planus

Make your choice in the comments column.  The answer will be posted tomorrow.

Beware of Fake Viagra

If you have a computer, you have certainly seen the many ads for on-line pharmacies where you can get just about any medication mailed to you.   Beware of fake Viagra (sildenafil).   According to researchers at the World Meeting on Sexual Medicine, they reported an analysis of tablets purchased from 22 different websites.  They found 77% of the samples were counterfeit and contained only between 30%-50% of the levels of active ingredient.  Some were adulterated with dangerous chemicals.

None of these phony websites required a prescription and 91% offered "generic Viagra" which the FDA has not yet authorized.  The fastest growing drug class in the world is counterfeit medications and it isn't just Viagra.

Not all on-line pharmacies are crooks.  Some Canadian and UK pharmacies deliver a quality product for a fraction of the price. They require authorized prescriptions from the doctor.  But if you see something that is too good to be is.  Not true that is.