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Showing posts from February, 2013

Image Challenge

In keeping with our GI theme this week, I present to you this image challenge from the New England Journal of Medicine.  This is a loop of bowel removed from a child from Kenya.  In case you aren't familiar with the appearance of bowel, I can tell you this is not normal.  What is the diagnosis?
Make your best guess in the comment section and I will post the answer tomorrow.

1.  Ascariasis
2.  Kala-azar
3.  Meckel's diverticulum
4.  Strongyloidiasis
5.  Trichobezoar

Click on the Image for a better view and go for it!

Fecal Microbiota Transplants

Yes, you read it right.  I said "Fecal Transplants".  It may sound disgusting but there is increasing evidence that placing a healthy patient's feces inside the GI tract of a patient with Clostridium difficile gut infection may be the wave of the future.  And it shows just how important our normal gut microbe flora is for good health.  Here is how it works:

Our GI tracts are colonized by hundreds of microorganisms at birth as we pass through the mother's birth canal.  These bacteria live in  balanced homeostasis, helping digest food, helping absorb Vitamin K and Vitamin B complex and helping our immune response.  When this balance is upset with antibiotics, Clostridium difficile bacteria overgrowth can occur.  Clostridium difficle infection is serious and it is the most common cause of hospital acquired diarrhea and often leads to severe illness and death. As patients are treated with yet more antibiotics to eradicate the infection a month later recurrent C. diff�…

Price of Health Care a Mystery for Patients

You have a $5000 annual deductible and need a test or treatment.   It should be easy to find out upfront what it will cost, right?  Good luck with that one!

I've written before about the problems with health care price transparency and hidden costs but there hasn't seemed to be much improvement over the years.  A new study published in the Journal of the American Medical Association (JAMA) found that only 16% of hospitals surveyed were able to provide an estimate for the total cost of a hip replacement procedure.

The researchers surveyed 122 hospitals covering all 50 States and asked each hospital to estimate the cost of a hip replacement for a 62 year old, uninsured individual who would pay "out-of-pocket".   They found that:
Only nine of the 20 orthopedic hospitals and 10% of the other hospitals could provide a full cost estimate for hospital and physician fees after a minimum of five phone calls;12 of the orthopedic hospitals could provide a complete cost estim…

Technology and Health Care

One of my tennis friends asked me about new innovative smart phone technology and why it hasn't been embraced in health care.  She had just watched a video about Dr. Eric Topol, Chief Academic Officer at Scripps Health in San Diego, and his demonstrations of how a smart phone could monitor blood sugar, take EKGs and cardiac ultrasounds and really deliver health care to the patient at home. 

My friend's question; "If this technology is here, why isn't it being used?"

According to Dr. Topol, new apps for the smart phones could eliminate 80% of echocardiograms that are done in facilities at costs between $300-$1500 each.  Having patients come into the office when they experience symptoms or for diabetics to get their blood sugar regulated could be eliminated.  New technology could be data driven and personalized and save millions of wasted dollars in health care.  So why is medicine so far behind the innovation curve?

The answer:  No-one pays for it. 

Why aren'…

New Info on Tennis Elbow

New information has come out on what works and what doesn't work for lateral epicondylitis...aka: tennis elbow.  A new study published in JAMA will change how we have treated this condition for decades.

Being a tennis player myself, I have suffered from this condition.  The outside elbow, where the lower arm tendon inserts on the epicondyle bone gets inflamed and swinging a racket or even lifting a carton of milk out of the refrigerator can cause excruciating pain.  This is a very common condition and can be caused by any repetitive motion of that muscle.  One of my patients got it from clipping roses.  Traditionally the treatment is anti-inflammatory medication (ibuprofen, aleeve), ice and rest.  For serious cases, physiotherapy and injection with a corticosteroid has always proved effective in my practice.

The researchers found, however, that patients treated with a single corticosteroid injection had a 14% greater chance of poor outcome and a 77% increased risk for re-injury…

Baby Boomers Health Lags

The baby boomers are strictly identified as being born between 1946-1964.  The boom lasted 19 years and delivered 76 million total births.  "Leading Edge" boomers were between 1946 and 1955.  They were the generation that were the wealthiest, most active, and most physically fit generation that had ever lived.  They were special and expected to have better lives than their parents.

Well, those leading edge boomers are now middle age and getting AARP bulletins.  And a new study published in The Journal of the American Medical Association  reveals their overall health status was lower than prior generations, with only 13.2% reporting 'excellent' health compared with 32% of individuals in the previous generation (P < .001). To really paint the picture, researchers reported more than twice as many baby boomers used walking assist devices (6.9% vs 3.3%), more were limited in their work by disability (13.8% vs 10.1%), and 13.5% vs 8.8% were coping with some type of…

DNA Proves Inocence