Thursday, October 16, 2014

Let's Talk Ebola

Ebola is all the rage so it is time for EverythingHealth to "talk ebola". Unless you have been in a coma, you are aware that Ebola is sweeping through West Africa and there have been 3 identified cases in the United States.  This is a big news story so anxiety and fear are being felt by anyone who picks up a paper, goes on the internet or watches TV.  What does EverythingHealth say?  First....

Calm down, everyone!

Here are some ebola facts:
  • There are actually 5 different ebola viruses that cause hemorrhagic (bleeding) fever.
  • Ebola is not very contagious because it is not air-borne
  • Initial symptoms are fever, body ache, diarrhea, stomach pain and vomiting
  • The incubation period is up to 21 days

The average American is not going to be at risk for ebola. Direct contact with body fluid is needed so standing in a room or an airplane with an ebola victim will not cause infection. Gunshots kill more than 30,000 Americans a year.  Now there is a risk for you to worry about!

Healthcare professionals, trash collectors and  airline clean up crews are the most at risk of exposure to Ebola virus.  Those workers should keep abreast of current events and take precautions.  Until the infection can be controlled in Africa, there is always the chance that a traveler will have silent disease.  The best way the World can protect itself is to help Africa contain the infection.  This does not mean closing airports.  That would simply prevent needed help and cause the virus to spread across borders to other countries in Africa.

What can you do?  First, get a flu shot.  As winter approaches, influenza will be here and it causes some of the same early symptoms as ebola.  I worry about our Emergency Departments being crushed by people with flu symptoms who think they may have ebola.  Please make it easy on all of us and

Get a Flu Shot!

Second, send some $$ to your favorite relief organization.  I recommend Partners in Health and International Medical Corp.   I have personally worked with both of these organizations and they do wonderful relief work around the world. 


Monday, August 4, 2014

Summertime Photosensitivity

EverythingHealth got a little behind in posting the answer to the image challenge this week.  Click back on the link to see the photo.  The answer was #3 - Phototoxic dermatitis.  The erythema (redness) that you see in the photo is only on the sun-exposed skin, with sparing of a linear area on her nose and much of her head, areas that were covered by glasses and hair. That is a big hint in the diagnosis.

It is not uncommon for facial products or even systemic medications to cause a photosensitivity when the skin is exposed to ultraviolet radiation.  The patient's lesions responded to sun protection and cortisone cream.

Photosensitivity is a type of sun toxicity of the skin.  Certain antibiotics (tetracycline, sulfa) can cause it in certain people.  Even NSAIDS like Advil or Naprosyn have been implicated as well as anti-fungal drugs and perfume fragrances.  It can occur minutes to hours after sun exposure and looks like an exaggerated sunburn.

Treatment is to avoid the causing agent, protect from the sun and symptomatic relief.

Thursday, July 31, 2014

A Summer Image Challenge

It's been awhile since I have challenged EverythingHealth readers so here it is from the New England Journal of Medicine.  You be the diagnostician.

Click on the photo for a closer look.  Put your answer in the comments section and return tomorrow for the answer.

Tuesday, July 8, 2014

Is it a Kidney Stone?


Kidney stones (nephrolithiasis) affects 1 in 11 people in the U.S.  Some say its the worst pain they have ever experienced.   There are a number of causes for these stones, including diet, hereditary, chronic urinary infections, gastric bypass surgery or inflammatory bowel disease, and other medical conditions.  Sometimes we just don't know the cause, although they are more prevalent in men than in women.

Patients with acute flank pan often show up in the emergency department with severe pain.  Because other things can cause abdominal or back pain, patients will often undergo lots of tests (cat scans, ultrasounds etc) to determine the cause.  The British Medical Journal has published a study that shows a clinical prediction rule that proved valid in determining that the patient did, in fact, have a kidney stone.  Here is what they found:

Eight factors were associated with the presence of a ureteral stone. Each of them was assigned points:
  • male sex (2 points)
  • duration of pain-greater than 24 hours (0 points) 
  • duration of pain-6-24 hours ( 1 point)
  • duration of pain less than 6 hours (3 points)
  • non black race (3 points) (stones are rare in black race)
  • nausea alone (1 point)
  • vomiting alone (2 points)
  • microscopoic hematuria (3 points)  (blood in urine)
Add up the points and if 0-5 - low probability (10%) for stone, 6-9 points is moderate probability (50%) and 10-13 points is high probability of a stone (90%)

Alternative causes (non-stone) were found in 1.6% of the high=probability group.  these causes were diverticulitis, appendicitis, mass, pyelonephritis, cholecystitis, pneumonia, bowel obstruction, colitis, aortic aneurysm and pancreatitis.

This algorithm was tested and validated in an emergency setting and it could help physicians with diagnosis and help prevent unnecessary testing.
 

Saturday, March 15, 2014

When to Get a Colonoscopy

When you turn 50 years old, you enter the "procedure years".  Fifty is the magic age for getting a screening colonoscopy.  Why age 50?  Most gastrointestinal cancers are more prevalent as a person ages.  So guidelines are set to benefit the largest numbers of patients by recommending "screening" tests to detect cancer while it can still be removed completely and cured.  The key word here is screening.  That means there are no symptoms and the doctor is just doing surveillance. If a person has symptoms, family genetic cancers or other conditions that increase the chance of cancer the magic age of 50 doesn't apply and colonoscopy can be done at any time to diagnose a problem.

what your colon looks like with a good prep
There are also clinical guidelines for continuing follow-up screening and here is where it gets muddled.  Gastroenterologists often don't adhere to these guidelines and patients can be confused as to when they should get a repeat exam.  These guidelines assume the baseline colonoscopy was complete and the physician was able to get the scope up to the cecum, the bowel prep was adequate for good visualization and any polyps were removed.  If you have a colonoscopy and a polyp was removed, remember to ask for the path report and keep it.  This report shows what type of polyp it was because that makes a difference to when the next colonoscopy is due.

Here are the guidelines as recommended by the US Multi-Society Task Force on Colorectal Cancer:

  • No polyps  -  repeat in 10 years
  • Small (< 10mm) hyperplastic polyp in rectum or sigmoid  -  repeat in 10 years
  • 1-2 Small (< 10mm) tubular adenomas  - repeat in 5-10 years
  • 3-10 tubular adenomas  - repeat in 3 years
  • > 10 adenomas  - repeat in less than 3 years
  • Any adenoma > 10mm  -  repeat in 3 years
  • Any adenoma with villous elements (villous or tubulovillous) or with high-grade dysplasia -  repeat in 3 years.
  • Any sessile or serrated adenoma  -  repeat in 3 years
  • Serrated polyposis syndrome  -  repeat in 1 year
When can you safely stop screening?  If the patient's life expectancy is less than 10 years, there is no reason to continue with screening colonoscopy.  

In medicine, it is just as important to prevent overuse as it is to make sure everyone gets the right screening at the right time.  If you are lucky enough to have a good primary care physician, she will make sure you are tested at the right time.  But more and more people are trying to manage their own health without expert help and knowing your pathology report and following these guidelines will help you with timing.

Tuesday, February 25, 2014

Forget Supplements-It's All About Diet



Millions of intelligent Americans are spending money on supplements that have no proven benefit in health or longevity and are ignoring what numerous studies have shown; preventing disease and dementia is all about the food you eat.  This is real science with reproduced results in numerous studies.  Here it is, folks.  Change your diet and change your life:

  • Avoid high glycemic carbohydrate diets:  Carbs with high glycemic index  have been shown to increase inflammation and oxidative stress leading to dementia.
  • Eliminate completely high sugar diets : Even intermittent small blood sugar elevations lead to dementia...even in non-diabetics
  • Eat one ounce of nuts/day:  Provides a great source of Vitamin E
  • Avoid trans fats and fast food:  Numerous studies from different Countries show a dose/response relationship of increased depression and anxiety, not to mention heart disease and early death.
  • Real fruit is better than fruit juice:  Real fruit is loaded with natural sugar but it has equal amounts of fiber that help metabolize.  Real fruit is always a good choice, not the juice.
  • Eat more eggs:  Don't worry about the cholesterol in eggs.  Eggs provide perfect protein in a nutrient-rich, low-calorie, low-fat package.

Diets high in fruits, vegetables, fish, plant oils, nuts and whole grains, with lower intakes of sugar, processed meat, and animal fats, are likely to be the best bet in supporting the health of our brain as well as the rest of our body.  If you eat this way you should not need vitamins or dietary supplements to maintain health.

Pay attention to everything you put into your body and lower your risk of disease and poor health.

Tuesday, January 21, 2014

How to Tell if it's the Common Cold or Flu


The "I feel awful" season is upon us.  I challenge any reader to say they don't know someone who is out sick with some type of upper respiratory infection.  Congestion, cough, body aches and fatigue can hit even if you wash your hands and take precautions.  So how can you tell if it is a viral cold or influenza?  And does it really matter since they are both viruses?

The symptoms of a cold or the flu can be quite similar and hard to tell the difference but here are some differentiating tips that doctors know and you can use too.  First, did it start slowly with a scratchy sore throat, sneezing and then build over a couple of days?  If you answered yes, it is probably a viral "cold".  The influenza virus usually hits with a slam.  You awaken feeling awful with body aches, fever and like you were "hit with a Mack truck".   People with the flu can tell you almost what hour they got sick and influenza is always respiratory.  That means a racking cough and maybe even vomiting.  The flu generally brings a fever and maybe even chills.

H1N1 virus
It is important to try and tell the difference because we can often lessen the flu symptoms if we catch it early and use the anti-viral; Tamiflu.  This year 90% of the flu cases are H1N1.  This years strain affects children and young adults and any flu is bad for people that have underlying lung problems or are pregnant or immune-compromised.

Both a cold virus and influenza last about 10 days.  Illness that goes longer should be evaluated by your physician.  For either infection listen to your body.  Rest, drink lots of water and herbal tea with honey.  Ibuprofen or Aleve are good for body aching and fever.

 Do not ask your doctor for antibiotics.  They will not help and will likely destroy your own good bacteria that keeps your intestines healthy

But  you can still get vaccinated for influenza: The vaccine lowers your chance of getting the flu by 60-65 percent. And if you do get it, your symptoms will likely be mild.

Wash your hands, make sure you are getting enough sleep, avoid crowds and eat an apple a day to stay healthy through cold and flu season.

Probiotics - What and When?

Probiotics contain microorganisms that are similar to the beneficial bacterial that occur naturally in our intestinal tract.  There is so...