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Wednesday, April 26, 2017

  • Monday, April 24, 2017 4:00 AM
    “Dad is getting awfully forgetful - could he have Alzheimer’s?” That’s becoming a more common question. We are more likely to encounter someone with Alzheimer’s dementia as the proportion of elderly in our society increases. Some forgetfulness is normal for most of us as we age. Many of us carry the fear of developing Alzheimer’s or another form of dementia as we get older.
    The word dementia stems from the Latin de- “apart or away” and mentis “mind.” It is characterized by a progressive decline in cognitive and behavioral function due to damage or disease in the brain beyond what is expected in normal aging. Alzheimer’s dementia or AD is the most common cause of dementia. 
    Approximately 5.2 million people in the U.S. suffer from clinically significant AD. There are many more who have mild disease (mild cognitive impairment) that remain functional. Most cases of AD are sporadic, while about seven percent of cases are genetic in origin.
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  •  The season of sneezin’ is fully upon us
    Monday, April 17, 2017 4:00 AM
    It’s once again time to run my annual column on allergies. Many of our readers are probably already cursing the annual return of allergy symptoms. The pollen levels in Indiana are already ramping up as spring (hopefully) arrives for good.
    Allergies are a major problem for many people. When allergy sufferers are asked about their quality of life, they generally rate allergies as more bothersome than heart disease and sometimes even cancer. There are many causes of allergies, but I want to focus on the seasonal type.
    Seasonal allergies are caused by pollen. Pollen actually contains the plant’s male DNA; it is analogous to sperm in animals. The goal of any biologic organism is to spread its genes as far and wide as possible. Pollen is the perfect vehicle to accomplish this task. 
    There are two main categories of pollen – anemophilous (wind-loving) and entomophilous (insect-loving). Anemophilous pollen is very lightweight which allows it to move great distances, particularly on windy days. In fact, engineers have used the geometric shapes of some of these pollen grains to shape golf ball dimples to help them fly farther. Anemophilous pollen is produced by trees, grasses and weeds.
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  • Monday, April 10, 2017 4:00 AM
    The summer sports season will be starting soon, as will gardening and other outdoor chores. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal injuries busy. I want to give everyone some pointers in how to take care of the inevitable sprains and strains.
    It’s interesting to me how many people come to my office after suffering an injury and don’t have any idea how to do some initial first aid. It’s extremely important to treat injuries immediately to prevent additional damage and disability.
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  • Monday, April 03, 2017 4:00 AM
    I’ve received a request to write about thyroid gland problems. Thyroid problems are common in a family medicine setting. For those who don’t know what the thyroid gland is or does, keep reading.
    The thyroid is an endocrine gland found in the front part of the neck below and to the sides of the Adam’s apple. Endocrine glands produce hormones and secrete them into the bloodstream. The hormones then travel around the body and trigger various biologic processes by interacting with cells in different tissues. Hormones are like molecular fingers that flip switches on cells to tell them to perform particular functions.
    The primary job of the thyroid gland is to control metabolism (energy use) in our cells. It does this by producing two hormones, T4 (thyroxine) and T3 (triiodothyronin). Both of these hormones contain iodine which is why iodine is so important in our diets.
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  • Monday, March 27, 2017 4:00 AM
    Snoring can certainly be annoying, but it doesn't always indicate a serious medical problem. This week, however, I do want to focus on a harmful condition that can be associated with snoring – sleep apnea.
    Sleep apnea is a condition where people have pauses in their breathing while sleeping. Most people have pauses to some degree, but people with sleep apnea have much longer pauses, sometimes lasting up to 30 seconds. These long pauses cause the level of oxygen in the blood to drop and carbon dioxide to rise. These changes can be very hard on the body, especially the heart and lungs.
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  • Monday, March 20, 2017 4:00 AM
    Last week I tried to explain the very complex non-Hodgkin lymphomas (NHL). This week I want to cover Hodgkin’s lymphoma, more commonly known as Hodgkin’s Disease (HD). It gets its eponymous name from Dr. Thomas Hodgkin, who first described it in 1832.
    Hodgkin’s is a potentially curable malignant lymphoma and carries a much better prognosis than non-Hodgkin lymphomas. It is a very specific type of lymphoma that is defined by its microscopic appearance and by specific proteins that are found on the cell membranes of the tumor cells.
    The estimate for 2015 was that there would be 9,050 new cases of Hodgkin’s Disease (5,100 men and 3,950 women) and 1,150 deaths (660 men and 490 women). It is more common in whites and slightly more common in men, except in childhood where 85 percent of the cases are found in boys. The disease has what is called a bimodal age distribution, with occurrences between the ages of 15 and 34 or over age 55.
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  • Monday, March 13, 2017 4:00 AM
    One of my patients asked me recently what lymphoma is. I must admit my knowledge of the subject is fairly limited; it’s a medical condition I’ve tended to avoid because of its complex and changing nature. It can, however, be a very interesting disease and a type of cancer that is illustrative of where cancer treatment in general is heading in the years to come.
    “Lymphoma” is a broad term used to describe a large number of “lymphoid neoplasms.” A neoplasm is an abnormal growth of cells that can be benign (not usually dangerous to one’s health) or malignant (cancerous). Lymphoid neoplasms are composed of cells found in the lymph system. This system is responsible for filtering out and killing foreign things in our bodies, especially infectious agents.
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  • Monday, March 06, 2017 4:00 AM
    A reader has asked that I write about osteomyelitis. This is a condition where the bone and/or bone marrow become infected, usually with bacteria. These bacteria cause a pyogenic reaction – the body produces pus that contains infection-fighting white blood cells. The bacteria that cause the infection vary based on the age of the patient and the location of the infection.
    Osteomyelitis is a fairly uncommon condition that is actually becoming less frequent, perhaps because of earlier diagnosis and more effective therapy. Despite being less frequent, when present, it can cause serious problems.
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  • Monday, February 27, 2017 4:00 AM
    Last week I hope I answered the first part of our reader’s question about how DNA can be used to treat inherited conditions. This week I want to focus on stem cells - what they are, where they come from, how they might be used to treat disease and finally the social and ethical challenges surrounding their use.
    Stem cells are cells that have the potential to change into other more specialized cells in the body. This process is known as “differentiation.” By definition, stem cells have to exhibit two properties: (1) they must be able to divide multiple times and remain unchanged, and (2) they have to have “potency,” the ability to differentiate into other cell types.
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  • Thank you Messrs. Mendel, Watson & Crick
    Tuesday, February 21, 2017 4:00 AM
    I received two queries from readers asking me to address how “DNA and stem cells” might be used to treat inherited medical conditions. That’s a tall order for the space allotted, so I’ll tackle DNA this week and stem cells next week. 
    Modern genetics started with Gregor Mendel’s work on the inheritance of various traits in pea plants in the mid 1800s. A century later, James Watson & Francis Crick (with a lot of help from Rosalind Franklin) determined the structure of DNA in 1953. There is no doubt that the expansive scientific knowledge borne from the discovery of the structure of DNA will continue to revolutionize medical science.
    DNA is an extremely elegant molecule that carries all the information needed to construct a living organism. The structure of DNA is described as a “double helix” which can be represented by imagining a ladder that has been doubly-twisted along its length (see diagram).
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  • What’s the difference between MRI and CT?
    Monday, February 13, 2017 4:00 AM
    Last week I had a young patient ask me what the difference is between an MRI and a CAT scan. Not long after that I noticed an error in a newspaper article that mixed up the two technologies.
    Radiologic imaging of the human body has revolutionized the diagnostic accuracy of physicians. However, it has also had the negative effect of reducing our reliance on a good medical history and physical examination.
    There is also a real concern about patients receiving too much radiation over their lifetimes as a result of having too many CT scans (more below). This is particularly concerning in children who may receive numerous scans over their lifetimes that may increase their risk of cancer.
    We are the only country in the world where a CT and/or MRI scanner is in the neighborhood of virtually every citizen. While this is convenient, it leads to over-utilization of these very expensive and sometimes unnecessary technologies.
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  • Monday, February 06, 2017 4:00 AM
    Sometimes I get asked questions in unusual places. A few months ago at church I was pulled aside and asked if I could write my column on a malady of menopausal women – hot flashes.
    Hot flashes are usually described as a feeling of intense heat, usually with sweating and a rapid heartbeat. They can last a few minutes up to a half hour or so. The feeling usually starts on the face or upper chest but can also be on the neck and even spread over the entire body. Many women experience flushing of the skin over the involved area, hence the alternate name “hot flushes.”
    Interestingly, some women never experience them. There is no hard and fast rule when or if hot flashes will develop. Some women are fortunate enough to have them for only a few months while others (up to 45 percent) may suffer for five to 10 years. Some may have infrequent episodes while others may have them numerous times a day.
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  • Monday, January 30, 2017 4:00 AM
    We do seem to be living in a post-truth world. It’s not just in the political sphere that we have to be careful of facts and “alternate facts.” It also extends to the scientific world as well. The public is being constantly bombarded with scientific information through the popular media and especially the Internet. How is a non-scientist supposed to filter all this information and figure out what to believe? I want to give you some tips to use when evaluating what you see or hear.
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  • Dr. Roberts wraps up discussion on shoulder pain
    Monday, January 23, 2017 4:00 AM
    Welcome back to part two of my series on shoulder pain. First, I want to do a quick review of shoulder anatomy (see diagram). The upper arm bone (humerus) joins to the scapula at the glenoid and is held in place by two structures: (1) a rim of cartilage (glenoid labrum) that forms a shallow cup for the head of the humerus to sit in, and (2) the rotator cuff which is made up of four tendons that wrap around the head of the humerus.
    As I stated last week, in order for the shoulder to move in so many directions, it has to be inherently unstable. Since it is so unstable, two of the most common injuries are dislocations and subluxations. Dislocations result when the ball on the head of the humerus slips out of the glenoid “cup” and stays there. This typically happens when a person’s upper arm is hit from behind when the arm is raised to the side and the shoulder is cocked and ready to throw.
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  • Ouch, my shoulder hurts! – Part One
    Wednesday, January 18, 2017 4:00 AM
    The next two weeks, I’d like to address a commonly injured body part – the shoulder. Most people experience shoulder pain at some point in their life. Doctors typically see it in athletes, people who overuse their shoulders and others who may have fallen on their shoulder or outstretched arm.
    To understand shoulder pain, it’s important to know the basic anatomy of the shoulder joint itself (see diagram). The joint is one of the most complex in the body. Most joints permit only a fairly limited range of motion. The anatomy of the shoulder joint, in contrast, allows for a vast range of movements. It has to be relatively unstable compared to other joints in order to be so versatile. 
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