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Monday, December 05, 2016

  • Monday, December 05, 2016 4:00 AM
    A patient who’s mother is having hearing difficulties asked me to write about the best way to choose someone to fit hearing aids. I’d like to begin with some background on hearing.
    It goes without saying that hearing is one of our most important senses. It is critical for our quality of life as well as for safety and social interaction. There are an estimated 30 million Americans who have some degree of hearing loss, 65 percent of whom are younger than 65 years of age. It’s very concerning that one in 14 younger adults and one in 20 adolescents have measurable hearing loss. Since 1971, the number of Americans over age three with hearing disorders has doubled.
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  • Monday, November 28, 2016 4:00 AM
    Winter cold and flu season is rapidly approaching. This week, I’d like to talk about a different kid of flu, “stomach flu.” I have to start by dispelling a common misconception that all flu is the same. “Stomach flu” is not caused by the same viruses as “respiratory flu.” Flu shots, given to prevent respiratory influenza, will not protect you against viruses affecting the gastrointestinal tract that can cause an infectious malady known as viral gastroenteritis.
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  • Monday, November 21, 2016 4:00 AM
    This week I want to address a malady that I’ve been seeing a fair amount of lately – dizziness. Primary Care doctors in the U.S. see about six million patients a year with dizziness. 
    Dizziness means different things to different people and can be a symptom of many different medical conditions. People usually describe being dizzy when they either feel faint or lightheaded or when they feel like they or the room are spinning. This latter sensation is called vertigo, from the Latin vertere meaning, “to turn.” 
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  • Monday, November 14, 2016 4:00 AM
    This week I’d like to write about a problem that costs taxpayers billions of dollars each year – Medicare fraud and abuse. Medicare paid out $505 billion in payments for services and medications in 2014, accounting for 14 percent of the federal budget. The Office of Management and Budget (OMB) reports that 12.7 percent of those payments were “improper,” meaning the services were not necessary, did not meet Medicare guidelines, or were downright fraudulent.
    Medicare fraud refers to individuals or companies who obtain payments from Medicare under false or illegal pretenses. The OMB has been making a concerted effort to limit Medicare fraud, but Medicare is an easy target since it is such a complex program. It’s like playing the lottery for those who are intent on defrauding the government, but with a much higher chance of a payoff.
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  • Dr. Roberts talks about complementary and alternative medicine
    Monday, October 24, 2016 4:00 AM
    I’m frequently asked by patients to comment on the use of “non-traditional” treatments or remedies they have heard or read about. I usually have to respond that I have limited knowledge about the product, but I will sometimes try to help the patient research the product or its ingredients.
    The business of complementary and alternative medicine or “CAM” is booming. This is largely an outgrowth of patient frustration with traditional medical practice in America. People are fed up with the high cost of medications and other treat-ments as well as the perceived lack of caring by medical professionals.
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  • Exercise isn’t just for the young
    Tuesday, October 11, 2016 4:00 AM
    “All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.” – Hippocrates
    Few things benefit the body more than maintaining physical fitness. While doctors have typically recommended exercise for younger patients, we’re realizing how important it is for our older patients as well. Regular exercise, even in one’s senior years, can still reduce your risk of a number of health conditions, particularly heart attacks and strokes. It also may be one of the few things to slow the onset of dementia.
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  • Conjunctivitis can be a pain in the eye
    Tuesday, October 04, 2016 4:00 AM
    Now that school is back is session and child day care services are in full swing, the incidence of “pink eye” is starting to pick up. This is a very common condition that accounts for over 30 percent of doctor visits for eye problems.
    Conjunctivitis is the medical term for “pink eye.” The conjunctiva is the continuous connective tissue membrane that covers the inside of the eyelids. It then folds back on itself to cover the front of the eyeball up to the edge of the cornea (where the white part of the eye meets the iris or colored part of the eye).
    The purpose of the conjunctiva is to provide a barrier to keep infectious organisms from entering the eye tissue itself. Conjunctivitis results when there is an irritation or breakdown of this defensive layer, a change in the normal organisms inhabiting the eye, or trauma that breaches the membrane.
    There are a number of causes of conjunctivitis. The most common are bacteria, viruses, allergies, fungi, parasites, and chemicals. These irritants cause varying degrees of redness, discharge, irritation and perhaps even pain on exposure to bright light, known as photophobia.
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  • Why are doctors always running late?
    Tuesday, September 20, 2016 4:00 AM
    I’m going out on a limb this week and have prepared myself for the possibility of some backlash to this column. I’m going to attempt to explain some of the reasons why doctors seem to always be running late. 
    I certainly won’t list myself among those who run on time regularly – I run behind frequently for various reasons. I’ll probably come off as sounding like a whiner, but there are some legitimate reasons why doctors leave patients waiting. 
    Some doctors don’t seem to place much importance on the value of their patients’ time, but I don’t think the majority of physicians feel that their time is more valuable. I honestly feel that most doctors would prefer to stay on time while being able to address all of their patient’s problems.
    Suffice it to say that doctors are not always in control of their time. Emergencies and interruptions do come up frequently throughout the day. The patient who was scheduled for what was thought to be a simple headache may really be suffering from spousal abuse and major depression. 
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  • Lifestyle modifications are foundation for treatment of GERD
    Tuesday, September 13, 2016 4:00 AM
    I left you hanging last week wondering about the treatment of Gastro Esophageal Reflux Disease (GERD). First, a quick review. Remember that GERD is caused by stomach (gastro) acid going backward (reflux) up the tube from the mouth to the stomach (esophagus).
    Recall that the risk factors for GERD include decreased tone of the lower esophageal sphincter (LES), loss of normal muscular function of the esophagus, excess production of stomach acid, delayed emptying of the stomach and overeating. Fatty or fried foods, coffee, tea, caffeinated drinks, chocolate and mint are all foods that can cause GERD. Alcohol and cigarette smoking are also risk factors.
    When I see someone complaining of GERD symptoms in the office I review my patient’s history to try and identify any risk factors. Many patients immediately request medication to help control the symptoms rather than try and control the underlying cause(s) of the GERD. Direct-to-consumer advertising has been very effective in selling medications to treat this ubiquitous problem. If you ask any insurance company what it’s largest drug expense is, it’s often a class of medications called PPIs or Proton Pump Inhibitors (more below).
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  • What exactly is GERD?
    Tuesday, September 06, 2016 4:00 AM
    I’ve been asked to re-run my columns about Gastro Esophageal Reflux Disease, more commonly known as GERD (now you know why we use GERD for short). Breaking down the term translates to: stomach (gastro) juices go up the tube that connects the mouth and stomach (esophagus) in a backward direction (reflux).
    It’s helpful to know the anatomy when trying to understand GERD (see top diagram). In the top diagram you can see the esophagus, a muscular tube that contracts in a rhythmic fashion and moves food down toward the stomach. The food passes through the diaphragm (the muscular dome that separates the chest and abdomen). The diaphragm helps form the lower esophageal sphincter (LES) that acts as a valve to help keep acid in the stomach. Food passes through the LES into the stomach where it is mixed with acid to aid digestion.
    It is estimated that 14 to 20 percent of adults in the U.S. are affected with GERD. These estimates are based on surveys of patients who report heartburn, one of the symptoms of GERD. The current medical definition of GERD is, “a condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.”
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  • Fungi and its causes
    Wednesday, August 31, 2016 4:00 AM

    I recently had to remove some of a patient’s toenails. Why on earth would someone want that done? Because they were infected with fungus. The medical term for a fungal infection of the toenails or fingernails is onychomycosis (OM).

    This condition is generally more of a nuisance than a real health threat. However, the nails can become quite enlarged and painful. Diabetics and people who have poor immune function do need to be concerned about OM. Infected nails in these folks can lead to inflammation of the skin around the nails and entry of skin bacteria that can lead to serious skin infections.

    Most people visit their doctors for OM because of the ugly nails. It is the most common nail disorder in adults and affects up to 13 percent of North Americans. It is 30 times more common in adults than children.

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  • Generic or name brand?
    Monday, August 22, 2016 4:00 AM

    This week I want to tackle the subject of generic vs. name brand medications. There are a number of reasons this topic is important. First of all, medications in general are becoming prohibitively expensive for many patients. Insurance companies are also pressuring patients and physicians to prescribe generics whenever possible to reduce health care costs (not necessarily a bad thing, but certainly a pain in the rump at times).

    I receive many questions about generics in the office. People want to know why every medication doesn’t have a generic substitute and if not, how long will it be until one is available. They also want to know if they are safe and effective.

    First let me describe what generic and name brand drugs are. Generic drugs are chemical compounds that never received patent protection or the patent on the name brand drug has expired. In contrast, name brand drugs are protected by a patent, meaning no other companies can produce or sell that particular drug.

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  • Monday, August 15, 2016 4:15 AM

    Summer barbeque season is still in full swing and it’s still a good time to review food safety. Food-borne illness is something that almost all of us have experienced at some point in our lives.

    Food-borne illness is defined as more than two people having a similar illness with evidence of food as the source. The overall rate of these illnesses has gone down drastically in the last century with improvements in food handling and sanitation. However, we still hear about illness outbreaks.

    There are approximately 76 million cases of food-related illness in the United States each year. There are also about 325,000 hospitalizations and 5,000 deaths. Underdeveloped countries, as a group, experience about one billion cases annually and four to six million deaths.

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  • Pneumothorax
    Sunday, July 17, 2016 10:15 PM

    I’ve received some questions recently asking what a pneumothorax is. The word is derived from the Greek word “pneuma,” meaning wind, air or breath and the Latin “thorax,” meaning chest. It literally means air in the chest.

    Some may now be questioning my knowledge of anatomy and physiology. You may be thinking, “of course, everyone has air in their chest!” The difference lies in where the air is located.

    Air is normally found inside the lung. When someone suffers a pneumothorax, the air is outside the lung, specifically between the outside of the lung and the inside of the chest cavity or thorax. This is not a normal physiologic state and it causes the lung to collapse. These injuries can be quite dangerous and even fatal.

    To understand how this all works, you need to have an understanding of the anatomy and physiology of breathing. When we take a breath or inhale, the muscles in the wall of the chest expand the chest outward. Likewise, the diaphragm (the muscular dome separating the chest and abdomen) pulls downward and expands the chest toward the abdomen.

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  • Carpal Tunnel Syndrome
    Monday, July 11, 2016 12:00 AM

    I see a number of people who suffer from carpal tunnel syndrome. Carpal tunnel is a very common condition, often related to repetitive injury at home or in the workplace. It is one of a number of repetitive strain injuries or “RSIs.”

    Carpal tunnel symptoms usually include numbness and/or pain in the hand and wrist that may extend up into the arm, shoulder or even neck. The numbness, tingling or pain frequently wakes people during sleep.

    To understand the condition, it’s helpful to have a lesson in wrist anatomy (see diagram). There are eight carpal bones that make up the wrist. When you hold your wrist with your palm facing up, these bones form a U-shaped valley. The top of the valley is enclosed by a piece of connective tissue called the transverse carpal ligament. These structures together form the carpal tunnel.

    The tunnel is a very cramped space and some very important structures are packed into it. There are nine flexor tendons and the median nerve. The tendons that run through the tunnel connect the muscles in the palm side of the forearm to the bones in the fingers. When the muscles in your forearm contract, the tendons slide through the tunnel and pull on your finger bones, allowing you to make a fist (finger flexion).

    The median nerve runs directly under the transverse carpal ligament. This nerve is responsible for the feeling in the thumb, index, middle, and the thumb side of the ring finger. It also controls the muscles in the thumb that allow you to pinch your thumb and index finger together.

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