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Tuesday, July 26, 2016

  • 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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  • Monday, June 27, 2016 12:00 AM

    Kidney stones are a topic near and dear to my heart as I’ve had the pleasure of passing three of the little beasts. Stones or calculi, from the Latin for pebble, can form and stay in the kidneys (renal calculi or nephrolithiasis) or move down the ureters, the tubes connecting the kidneys to the bladder (ureteral calculi or urolithiasis). Stones may also be found in the bladder.

    The ureters are very small tubes that contain smooth muscle cells. These cells contract to help move the urine toward the bladder.  When a stone is too large to pass down the ureter, it can partially or completely block the flow of urine, causing pressure to build up. This pressure, along with contractions of the walls of the ureter results in severe pain called ureteral colic.

    The peak onset of kidney stones is in the third and fourth decades. It is rare after age 60. Men have about a 12 percent lifetime chance of developing a kidney stone while women have a seven percent chance. Interestingly, stones are more common in the Southeast United States. The chance of developing a recurrence of stones is 14 percent at one year, 35 percent at five years, and 52 percent at ten years.

    Stones form when the urine becomes supersaturated. This means that compounds in the urine become so concentrated that they start to form crystals. These eventually grow to form stones. Maintaining adequate fluid intake to keep the urine diluted is therefore very important in reducing the risk of stone formation. Other types of stones may be formed by infection in the kidneys. 

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  • Monday, June 20, 2016 12:00 AM

    I’ve started to see some cases of swimmer’s ear in the last few weeks. We tend to see more of this malady in hot, humid weather, but it can also be brought on by other conditions as well.

    The medical term for swimmer’s ear is otitis externa, indicating inflammation of the external ear. This is in contrast to the more common otitis media, or inflammation of the middle ear (the part of the ear behind the ear drum).

    The number of people who suffer from swimmer’s ear is about four per 1,000 per year, or about three to five percent of the population. It afflicts males and females in equal numbers and tends to present between seven and twelve years of age, though older folks can certainly be afflicted.

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  • Sunday, June 12, 2016 10:52 PM

    “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 dementia as we get older.

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  • Tuesday, June 07, 2016 1:12 AM
    Despite brief cool down we’ve had over the weekend, it’s time to start thinking about the dog days of summer. Although I don’t see a significant number of heat-related emergencies in my office, many patients do end up in emergency departments suffering from exposure.
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  • Monday, May 23, 2016 3:56 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 will be ramping up as spring (hopefully) arrives for good.
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  • Monday, May 16, 2016 12:50 AM

    I had a request to write about lupus. Lupus is the shortened name of Systemic Lupus Erythematosus. It is an autoimmune disease first described by the physician Rogerius in the 12th Century. There are many opinions regarding the origin of the name. One of the most popular is that the rash on the face of many lupus sufferers resembles a wolf’s face. Lupus is Latin for wolf.

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  • Sunday, May 08, 2016 11:19 PM
    The summer sports season is about to begin and gardening and other outdoor chores are upon us. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal abuses busy. I want to give everyone some pointers in treating those inevitable injuries.
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  • Monday, May 02, 2016 11:03 PM
    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.
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  • Monday, April 25, 2016 12:40 AM

    Readers have asked me to address more summer safety issues. It’s great to see kids and adults out on their bicycles now that the weather has warmed up (especially kids who aren’t sitting on the couch). This will undoubtedly result in more bike accidents. Some of the saddest experiences I had during my Family Medicine residency were to have to take care of kids who were brain injured as a result of a bike accident.

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  • Monday, April 18, 2016 12:36 AM
    This past weekend’s beautiful weather reminded me it’s time to think about summer. This week, I want to briefly review some sun and water safety tips.
    Most people enjoy a good day in the sun. Whether it’s lounging by the water or working outdoors, we all get our fair share of sun every summer.
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  • Sunday, April 10, 2016 10:39 PM
    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. 
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  • Monday, April 04, 2016 2:23 AM

    One of my patients asked me to write about lymphoma. I must admit my knowledge of the subject is fairly limited; it’s a medical condition I’ve always avoided because of its complex and changing nature. It can, however, be a very interesting disease and a type of cancer that illustrates where cancer treatment in general is heading in the years to come.

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  • Sunday, March 27, 2016 11:58 PM

    The mother of one of my patients asked me to write about meningitis. First of all, I want to state that meningitis is a very rare condition. The incidence of bacterial meningitis in the United States is about two to three per 100,000 people per year, while viruses cause about 11 cases per 100,000 per year. 

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