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Tuesday, May 30, 2017
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  • Monday, May 22, 2017 4:00 AM
    Despite not getting to Memorial Day yet (thanks to all those who gave the ultimate sacrifice), 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.
    Deaths from heat-related illness range from 300 to several thousand per year in the U.S. The number is increasing with our warming climate and is markedly increased during heat waves. There are tens of thousands of visits each year to doctors’ offices and emergency rooms.
    Risk factors that make one more prone to heat-related illness include being elderly, very young or obese. Some prescription or even non-prescription drugs, particularly alcohol, cocaine, antihistamines, beta blockers, diuretics, ADD/ADHD medications, and some psychiatric medications can increase the likelihood of heat illness. Workers like firefighters, who have to wear heavy clothing, are also at very high risk.
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  • Monday, May 15, 2017 4:00 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.
    In 2014, there were 726 deaths from bicycle accidents in the United States. Most of these deaths were the result of head injuries from people being hit by or running into automobiles. Bike accidents account for about half a million visits to emergency departments each year and account for over $10 billion in health care costs.
    While most kids own bike helmets, often they tell me they don’t wear them. Parents often bring up the fact that they never wore a helmet when they were kids. Most of the time, the reason is because helmets did not exist when they were kids.
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  • Monday, May 08, 2017 4:00 AM
    This past weekend’s sunny (yet chilly) weather reminded me it’s time to starting thinking 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. Everyone knows you can get a burn if you’re out in the sun too long. However, many people don’t realize that you can still get a burn in the shade or on a cloudy day. Ultraviolet rays come in two forms: UVA and UVB. UVA accelerates aging of the skin, while both UVA and UVB can cause skin cancer.
    Sunscreen lotions work by absorbing the UV rays before they penetrate into your skin and cause damage. They can be effective, but only if used properly. Dermatologists will all tell you it’s safer to use physical blocking agents like widely available sun-protective clothing and wide-brimmed hats.
    Sunscreens are rated using the “SPF” scale. Don’t bother with lotions with an SPF below 15. An SPF of 15 theoretically allows you to stay in the sun 15 times longer before you burn. However, the effectiveness does not last near that long since the lotion usually wears off from sweating, swimming, or friction. They should be applied liberally (at least 2-3 tablespoons per application) before going out in the sun. They need to be re-applied at least every two hours. It’s important to get a broad-spectrum lotion that absorbs UVA and UVB.
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  • Monday, May 01, 2017 4:00 AM
    I had a request to write about lupus. Lupus is the common name for 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.
    Autoimmune diseases are a group of illnesses caused by a person’s immune system attacking their own cells. In the case of lupus, the immune system makes antibodies against proteins in the nuclei of cells, the part of the cell where the DNA is found. It is believed that people who develop lupus have an underlying genetic predisposition to the disease. There is no single “lupus gene.” Like most genetic diseases, it appears to involve problems with multiple genes and interactions with the environment.
    Certain environmental factors are felt to trigger damage to cells that results in exposing proteins, normally hidden in the nucleus, to the immune system. Some of the factors causing damage are thought to include ultraviolet light, stress, medications, and infections, likely by viruses. Drug-induced lupus usually goes away when the offending medication is stopped.
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  • 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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  • 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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