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Friday, June 23, 2017

  • Monday, June 19, 2017 4:00 AM
    Summer barbecue season is in full swing and it’s 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.
    The Centers for Disease Control estimates that 97 percent of all cases of food-borne illness come from improper food handling. Most of these (79 percent) are from commercial establishments, while the other 21 percent originate in the home.
    There are a few common denominators that account for most cases of food poisoning. Leaving foods at temperatures that allow bacterial growth is a frequent cause, especially in the summer months when food is left out in warm weather. This can result Staphylococcal food poisoning that is usually seen in foods like potato salad and pies that are high in salt or sugar content.
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  • Monday, June 12, 2017 4:00 AM
    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. It used to be much more common when I did my training in the late 80’s, but with the advent of preventative vaccines, the incidence has dropped dramatically.
    Meningitis is a condition that causes inflammation of the meninges, the coverings surrounding and protecting the brain and spinal cord. Most of the symptoms of meningitis are caused by the inflammatory reaction of the body to infection by viruses and bacteria, and rarely fungi or parasites. These microorganisms reach the meninges either through the bloodstream or by direct contact of the mininges with the nasal cavity or skin.
    Meningitis, especially bacterial, can be very serious if not diagnosed and treated promptly. Death from meningitis occurs about 20 percent to 30 percent of the time in infants, about two percent in older children, and from 19 percent to 37 percent in adults. The risk is much higher in those who have other co-existing medical problems.
    Viruses are the most common causative agent in meningitis. Viral meningitis is usually caused by enteroviruses, herpes viruses, varicella (chickenpox) virus, mumps virus, measles virus or HIV.
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  • Monday, June 05, 2017 4:00 AM
    Summer is just around the corner which means we’ll start to see patients complaining of “swimmer’s ear.” 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 infection of the middle ear (the air filled cavity just 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.
    The wax (cerumen) that everyone is always trying to get out of their ears is actually there to protect the external ear canal. There exists a delicate balance of too much or too little cerumen. If there is not enough present, the ear canal can dry out, crack and develop infection. If there is too much, the ear canal can become too moist. This leads to swelling and breakdown of the skin lining the ear canal.
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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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