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Tuesday, February 28, 2017

  • 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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  • Monday, January 09, 2017 4:00 AM
    I continue to be amazed that, when asked what the number one killer of women is, the majority of women respond, “breast cancer.” While breast cancer is the number one cancer killer of women, and is estimated to have claimed about 40,000 women last year, it is not the biggest threat women face. Heart disease kills 10 times as many.
    Cardiovascular disease is arguably the most important women’s health issue and is largely preventable. How can women be so aware that they have a one in 31 chance of dying from breast cancer, but not the much higher one in three chance of dying from heart disease? Could it be that breast cancer is so much more visible in popular media? Perhaps it’s that breast cancer is generally more frightening and potentially disfiguring. Let’s face it, heart disease is just plain boring to talk about.
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  • Thursday, January 05, 2017 4:00 AM
    There is no doubt that antibiotics have saved millions of lives. But, is it all good news? I hope our readers have been noting the increasing number of news stories related to problems with the overuse of antibiotics and the development of resistant bacteria. We have known this was coming for decades, but it has now reached a tipping point. Sally Davies, the Chief Medical Officer of the United Kingdom, has equated the critical health threat of antibiotic resistance to the risk of terrorism. 
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  • Wednesday, December 28, 2016 4:00 AM
    My patient Jim asked me to re-run my column about warts. It’s estimated that up to 12 percent of people worldwide have had warts and that 10 to 20 percent of school-aged children have them at any given time.
    Warts are caused by a group of viruses called human papilloma viruses or HPV. When people hear HPV they often think of genital warts that are caused by certain strains of HPV virus, some of which can cause cervical or even mouth and throat cancers. There are over 100 known types of HPV, all of which share the characteristic of being able to infect skin cells.
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  • Monday, December 19, 2016 4:00 AM
    An adult patient has asked me to write about night terrors. While night terrors can be seen in adults, they are much more common in children. It’s hypothesized that this is due to brain development.
    Night terrors are a subclass of sleep disorders called “parasomnias.” Rather than focus specifically on adults, I’d also like to talk a bit about kids. People who exhibit parasomnias often have family members who suffer from them as well. Virtually all of these conditions go away with time.
    Parasomnias are a category of sleep disorders defined by abnormal and unnatural movements, behaviors, emotions, perception, and dreams. They occur while falling asleep, sleeping, between sleep stages, or arousal from sleep. They are further classified by when they occur in the sleep cycle – during REM (Rapid Eye Movement) sleep or during non-REM sleep.
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  • Monday, December 12, 2016 4:00 AM
    Winter has arrived and hopefully that means you have all received your flu shot. Most people us the term “flu” in a very generic sense, meaning anything from cold symptoms to having a case of vomiting and diarrhea. The “flu” in this column refers to respiratory influenza.
    Two particular types of influenza viruses, Type A and Type B cause the majority of influenza infections. Type B typically does not cause severe disease whereas Type A can be lethal, particularly in the young, elderly and in those who have compromised immune systems.
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  • 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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