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home : columnists : dr. john roberts January 25, 2015


What's in a (brand) name?
This week I want to tackle the subject of generic versus 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.

Monday, January 19, 2015
Dr. Roberts expands on shoulder pain
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) sits on 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.

Sunday, January 11, 2015
My shoulder hurts! What's the problem, Doc?
The next two weeks I want to discuss shoulder pain. Most people experience shoulder pain at some point in their lifetimes. 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. 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.

Sunday, January 4, 2015
Kidney Stones, while small, can be a big problem
Kidney stones are a topic near and dear to my heart as I've had three myself.

The medical term for stones is nephrolithiasis (nephro - kidney, lith - stone, sis - condition). Stones or calculi, from the Latin for pebble, can form and stay in the kidneys (renal calculi) or move down the ureters, the tubes connecting the kidneys to the bladder (ureteral calculi). 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. Stones are rare after age 60. Men have about a 12 percent lifetime chance of developing a kidney stone while women have a seven percent chance.

Sunday, December 28, 2014
The resurgence of whooping cough
I've been fielding a fair number of questions lately about pertussis (whooping cough). Public health officials have been concerned about the rapid increase in pertussis cases the last few years. It is becoming a big problem. Indiana health officials are predicting that at the current rate, they will see more cases than they have in the last 50 years. There have been a number of deaths nationwide from pertussis, particularly in infants less than two months of age.

Pertussis, commonly referred to as "whooping cough," is a highly contagious bacterial disease caused by Bordetella pertussis. The bacterium is named after Dr. Bordet who isolated the causative organism in 1906.

Pertussis was a scourge in the U.S. prior to widespread vaccination of children. It remains the leading cause of vaccine-preventable death in children and accounts for 30-50 million cases of whooping cough worldwide each year and about 300,000 deaths.

Monday, December 22, 2014
Do you suffer from restless leg syndrome?
Someone told me the other day that they thought "restless leg syndrome" was a condition made up by pharmaceutical companies to sell more medications. I'm sure many of you have seen the commercials for Requip® and Mirapex®, both drugs used to treat this malady.

People have described symptoms suggestive of restless legs since the 17th Century. The Swedish neurologist Erik Ekborn, initially coined the term "restless legs syndrome" in the 1940s. It is estimated that between ten to fifteen percent of Americans suffer from RLS to some degree. The incidence in women is about twice that of men. About 40 percent of people develop symptoms prior to age 20. Since symptoms tend to be mild initially and worsen with age, most sufferers are not diagnosed for 10 to 20 years.

Monday, December 15, 2014
Carpal tunnel syndrome is common among folks who do repetitive motion
I see a number of people each month 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 "RSI's."

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

Monday, December 8, 2014
'My finger is stuck,' a common complaint of trigger finger condition
I've had a run of patients recently, all presenting with problems getting their fingers to move. They all described "catching" or "popping" when trying to flex or extend a finger. They were all suffering from trigger finger, a condition also known as trigger digit or by the medical term stenosing tenovaginitis.

The condition is very common. It is seen up to six times more frequently in women than men and typically starts showing up around 55-60 years of age. It is also seen more often in a person's dominant hand. It can affect any of the fingers, most often in the thumb, followed by the ring, middle , little and index fingers.

Sunday, November 30, 2014
Warts are a common problem for people
I had a patient ask me to re-run my column about warts. It's estimated that up to 12 percent of people worldwide have had warts and that 10-20 percent of school-aged children have them at any given time.
Sunday, November 23, 2014
Senior safety is serious business
I've seen a fair number of elderly patients lately who have suffered injuries from falls. This is a very important topic because the older segment of our population is growing rapidly. In fact, 40 percent of deaths after the age of 65 are due to accidents in the home. There are many issues to look at when considering safety for seniors. Falls are probably the most concerning.

Seniors are naturally more prone to falling and as a result, suffer many injuries. As we age, our bones become weaker and our muscular fitness starts to decline. Reflexes start to slow down and dizziness and lightheadedness become more common, particularly from medication side effects. Throw in decreases in vision, depth perception and hearing and you have a perfect recipe for disaster.

It is therefore very important for seniors to do everything they can to minimize their risk for falls. I usually recommend that throw rugs are removed from the home and if not, that they are taped down with double-sided carpet tape. Wood floors can be slick and should be covered with wall-to-wall carpeting if possible. This also provides extra padding in case of a fall.

Electrical cords and water hoses should be kept out of walking paths. Pets are also a common tripping hazard. Many of the falls I see patients for are the result of not using the cane or walker that was prescribed by their physician. These aids can really help with stability and safety.

Sunday, November 16, 2014


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