An image.
Home | The Paper | Subscribe | Contact Us | Community Events
Sunday, September 23, 2018

  • Monday, September 17, 2018 4:00 AM
    The title of this column, a quote from comedian W.C. Fields, refers to his penchant for drinking alcohol. So what do alcohol and W.C. Fields have to do with my topic of rosacea? Read on. 
    Rosacea is a common skin condition usually found on the face, which can be a great source of consternation. It is a disease with various clinical signs. These can include redness/flushing, coarse skin, and bumps and pustules resembling acne. It may also present with visible superficial blood vessels called telangiectasias. 
    The condition is found three times more often in women and usually presents between 30 and 60 years of age. It is also more common in fair-skinned people of European and Celtic origin. One of its nicknames is the “curse of the Celts.”
    The diagnosis of rosacea is made on clinical grounds (i.e. signs and symptoms). There has to be a persistent rash on the central part of the face for at least three months to qualify as rosacea. Classifying rosacea is important in determining the best treatment. 
    The exact cause of rosacea is not well understood, though there are numerous factors that likely play a role. The flushing associated with rosacea is thought to be due to the increased number of blood vessels that are close to the skin surface as well as the increased sensitivity of the vessels to heat. Sun exposure may play a role based on the location of the rash, though some studies refute this.
    0 comment(s)
  • Can you prevent Shingles?
    Monday, September 10, 2018 4:00 AM
    I’ve had requests to re-run my column on shingles. I think the increased interest has been brought on by the television ads for the vaccine to help prevent shingles, which are quite accurate and compelling. I’ve had quite a few patients who have recently been suffering from this malady, two quite severely.
    Shingles is caused by the Varicella-zoster virus (VZV). The virus is also known as chickenpox virus, varicella virus, and zoster virus. It is a member of the herpes virus family, of which eight strains are known to infect humans. 
    The biology of herpes viruses is very interesting. They infect humans through the skin and mucus membranes that line body openings. The initial or “primary” infection results shortly after exposure to the virus. This usually causes itching and redness of the skin followed by development of small fluid-filled blisters known as vesicles. Some readers may have seen chicken pox, though it is becoming a very rare disease since the advent of the childhood vaccination to help prevent the disease.
    Interestingly, herpes viruses are never completely cleared from the body. Once the initial infection has subsided, the viruses travel to parts of the nervous system called ganglia that reside deep in the body. The viruses are quite happy playing Rip Van Winkle until they are awakened from slumber at some point in the future.
    0 comment(s)
  • Red Eye can spread easily if you aren’t careful
    Tuesday, September 4, 2018 4:00 AM
    Now that school is back is session and child day care services are in full swing, the incidence of “pink eye” is starting to pick up. This is a very common condition that accounts for over 30 percent of patient visits for eye problems.
    Conjunctivitis is the medical term for “pink eye.” The conjunctiva is the continuous connective tissue membrane that covers the inside of the eyelids. It then folds back on itself to cover the front of the eyeball up to the edge of the cornea (where the white part of the eye meets the iris or colored part of the eye).
    The purpose of the conjunctiva is to provide a barrier to keep infectious organisms from entering the eye tissue itself. Conjunctivitis results when there is an irritation or breakdown of this defensive layer, a change in the normal organisms inhabiting the eye, or trauma that breaches the membrane.
    There are a number of causes of conjunctivitis. The most common are bacteria, viruses, allergies, fungi, parasites, and chemicals. These irritants cause varying degrees of redness, discharge, irritation and perhaps even pain on exposure to bright light, known as photophobia.
    It can be difficult to tell the exact cause of conjunctivitis unless the doctor has special equipment. Ophthalmologists and optometrists have slit lamps that can help differentiate the cause. A slit lamp is the instrument that you rest your chin on where the doctor sweeps a bright light across your eye
    Doctors without special equipment can sometimes get clues to the cause of the inflammation. For instance, people who have had a recent cold are more likely to be suffering from a viral conjunctivitis. Viruses are also more common from early spring through late fall. Bacterial conjunctivitis is more common in the winter and spring. Patients usually recall exposures to things that might cause chemical or allergic conjunctivitis.
    0 comment(s)
  • Sunday, August 26, 2018 10:57 PM
    The arrival of warm weather each year means we have to start worrying more about Lyme Disease. Most people are aware of the association between tick bites and Lyme disease, but few know exactly what Lyme disease is or what causes it. Indiana has seen an increasing number of confirmed cases of Lyme disease, particularly since 2013. The most recent statistics from 2016 showed 127 confirmed cases in Indiana.
    Lyme disease received its name in the late 1970s when a number of children around Lyme, Connecticut developed arthritis. The actual disease has been described since the early 1900s. It is mostly found in New England as well as Wisconsin and Minnesota. When a case does occur in Indiana, the news spreads rapidly, sometimes inciting panic. Most infections (85 percent) are seen in the spring and summer with the remainder in the fall. 
    Ticks do not actually cause the disease, though they do carry the organism that does cause it, the spirochete Borrelia burgdorferi. Spirochetes are bacteria that have a spiral shape. Another common misconception is that any tick can spread B. burgdorferi infection, when in fact only Ixodes (deer) ticks carry the organism. The accompanying photo shows a deer tick on a fingernail – they are very small.
    The B. burgdorferi organism, during its various life stages, mainly infects field mice and white tailed deer. Humans are innocent bystanders when we wander into deer habitat. The ticks lie in wait on the tips of grasses and shrubs and crawl onto us as we brush by. They then crawl about until they find a nice tender spot where they attach and begin to feed.
    0 comment(s)
  • Sunday, August 19, 2018 10:40 PM
    Health care at the end of life has been a popular discussion topic over the last few years. It has come up for discussion as we continue to search for ways to deliver compassionate, more cost effective care. Excellent books such as Dr. Atul Gwande’s book, Being Mortal: Medicine and What Matters in the End, have also popularized the topic.
    As a family physician, I see it as my professional duty to discuss end of life planning and care with my patients. In fact, when appropriate, I would consider it negligent to not hold these discussions. 
    To put this discussion in financial perspective, about 30 percent of Medicare expenditures are paid out in the final six months of Medicare recipients’ lives. This equates to about $6 billion a year. This would be money well spent if it went to improving health or quality of life, but most of it does not.
    However, this should not be a simple dollars and cents discussion. Determining a patient’s wishes regarding end of life treatment is both sensible and humane. Forcing patients to have treatments to keep them alive against their stated wishes is irrational and degrading.
    I suppose I have served on numerous “death panels.” I am guilty of having guided my patients and their families to help them recognize the importance of advance planning as well as carrying out those plans when the time came. It can be heart-wrenching for patients, families and their doctors. Allowing someone to die with dignity is aptly described in the modern Hippocratic Oath: “I will keep them [the sick] from harm and injustice.”
    To help patients put their wishes on paper, I want to briefly describe the advance directives that are available in the State of Indiana. Everyone should have one or more of these documents when they feel the time is appropriate. I like to start the discussion when my patients turn 50 or even younger, particularly if they have other chronic diseases.
    0 comment(s)
  • Monday, August 13, 2018 4:00 AM
    I recently had to remove some toenails. Why on earth would someone want that done? Because they were infected with fungus. The medical term for a fungal infection of the toenails or fingernails is onychomycosis (OM).
    This condition is generally more of a nuisance than a real health threat. However, infected nails can become quite enlarged and painful. Diabetics and people who have poor immune function need to be concerned about OM. Infected nails in these folks can lead to inflammation of the skin around the nails and entry of skin bacteria that can lead to serious skin and even bone infections.
    Most people visit their doctors for OM because of the ugly nails. It is the most common nail disorder in adults and affects up to 13 percent of North Americans. It is 30 times more common in adults than children.
    OM is caused by three types of fungi. The vast majority of these infections are caused by fungi that invade and feed on hair, skin and nails. These organisms are called dermatophytes and account for 90 percent of OM. Trichophyton rubrum (70 percent) and Trichophyton mentagropytes (20 percent) are the most common dermatophytes.
    Yeasts and molds cause the remaining cases. It’s often difficult to tell what organism is causing the infection without doing a culture in the lab which is usually recommended prior to starting treatment.
    0 comment(s)
  • Dr. Roberts reminds us, leaflets three … let it be!
    Monday, August 6, 2018 4:00 AM
    We’ve had pretty good weather so far this summer, allowing many of our readers to commune with nature. This has resulted in a lot more rashes showing up in my office. Most of this contact dermatitis was likely caused by poison ivy, one of three plants in Indiana in the genus Toxicodendron. This genus also includes poison sumac, and occasionally poison oak.
    The physical appearance of the poison ivy plant is highly variable, though it always has leaves in sets of three (see illustration). A memory aid from my days as a Boy Scout lets me recall what it looks like – “leaflets three let it be, berries white a poisonous sight.” The white berries can sometimes be seen in wintertime. The plant is small and low to the ground when young. As it grows, it can be found in various sizes all the way up to thick vines attached by small red roots to trees or other structures.
    The rash of poison ivy, like most contact rashes, results from the reaction of the immune system to a foreign compound on the skin. The compound binds to skin cells, is recognized by the immune system, and attacked. When dealing with poison ivy, sumac or oak, it causes a typical rash, known as “rhus dermatitis.”
    In the case of poison ivy, oak and sumac, the offending chemical is the plant resin or oil urushiol. Interestingly, urushiol is also found in mangos and the shells of cashew nuts. This oil can remain in the environment for years after a plant dies.
    0 comment(s)
  • Monday, July 30, 2018 4:00 AM
    The joy of summer sports and yard work has resulted in a number of patients coming to see me complaining of sore shoulders, elbows, hips and knees. Many of these folks have been suffering from bursitis. Most of you have probably heard the term, but what is it? 
    Any time a medical term ends in the suffix “itis,” it indicates inflammation of the tissue or organ involved. In this case, bursitis is an inflammation of a bursa (pleural bursae or bursas). Bursa is Latin for purse, a very good descriptor of what it looks like – a small sac made of connective tissue.
    A bursa is lined by a synovial membrane that secretes fluid into the sac. This turns the bursa in to a little pillow filled with a slippery liquid that helps cushion structures around it. It also allows these structures to glide more easily over each other. Here’s a fun activity for the kids; make your own bursa by putting just a little water in a small balloon. Then put an object like a book on top of it and roll it around on the table to get an idea of how bursas work.
    Our bodies contain many bursas. The ones that cause the most problems are found in the shoulder, elbow, hip, and knee. These joints are fairly complex and have many bones, tendons and ligaments that intersect and move over each other. Without the aid of bursas, these structures would rub together, causing a lot of pain as well as wear and tear.
    0 comment(s)
  • Monday, July 23, 2018 4:00 AM
    I continue to be amazed when I ask women what the number one killer of women is, the majority 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. It’s estimated that ten times that many died of heart disease last year.
    Cardiovascular disease is arguably the most important women’s health issue, and is largely preventable. How can women be so unaware that they have a one in 31 chance of dying from breast cancer but a much higher one in three chance of dying from heart disease? Could it be that breast cancer gets so much more coverage in mainstream and social media? Is breast cancer generally more frightening & potentially disfiguring? Is heart disease just plain boring to talk about?
    Whatever the reason(s), women need to become educated about their risk of developing heart disease. The American Heart Association’s “Go Red for Women™” campaign (www.goredforwomen.org) has helped raise awareness.
    It is well documented that doctors tend to give less attention to heart problems in women and that they receive inferior treatment compared to men. Much of this has stemmed from scientific studies on heart disease that have not included women. More recent information is shedding light on the diagnosis and management of heart disease in females.
    0 comment(s)
  • Monday, July 16, 2018 4:00 AM
    I saw a young athlete two weeks ago who complained of shin pain. He had been upping his running mileage; the pain was due to a stress fracture. It is estimated that between five and 30 percent of athletes and military recruits develop a stress fracture each year. Briefhaupt first described the condition in 1855 when examining military recruits.
    Everyone is familiar with bone fractures, especially those that result from acute trauma. These fractures are usually easy for an untrained person to see on an X-ray – the bone looks like a broken stick. Stress fractures, however, can be much more difficult to diagnose. 
    Stress fractures result from repeated stress on the bone. This repetitive microtrauma causes disruption of the microscopic structure of the bone over time that eventually exceeds the bone’s ability to heal itself. A tiny crack subsequently develops in the bone that may or may not be obvious on an X-ray. Think of bending a piece of metal over and over; eventually it weakens and breaks.
    Stress fractures typically occur in bones that are prone to repetitive stress based on particular sports. The fractures can involve any bone, but the most common locations and their associated sports include the leg, hip and foot (runners & jumpers), the spine (gymnasts, divers & volleyball players), arms (throwers), and ribs (rowers). The forces experienced by bones in the feet and legs can be up to twelve times a person’s weight. Stress fractures are one of the five most common injuries in runners and account for up to half of injuries in soldiers.
    0 comment(s)
  • Monday, July 9, 2018 4:00 AM
    Kidney stones are a topic near and dear to my heart as I’ve had the distinct pleasure of passing four of them. Stones are also known as calculi, from the Latin for pebble. They 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 involuntarily to help move the urine from the kidneys to 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 muscles in the ureter, causes deep, severe, unrelenting pain known as ureteral colic. Stones may also cause blood in the urine.
    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 minerals and molecules 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.
    0 comment(s)
  • Monday, July 2, 2018 4:00 AM
    This week I want to tackle the subject of generic vs. 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.
    First let me describe what generic and name brand drugs are. Generic drugs are chemical compounds that either never received patent protection or the patent on the name brand drug has expired. In contrast, name brand drugs are protected by a patent, meaning no other companies can produce or sell that particular drug. 
    This brings me to the answer for one of the most commonly asked questions – when will the generic version of a drug be available? When a drug is patented, the patent on the specific formulation is in effect for 20 years. Patents are granted shortly after the drug is discovered in the research lab. This is usually long before it is even tested in clinical trials in humans, which can take 8 - 13 years. Therefore, generics often aren’t even available until 7 - 12 years after the name brand hits the market.
    0 comment(s)
  • Monday, June 25, 2018 4:00 AM
    Urinary tract infections (UTIs) account for about eight million visits to physicians each year in the United States. These infections are much more common in adults, particularly in women. Children account for one to two percent of all UTIs, but their infections are often more serious. About 40 percent of women and 12 percent of men have a UTI at some time in their lives.
    The urinary system or “tract” is composed of the kidneys, ureters, bladder and urethra. The kidneys filter waste products from the blood and produce urine that passes down the ureters to the bladder, where it is stored, before passing out the urethra. An infection can involve one or more parts of the urinary tract.
    Bacteria that normally inhabit the bowel and live around the anus are the cause of most UTIs. The gut bacterium Escherichia coli (E. coli) is far and away the most common offender. Bacteria cause UTIs by making their way to the opening of the urethra where they can enter and start to grow anywhere in the urinary tract. 
    The two most common ways bacteria enter the urinary tract in women is through improper hygiene (wiping from back to front after a bowel movement), and sexual intercourse. Older men are also more prone to UTIs because their bladders may not empty completely due to obstruction from enlargement of the prostate gland.
    If the urethra is the only part of the urinary tract involved, the condition is called urethritis. This can be caused by colon bacteria, but may also be caused by sexually transmitted organisms. The infection can progress up the urinary tract causing infection of the bladder (cystitis) or one or both kidneys (pyelonephritis).
    0 comment(s)
  • Monday, June 18, 2018 4:00 AM
    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.
    0 comment(s)
  • Monday, June 11, 2018 4:00 AM
    The mother of one of my patients asked me to write about meningitis. Meningitis is a very rare condition. The incidence of all types of bacterial meningitis in the United States is about two to three cases per 100,000 people per year, while viruses cause about 11 cases per 100,000 per year. I frequently witnessed the devastation of meningitis during my training in the late 80’s. However, with the advent of vaccines to prevent the most common causes of bacterial meningitis, physicians rarely see a case today.
    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, usually through some type of trauma.
    Meningitis, especially bacterial, can be very serious, if not diagnosed and treated promptly. Depending on the cause, 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. 
    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, and HIV.
    0 comment(s)
Looking for something older? Try our archive search
Copyright 2018
The Paper of Montgomery County,
a division of Sagamore News Media 
201 E. Jefferson Street
P.O. Box 272
Crawfordsville, Indiana 47933

 

Main:
Classifieds:
Fax:
(765) 361-0100
(765) 361-8888
(765) 361-5901
Advertising:
Editorial:
(765) 361-0100 Ext. 18
(765) 361-8888

Software © 1998-2018 1up! Software, All Rights Reserved
GO



Our app is now available!