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Wednesday, November 13, 2019
  • Monday, November 4, 2019 4:00 AM
    Someone told me the other day that they thought “restless leg syndrome” (RLS) was a conspiracy created by pharmaceutical companies to sell more medications. You may have seen the commercials for Requip® and Mirapex®, both drugs used to treat this condition.
    People have described symptoms suggestive of restless legs since the 17th Century. The Swedish neurologist Erik Ekborn initially coined the term in the 1940’s. We estimate that between ten to fifteen percent of Americans suffer from restless leg syndrome to some degree. The incidence in women is about twice that of men. About 40 percent of people develop symptoms prior to age twenty. Since symptoms tend to be mild initially and worsen with age, most sufferers are not diagnosed for 10 to 20 years after they start having symptoms.
    The symptoms of RLS are highly variable, but most people describe a bothersome, irresistible urge to move their legs. This urge is worse during periods of inactivity and often interferes with sleep. About 85 percent of sufferers have difficulty falling asleep. Stress and fatigue can also exacerbate the symptoms.
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  • Tuesday, October 22, 2019 3:43 AM
    “All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.” - Hippocrates
    Few things benefit the body more than maintaining physical fitness. While doctors routinely recommend exercise for younger patients, we’re realizing how important it is for our older patients as well. Regular exercise, even in one’s senior years, can still reduce your risk of a number of health conditions, particularly heart attacks, strokes, and falls. It also may be one of the few things to slow the onset of dementia.
    Most communities are blessed to have many options available for exercise, especially programs that are supervised. I prefer these activities because a trained professional typically leads the group. This person can make recommendations to get the most out of a program in the safest way possible.
    Why is regular exercise so important for seniors? You may have noticed that as our bodies age a number of physiologic changes occur. We lose muscle mass and tone that leads to weakness and problems with balance. Flexibility becomes an issue (the most common cause of night time leg cramps). Our bones become weaker from a lack of weight-bearing activity. Balance problems and weak bones can lead to falls and fractures. Our hearts and lungs can get out of shape, resulting in reduced stamina and difficulty breathing with activity. This can lead to a reduced level of confidence & independence.
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  • Monday, September 16, 2019 3:55 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 tinea unguium, also known as 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 system functions 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 disfigured 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 two major genera of fungi, Trichophyton rubrum and Trichophyton interdigitalis. These fungi invade and feed on hair, skin and nails. These organisms are called dermatophytes and account for up to 99 percent of OM.
    Yeasts and molds cause the remaining cases. It’s often difficult to tell what organism is causing the infection without doing a culture or DNA testing in the lab.
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  • Monday, September 9, 2019 4:00 AM
    The weather is finally starting to break a bit allowing many of our readers to get back out in the yard to prepare for fall. This has resulted in a lot of rashes showing up in our office. Most of these rashes were caused by poison ivy, one of three plants in Indiana in the genus Toxicodendron. This genus also includes poison sumac, and poison oak.
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  • Monday, September 2, 2019 4:00 AM
    Doctors nationwide have been seeing a definite uptick in patients going to hospitals and imaging centers to have various screening tests done. The most common are heart and lung CT exams and possibly ultrasound tests to evaluate for blockages in the arteries in the legs. The scans typically have out-of-pocket costs in the $49 to $99 range and are not covered by insurance. They are promoted to identify early heart disease, artery blockages and/or lung cancer.
    People usually ask for these tests after seeing them advertised by the facilities doing the testing. While screening can save lives, it can also lead to unnecessary additional testing and worry for patients. Many of these scans are done inappropriately without a prior discussion of their utility and limitations and determination if there is actually an evidence-based need to do the test. 
    It is important to know the risks of any screening test including false positives (seeing things on the scans that have no medical significance, yet may cause a great deal of angst for patients), false negatives (not seeing something that is actually there), as well as exposure to radiation.
    The coronary artery calcium (CAC) scoring test involves doing a CT scan to see if calcium deposits are present in the walls of the coronary arteries that supply oxygen and other nutrients to the heart. The test produces a cardiac calcium score that can give some indication a person may have coronary artery disease, with an increased risk of suffering a heart attack. 
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  • Monday, August 19, 2019 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?
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  • Monday, August 5, 2019 4:00 AM
    I saw a young athlete last week who complained of shin pain. He had been upping his running mileage in preparation for the cross country season. The pain was due to a stress fracture. It is estimated that between 5 and 30 percent of athletes develop a stress fracture each year. Briefhaupt first described the condition in 1855 when examining military recruits, another group that frequently suffers this injury. 
    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 where the bone looks like a broken stick. Stress fractures, however, can be much more difficult to diagnose. 
    Stress fractures, as the name implies, 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.
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  • Monday, July 8, 2019 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.
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  • Tuesday, July 2, 2019 11:55 PM
    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 medical training in the late 1980s. 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. Fungi or parasites occasionally cause infections as well. 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 to 30 percent of the time in infants, about two percent in older children, and from 19 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.
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  • Tuesday, June 11, 2019 1:28 AM
    As we tick through the last days of spring, 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 heat illness.
    These illnesses account tens of thousands of visits each year to doctors’ offices and emergency rooms. Deaths from heat-related illness in America range from 300 to several thousand per year. The number is increasing with our warming climate and increase markedly during heat waves.
    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 risk of heat illness. Workers like firefighters, who have to wear heavy clothing, are at very high risk.
    Absorbing too much heat from the environment or producing too much heat internally can lead to heat illness. The two main types of heat illness are heat exhaustion and heat stroke.
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  • Monday, June 3, 2019 11:02 AM
    Summer is just around the corner which means I’ll start to see patients complaining of “swimmer’s ear.” Doctors 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 people 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 20, 2019 2:46 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 2017, there were 783 deaths from bicycle accidents in the United States, a decrease of about 7 percent from the previous year. 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 13, 2019 1:54 AM
    It will soon be warm outside (hopefully) – 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.
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  • Monday, May 6, 2019 4:00 AM
    The summer sports season, gardening and other outdoor chores will be starting soon. 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 of summer.
    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.
    When a musculoskeletal injury occurs, a biochemical chain reaction is triggered to begin the process of healing the injury. Injured cells release various messengers that start the process, but this also results in pain and swelling. The intent of this inflammation is to get the person to rest the injured area so it can heal. We naturally want to try and avoid pain and swelling.
    The goal of orthopedic and sports medicine is to promote healing of an injury, but to also to try and speed up the recovery process. We used to think the best way to do achieve this was to prevent or slow the body’s normal inflammatory processes. However, our traditional treatment methodology may need to change. 
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  • What’s the thyroid and why’s it acting up?
    Monday, April 22, 2019 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 larynx or Adam’s apple. Endocrine glands make hormones that are released into the bloodstream. The hormones then travel around the body and interact with cells in different tissues, biochemically instructing 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.
    Our cells have hormone receptors on their cell membranes that act as sensors to constantly monitor body functions and tweak them to maintain “homeostasis,” a balanced internal environment. Biochemical systems that maintain homeostasis are extremely elegant. Some work like a furnace thermostat that turns the furnace on or off based on the temperature in the room. Instead of using wires and electricity to communicate, the body uses the circulatory system and hormones as chemical messengers.
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