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Saturday, March 24, 2018

  • Monday, March 19, 2018 4:00 AM
    One of my patients asked me recently what lymphoma is. I must admit my knowledge of the subject is 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.
    The lymph system contains two types of specialized cells that can kill these foreign invaders either directly (T cells) or indirectly (B cells). B cells produce antibodies that bind to the germs to help remove them from the body. It is these B and T cells that multiply out of control resulting in lymphomas. 
    The various types of lymphomas are named using a complex classification system based on cell morphology (what they look like) and lineage (their genetic makeup). Lymphomas are broadly classified into Hodgkin and non-Hodgkin lymphomas (NHL). Non-Hodgkin lymphoma is further divided into B-cell and T-cell types. B-cell lymphomas account for about 80 percent of NHL.
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  • Wednesday, March 14, 2018 4:00 AM
    I’ve seen a lot of patients this year with concussions. Usually this is an athletic injury, but it is frequently seen in others as well. Concussions have always been a part of sports, especially those involving high-energy collisions, most notably football, soccer, hockey and basketball. Intensive research, along with lawsuits like the NFL Players Association vs. the NFL is causing research to move rapidly to help us get a firmer grasp on how to prevent and manage concussions.
    A concussion is a trauma-induced alteration in mental status that usually does not involve a loss of consciousness and does not have to be a result of a blow to the head. In fact, only ten percent of concussions are associated with a loss of consciousness.
    A concussion is the result of soft brain tissue moving violently inside the bony skull. It is important to realize that this movement can result in varying degrees of microscopic injury to the brain, the majority of which do not show up on radiology imaging studies like CT or MRI scans.
    You may have seen headlines last month like this one from the New York Times: “Concussions Can Be Detected With New Blood Test Approved by FDA.” Unfortunately, this is totally inaccurate. The test was developed to detect two proteins released into the bloodstream that indicate there is bleeding in the brain, NOT to aid in the diagnosis of concussion. The test will be used primarily in emergency rooms to determine if a patient needs a CT scan to evaluate for a brain bleed. The diagnosis of concussion remains a clinical one, based on the history, physical exam and some additional tools.
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  • Monday, March 5, 2018 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 through a process 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.
    There is a hierarchy of potency in stem cells that is important in determining what they are capable of doing. Totipotent cells have the capacity to differentiate into any of our 220 cell types. Pluripotent cells can differentiate into nearly all cells, while multipotent cells can become only cells of a closely related family of cells. There are additional levels of potency that produce even fewer cell types.
    There are two types of stem cells in humans – embryonic and adult. Embryonic stem cells are derived from embryos that are 4-5 days old. Embryos at this stage contain about 50-150 cells, some of which are pluripotent and can propagate indefinitely.
    Adult stem cells are found in most tissues in the body and are multipotent. They are typically able to generate all of the cell types of the organ where they reside. They can also be found in umbilical cord blood. These cells exist to replace and repair tissues. It is also hypothesized that they may bear some responsibility for developing into cancers.
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  • Messrs. Mendel, Watson & Crick
    Monday, February 26, 2018 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).
    The “rungs” of the DNA ladder are comprised of chemical units called base pairs. Each half of a rung is comprised of a base (also known as a nucleotide) that binds in the middle of the rung to the base on the other side. DNA contains four different nucleotides. The genetic code contained in the DNA molecule is determined by the sequence of these nucleotides.
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  • Monday, February 19, 2018 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.
    CAT (CT) scanners have been around longer than MRI scanners. CAT stands for Computed Axial Tomography, but we typically use the shortened abbreviation CT for Computed Tomography. This test uses ionizing radiation (X-rays) to produce the medical image.
    When performing a CT scan, the patient lies on a table that is surrounded by a big ring called a gantry that contains an X-ray tube that rotates around the patient. As the tube is spinning around the patient, the table moves the patient through the ring.
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  • Monday, February 12, 2018 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 that 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.
    What causes hot flashes? The primary culprit is a woman’s lack of the hormone estrogen that is made primarily by her ovaries. The production of estrogen gradually tapers off as a woman ages. If a woman has undergone surgical removal of the ovaries, the estrogen level drops rapidly and she develops “surgical menopause.”
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  • Monday, February 5, 2018 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.
    The most important thing to look for when reading a science article is whether the author or source is credible. Does the author have the proper credentials? Is the person writing on a subject he/she has training and knowledge in? Just because someone has an M.D., it does not mean he/she has the expertise to comment on the subject at hand – it may be completely out of his/her specialty.
    Does the author have a degree from a well-recognized accredited institution or are they simply a member of an organization that has little or no credibility in the scientific community?
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  • Dr. Roberts talks shoulder pain - part 2
    Wednesday, January 31, 2018 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 of the right shoulder from the front view). 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.
    A subluxation is less severe than a dislocation. The ball does not completely come out of the cup. Subluxations are usually brief events and the ball returns to its normal position spontaneously, but can feel unstable afterward. Dislocations sometimes reduce spontaneously, but often require manipulation by a doctor to get the head of the humerus back in position.
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  • Hey Doc, my shoulder hurts! – Part 1
    Wednesday, January 24, 2018 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 of the front view of the right shoulder). 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. To be so versatile, It has to be relatively unstable compared to our other joints.
    The easiest way to describe the shoulder joint is to picture a basketball sitting on a dinner plate. The basketball represents the head of the humerus, the top part of the bone in the upper arm. The plate represents the glenoid fossa, the part of the shoulder blade (scapula) that articulates with the head of the humerus. If you picture the ball on the plate, you can understand how unstable this joint is – the ball can slide around on the plate or even roll off of it.
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  • Monday, January 8, 2018 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 since Alexander Fleming (the discoverer of penicillin) warned of it in his Nobel Prize speech in 1945, 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. 
    Each year in the United States two million people are infected with antibiotic-resistant bacteria and 23,000 die. The CDC published an excellent report in 2013 on the threat that can be downloaded here: The primary cause of resistant bacteria is the overuse of antibiotics, both in medicine and agribusiness. This is also complicated by the fact that very few new antibiotics are being developed – there’s no profit in drugs that will become quickly ineffective as bacteria become resistant.
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  • Tuesday, December 26, 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.
    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 ( is attempting to raise awareness.
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  • Monday, December 18, 2017 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.
    Warts are spread by direct or indirect contact with another person who has them. People can also spread them from one location to another on their own bodies. They commonly attack areas where there is dry, cracked skin or open wounds. The incubation period from infection to development of a wart is usually one to three months, but it can take years.
    The appearance of warts can vary from very flat lesions to large, raised ones. Larger warts are typically seen on the palms or soles of the feet. “Planter’s wart” is common misnomer for a wart on the bottom of the foot. These warts have nothing to do with gardening or farming. The proper term is “plantar wart.” Plantar is the anatomic term for the bottom surface of the foot. These warts usually appear to have a central core or seed, hence the term “seed wart.” These “seeds” are actually small blood vessel capillaries that contain blood clots.
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  • Monday, December 11, 2017 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 in these children. 
    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 4, 2017 4:00 AM
    The cold weather is finally arriving and it’s time to prepare for the flu. 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 that kills 36,000 Americans each year and puts another 200,000 in the hospital.
    Influenza is caused by a virus and Type A and Type B cause the majority of infections. Type B typically does not cause severe disease whereas Type A can be lethal, particularly in the young, elderly, and those who have compromised immune systems. 
    Type A virus can be broken down further into different subtypes or “serotypes” based on which proteins are found on the surface of the virus. When you read about influenza virus with a name like “H3N2,” the “H” and “N” refer to the different proteins on the surface and the numbers refer to the serotype. The serotypes are also often given common names, usually from their region of origin, such as Influenza A “Hong Kong.” 
    Influenza viruses are constantly changing or mutating slightly so that each flu season brings new serotypes. Scientists make an educated guess each year on what serotypes of virus might occur the following year and formulate that year’s vaccine accordingly.
    It appears that the predominant serotype of influenza A this year will be H3N2. This type has a history of causing more severe illness. Unfortunately, this serotype is not in the vaccine this year. That means we can expect a more severe flu season.
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  • Monday, November 27, 2017 4:00 AM
    A patient whose 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 with hearing disorders over three years old has doubled.
    The primary cause of hearing loss is environmental noise. The louder the volume (measured in decibels or dB) and/or the longer the exposure, the more likely it is for damage to occur. Repeated exposure to noise over 85 dB like lawn mowers, truck traffic and shop tools can lead to gradual hearing loss.
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