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Wednesday, March 20, 2019
  • Monday, March 11, 2019 4:00 AM
    Snoring can certainly be annoying, but it doesn't always indicate a serious medical problem. This week, however, I do want to focus on a harmful condition that can be associated with snoring – sleep apnea.
    Sleep apnea is a condition where people have pauses in their breathing while sleeping. Most people have pauses to some degree, but people with sleep apnea have much longer pauses, sometimes lasting up to 30 seconds. These long pauses cause the level of oxygen in the blood to drop and carbon dioxide to rise. These changes can be very hard on the body, especially the heart and lungs.
    There are two main types of sleep apnea – central and obstructive. Central sleep apnea is a problem with how the brainstem sends signals to the breathing muscles. It is not a very common cause of sleep apnea in adults; obstructive sleep apnea (OSA) is seen much more often. 
    Obstructive sleep apnea is caused by any type of obstruction to the flow of air in and out of the lungs. This usually occurs in the back of the throat when excess or loose tissue collapses into the throat when the throat muscles relax during sleep. This is why OSA is much more common in obese individuals – they have a lot of extra tissue in their throats.
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  • Monday, March 4, 2019 4:00 AM
    I’m running through my list of suggested topics from readers, and this one goes out to a reader from Sheridan. It’s a common problem, but one of those topics that doesn’t usually come up in casual conversation - constipation.
    There are three common times in a person’s life when constipation can become a problem. The first is during early childhood, the second when a person has decreased activity for some reason, and the last is during the elder years. Each one has different causes.
    First, I have to deliver yet another lesson in basic anatomy and physiology. When we eat, food travels through the following structures: mouth, esophagus, stomach, small intestine and finally, the large intestine. This journey is facilitated by peristalsis, a process where involuntary muscles in the wall of the digestive tract contract to move food from north to south.
    While constipation can involve trouble anywhere along the way, the vast majority of problems occur in the colon. One of the main jobs of the colon is to reclaim water from the stool. If the stool is slowed down in its transit through the colon, more water is absorbed, making the stool firmer.
    Young children can develop problems with constipation when they put off going to the bathroom for various reasons. When this happens, they can retain incredible amounts of stool in their colons. This stretches the wall of the colon to the point it weakens the muscles responsible for peristalsis. Encopresis is the medical term for this condition.
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  • Monday, February 25, 2019 4:00 AM
    Last week I tried to explain the very complex non-Hodgkin lymphomas (NHL). This week I want to cover Hodgkin’s lymphoma, more commonly known as Hodgkin’s Disease (HD). It gets its eponymous name from Dr. Thomas Hodgkin, who first described it in 1832. 
    Hodgkin’s is a potentially curable malignant lymphoma that carries a much better prognosis than non-Hodgkin lymphomas. It is a very specific type of lymphoma, defined by its microscopic appearance and by specific proteins that are found on the cell membranes of the tumor cells.
    The estimate for 2017 was that there would be 8,260 new cases of Hodgkin’s Disease (4,650 men and 3,610 women) and 1,070 deaths (630 men and 440 women). It is more common in whites and slightly more common in men, except in childhood where 85 percent of the cases are found in boys. The disease has what is called a bimodal age distribution, with occurrences between the ages of 15 and 34 or over age 55.
    The cause of HD is unknown. It’s hypothesized that a viral infection, perhaps Epstein-Barr virus (EBV) may cause HD. Eptein-Barr virus causes mononucleosis (mono). EBV is found in half of HD tumors in people with normal immune systems and 100 percent of the tumors in people infected with HIV. One percent of people with HD have a family history of the disease. Siblings of a person with HD are about three to seven times more likely to develop HD themselves.
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  • Monday, February 18, 2019 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 evolving 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 invaders in our bodies, particularly infectious agents.
    The lymph system contains two types of specialized cells that can kill these foreign substances, either directly (T cells), or indirectly (B cells). B cells produce antibodies that bind to the foreign agents to help remove them from the body. When B and T cells multiply out of control, it results 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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  • Monday, February 11, 2019 4:00 AM
    We continue to see quite a few kids in our office each year with concussions. Usually this is an athletic injury, but it is commonly 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 one the NFL Players Association brought against 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 will not show up on radiology imaging studies like CT or MRI scans. 
    Concussions alter the ability of brain cells to properly use energy to communicate – the brain’s demand for energy exceeds what can be delivered, resulting in many signs (observable by others) and symptoms (what the athlete feels). The injured brain is at increased risk of additional injury, sometimes catastrophic, until this mismatch of energy supply and demand is resolved.
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  • Stem cells have promise but are in infancy
    Monday, February 4, 2019 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.
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  • Kudos to Messrs. Mendel, Watson & Crick
    Monday, January 28, 2019 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 instructions 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 the nucleotides.
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  • Monday, January 21, 2019 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 our diagnostic accuracy. However, it also has 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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  • Wednesday, January 16, 2019 4:00 AM
    We are definitely living in a post-truth world. It’s not just in the political sphere that we have to be careful of facts and “alternative 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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  • Monday, January 7, 2019 4:00 AM
    We are definitely living in a post-truth world. It’s not just in the political sphere that we have to be careful of facts and “alternative 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 addressing a subject on which he or she has training and knowledge? 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? 
    There are a number of other things to watch for in scientific articles. The first that should raise a huge red flag is if, in addition to presenting information, an article is trying to sell or promote something. Honest scientists or organizations are interested in disseminating information for scientific and public discussion – not to use it to sell a product or service. Unfortunately, doctors can fall into this trap by promoting treatments or procedures that benefit them.
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  • Dr. Roberts talks shoulder pain - part 2
    Monday, December 31, 2018 4:00 AM
    Welcome back to my two-part series on shoulder pain. First, I want to do a quick review of shoulder anatomy (see diagram of a view of the right shoulder from the front). 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! What’s the story?
    Monday, December 24, 2018 4:00 AM
    The next two weeks, I’d like to address shoulder pain and injuries. 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 directly on their shoulder or on an 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 shoulder 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 round top part of the upper arm bone. The plate represents the glenoid, 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, December 17, 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. Dr. 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: 1.usa.gov/1n5K4VF. 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 little profit in drugs that will become quickly ineffective as bacteria become resistant.
    In addition to the development of resistant bacteria and the infections associated with them, the overuse of antibiotics is also being identified as a probable cause of a number of other medical conditions involving the immune system. This is an absolutely fascinating and rapidly expanding area of medical research and may hold the key to putting the brakes on many of the disease trends that have been on the rise in the decades since antibiotic use has become commonplace. Researchers have hypothesized that altering the bacteria that reside in the gastrointestinal tract and elsewhere in and on our bodies can lead to the development of many diseases.
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  • Monday, December 10, 2018 4:00 AM
    My patient Jim asked me to re-run my column about warts. They are very common - 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 (HPV). When people hear HPV they often think of genital warts that are caused by particular strains of HPV virus, some of which have been associated with cervical, 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 body location to another. They commonly attack skin that is dry, cracked or has an open wound. The incubation period from infection to development of a wart is usually one to three months, but may take years.
    The appearance of warts runs the gamut from small 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 their other common name, “seed wart.” These “seeds” are actually small blood capillaries that have clotted.
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  • Monday, December 3, 2018 4:00 AM
    An adult patient 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 has something to do with brain development in these children. 
    Night terrors are a subclass of sleep patterns called parasomnias (para-, meaning abnormal, and -somnia meaning sleep). 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.
    REM sleep is very light sleep characterized by rapid eye movements and muscle relaxation. This is the stage of sleep when dreaming occurs. Babies spend about 50 percent of their sleep time in REM while adults spend about 20 percent in this stage. Non-REM sleep is comprised of three or four stages, with stage 3 or 4 being the deepest sleep.
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