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Wednesday, August 21, 2019
  • 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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  • 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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  • 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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