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Saturday, October 01, 2016

  • Why are doctors always running late?
    Tuesday, September 20, 2016 4:00 AM
    I’m going out on a limb this week and have prepared myself for the possibility of some backlash to this column. I’m going to attempt to explain some of the reasons why doctors seem to always be running late. 
    I certainly won’t list myself among those who run on time regularly – I run behind frequently for various reasons. I’ll probably come off as sounding like a whiner, but there are some legitimate reasons why doctors leave patients waiting. 
    Some doctors don’t seem to place much importance on the value of their patients’ time, but I don’t think the majority of physicians feel that their time is more valuable. I honestly feel that most doctors would prefer to stay on time while being able to address all of their patient’s problems.
    Suffice it to say that doctors are not always in control of their time. Emergencies and interruptions do come up frequently throughout the day. The patient who was scheduled for what was thought to be a simple headache may really be suffering from spousal abuse and major depression. 
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  • Lifestyle modifications are foundation for treatment of GERD
    Tuesday, September 13, 2016 4:00 AM
    I left you hanging last week wondering about the treatment of Gastro Esophageal Reflux Disease (GERD). First, a quick review. Remember that GERD is caused by stomach (gastro) acid going backward (reflux) up the tube from the mouth to the stomach (esophagus).
    Recall that the risk factors for GERD include decreased tone of the lower esophageal sphincter (LES), loss of normal muscular function of the esophagus, excess production of stomach acid, delayed emptying of the stomach and overeating. Fatty or fried foods, coffee, tea, caffeinated drinks, chocolate and mint are all foods that can cause GERD. Alcohol and cigarette smoking are also risk factors.
    When I see someone complaining of GERD symptoms in the office I review my patient’s history to try and identify any risk factors. Many patients immediately request medication to help control the symptoms rather than try and control the underlying cause(s) of the GERD. Direct-to-consumer advertising has been very effective in selling medications to treat this ubiquitous problem. If you ask any insurance company what it’s largest drug expense is, it’s often a class of medications called PPIs or Proton Pump Inhibitors (more below).
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  • What exactly is GERD?
    Tuesday, September 06, 2016 4:00 AM
    I’ve been asked to re-run my columns about Gastro Esophageal Reflux Disease, more commonly known as GERD (now you know why we use GERD for short). Breaking down the term translates to: stomach (gastro) juices go up the tube that connects the mouth and stomach (esophagus) in a backward direction (reflux).
    It’s helpful to know the anatomy when trying to understand GERD (see top diagram). In the top diagram you can see the esophagus, a muscular tube that contracts in a rhythmic fashion and moves food down toward the stomach. The food passes through the diaphragm (the muscular dome that separates the chest and abdomen). The diaphragm helps form the lower esophageal sphincter (LES) that acts as a valve to help keep acid in the stomach. Food passes through the LES into the stomach where it is mixed with acid to aid digestion.
    It is estimated that 14 to 20 percent of adults in the U.S. are affected with GERD. These estimates are based on surveys of patients who report heartburn, one of the symptoms of GERD. The current medical definition of GERD is, “a condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.”
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  • Fungi and its causes
    Wednesday, August 31, 2016 4:00 AM

    I recently had to remove some of a patient’s 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, the nails can become quite enlarged and painful. Diabetics and people who have poor immune function do 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 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.

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  • Generic or name brand?
    Monday, August 22, 2016 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 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.

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  • Monday, August 15, 2016 4:15 AM

    Summer barbeque season is still in full swing and it’s still 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.

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  • Pneumothorax
    Sunday, July 17, 2016 10:15 PM

    I’ve received some questions recently asking what a pneumothorax is. The word is derived from the Greek word “pneuma,” meaning wind, air or breath and the Latin “thorax,” meaning chest. It literally means air in the chest.

    Some may now be questioning my knowledge of anatomy and physiology. You may be thinking, “of course, everyone has air in their chest!” The difference lies in where the air is located.

    Air is normally found inside the lung. When someone suffers a pneumothorax, the air is outside the lung, specifically between the outside of the lung and the inside of the chest cavity or thorax. This is not a normal physiologic state and it causes the lung to collapse. These injuries can be quite dangerous and even fatal.

    To understand how this all works, you need to have an understanding of the anatomy and physiology of breathing. When we take a breath or inhale, the muscles in the wall of the chest expand the chest outward. Likewise, the diaphragm (the muscular dome separating the chest and abdomen) pulls downward and expands the chest toward the abdomen.

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  • Carpal Tunnel Syndrome
    Monday, July 11, 2016 12:00 AM

    I see a number of people who suffer from carpal tunnel syndrome. Carpal tunnel is a very common condition, often related to repetitive injury at home or in the workplace. It is one of a number of repetitive strain injuries or “RSIs.”

    Carpal tunnel symptoms usually include numbness and/or pain in the hand and wrist that may extend up into the arm, shoulder or even neck. The numbness, tingling or pain frequently wakes people during sleep.

    To understand the condition, it’s helpful to have a lesson in wrist anatomy (see diagram). There are eight carpal bones that make up the wrist. When you hold your wrist with your palm facing up, these bones form a U-shaped valley. The top of the valley is enclosed by a piece of connective tissue called the transverse carpal ligament. These structures together form the carpal tunnel.

    The tunnel is a very cramped space and some very important structures are packed into it. There are nine flexor tendons and the median nerve. The tendons that run through the tunnel connect the muscles in the palm side of the forearm to the bones in the fingers. When the muscles in your forearm contract, the tendons slide through the tunnel and pull on your finger bones, allowing you to make a fist (finger flexion).

    The median nerve runs directly under the transverse carpal ligament. This nerve is responsible for the feeling in the thumb, index, middle, and the thumb side of the ring finger. It also controls the muscles in the thumb that allow you to pinch your thumb and index finger together.

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  • Monday, June 27, 2016 12:00 AM

    Kidney stones are a topic near and dear to my heart as I’ve had the pleasure of passing three of the little beasts. Stones or calculi, from the Latin for pebble, 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 to help move the urine toward 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 walls of the ureter results in severe pain called ureteral colic.

    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 compounds 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. 

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  • Monday, June 20, 2016 12:00 AM

    I’ve started to see some cases of swimmer’s ear in the last few weeks. We 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 inflammation of the middle ear (the part of the ear 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 folks can certainly be afflicted.

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  • Sunday, June 12, 2016 10:52 PM

    “Dad is getting awfully forgetful - could he have Alzheimer’s?” That’s becoming a more common question. We are more likely to encounter someone with Alzheimer’s dementia as the proportion of elderly in our society increases. Some forgetfulness is normal for most of us as we age. Many of us carry the fear of developing Alzheimer’s dementia as we get older.

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  • Tuesday, June 07, 2016 1:12 AM
    Despite brief cool down we’ve had over the weekend, 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 exposure.
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  • Monday, May 23, 2016 3:56 AM
    It’s once again time to run my annual column on allergies. Many of our readers are probably already cursing the annual return of allergy symptoms. The pollen levels in Indiana will be ramping up as spring (hopefully) arrives for good.
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  • Monday, May 16, 2016 12:50 AM

    I had a request to write about lupus. Lupus is the shortened name of Systemic Lupus Erythematosus. It is an autoimmune disease first described by the physician Rogerius in the 12th Century. There are many opinions regarding the origin of the name. One of the most popular is that the rash on the face of many lupus sufferers resembles a wolf’s face. Lupus is Latin for wolf.

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  • Sunday, May 08, 2016 11:19 PM
    The summer sports season is about to begin and gardening and other outdoor chores are upon us. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal abuses busy. I want to give everyone some pointers in treating those inevitable injuries.
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