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Tuesday, January 24, 2017
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Dr. Roberts wraps up discussion on shoulder pain
Monday, January 23, 2017 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). 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.
Ouch, my shoulder hurts! – Part One
Wednesday, January 18, 2017 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). 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. It has to be relatively unstable compared to other joints in order to be so versatile.
The top health concern in women is heart disease
Monday, January 09, 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.
Treatment of warts must be consistent, targeted
Wednesday, December 28, 2016 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.
Sleep disorders come in various forms
Monday, December 19, 2016 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.
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.
Dr. Roberts: It’s time to get your flu shot
Monday, December 12, 2016 4:00 AM
Winter has arrived and hopefully that means you have all received your flu shot. 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.
Two particular types of influenza viruses, Type A and Type B cause the majority of influenza infections. Type B typically does not cause severe disease whereas Type A can be lethal, particularly in the young, elderly and in those who have compromised immune systems.
“I’m having trouble hearing, what’s the problem?”
Monday, December 05, 2016 4:00 AM
A patient who’s 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 over age three with hearing disorders has doubled.
Norovirus needs to be treated seriously
Monday, November 28, 2016 4:00 AM
Winter cold and flu season is rapidly approaching. This week, I’d like to talk about a different kid of flu, “stomach flu.” I have to start by dispelling a common misconception that all flu is the same. “Stomach flu” is not caused by the same viruses as “respiratory flu.” Flu shots, given to prevent respiratory influenza, will not protect you against viruses affecting the gastrointestinal tract that can cause an infectious malady known as viral gastroenteritis.
Know what’s what if your head’s spinning
Monday, November 21, 2016 4:00 AM
This week I want to address a malady that I’ve been seeing a fair amount of lately – dizziness. Primary Care doctors in the U.S. see about six million patients a year with dizziness.
Dizziness means different things to different people and can be a symptom of many different medical conditions. People usually describe being dizzy when they either feel faint or lightheaded or when they feel like they or the room are spinning. This latter sensation is called vertigo, from the Latin vertere meaning, “to turn.”
Dr. Roberts warns of potential fraud in medicine
Monday, November 14, 2016 4:00 AM
This week I’d like to write about a problem that costs taxpayers billions of dollars each year – Medicare fraud and abuse. Medicare paid out $505 billion in payments for services and medications in 2014, accounting for 14 percent of the federal budget. The Office of Management and Budget (OMB) reports that 12.7 percent of those payments were “improper,” meaning the services were not necessary, did not meet Medicare guidelines, or were downright fraudulent.
Medicare fraud refers to individuals or companies who obtain payments from Medicare under false or illegal pretenses. The OMB has been making a concerted effort to limit Medicare fraud, but Medicare is an easy target since it is such a complex program. It’s like playing the lottery for those who are intent on defrauding the government, but with a much higher chance of a payoff.
Dr. Roberts talks about complementary and alternative medicine
Monday, October 24, 2016 4:00 AM
I’m frequently asked by patients to comment on the use of “non-traditional” treatments or remedies they have heard or read about. I usually have to respond that I have limited knowledge about the product, but I will sometimes try to help the patient research the product or its ingredients.
The business of complementary and alternative medicine or “CAM” is booming. This is largely an outgrowth of patient frustration with traditional medical practice in America. People are fed up with the high cost of medications and other treat-ments as well as the perceived lack of caring by medical professionals.
Exercise isn’t just for the young
Tuesday, October 11, 2016 4:00 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 have typically recommended 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 and strokes. It also may be one of the few things to slow the onset of dementia.
Conjunctivitis can be a pain in the eye
Tuesday, October 04, 2016 4:00 AM
Now that school is back is session and child day care services are in full swing, the incidence of “pink eye” is starting to pick up. This is a very common condition that accounts for over 30 percent of doctor visits for eye problems.
Conjunctivitis is the medical term for “pink eye.” The conjunctiva is the continuous connective tissue membrane that covers the inside of the eyelids. It then folds back on itself to cover the front of the eyeball up to the edge of the cornea (where the white part of the eye meets the iris or colored part of the eye).
The purpose of the conjunctiva is to provide a barrier to keep infectious organisms from entering the eye tissue itself. Conjunctivitis results when there is an irritation or breakdown of this defensive layer, a change in the normal organisms inhabiting the eye, or trauma that breaches the membrane.
There are a number of causes of conjunctivitis. The most common are bacteria, viruses, allergies, fungi, parasites, and chemicals. These irritants cause varying degrees of redness, discharge, irritation and perhaps even pain on exposure to bright light, known as photophobia.
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.
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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