Health Tip: Your Family Has a Medical History

Your doctor probably has asked you questions about your family history, since it may have a significant impact on your well-being. Read more

Health Tip: Be Proactive at Your Next Doctor Visit

(HealthDay News) -- If you don't go to the doctor very often, it's important to make the most of every visit.

It's your opportunity to talk to your doctor about any health problems, or questions that you have.

Here are conversation pointers for your next medical visit, as recommended by the American Academy of Family Physicians:

• Bring up any symptoms or health concerns that you have.
• Create a log of your health history and bring it to your appointment.
• Tell your doctor about any stress in your life that could be affecting your health.
• Discuss any medications or supplements that you take, and any side effects that you suspect may be caused by them.
• Bring any recent medical records, test results or X-rays.
• Clarify anything your doctor says that you don't understand.
• sk for extra time to spend with your doctor, if you need it. If your doctor can't be available personally, a nurse or physician assistant may be able to spend time with you.
  
  

Most Astonishing Health Disaster of the 20th Century

For over 100 years conventional medicine has seized control of the US health care system and as a result we have over 800,000 people who are killed by interacting with this system. It is likely that over 50 million Americans have died prematurely from this abuse.

Watch: Blind Faith in Medicine...
So get always at least a second opinion and asking questions...

Health Tip: Caring for a Sprain

(HeathDay News) -- There's a good chance that while playing or stepping on an uneven surface, you will sprain your ankle. More than 25,000 people do it every day, according to the American Academy of Orthopaedic Surgeons.

Depending on how severe the sprain is, your ankle might swell and hurt too much to stand on it. You might even have felt a "pop" when the injury happened.

Tell your doctor what you were doing when you sprained your ankle. An X-ray may be necessary to make sure no bones are broken.

For a minor sprain, rest your ankle by not walking on it, ice it to keep the swelling down, use compressive bandages to support your injury, and elevate your ankle above your heart level for 48 hours.

For severe ankle sprains, your doctor may treat you with a short leg cast for up to three weeks or a cast-brace.

And for people who sprain an ankle repeatedly, there's also the possibility of surgical repair to tighten the ligaments.

A Doctor on Vacation: Diagnosing Disease Wherever She Goes

By Dena Rifkin, MD

As I prepared for a vacation recently, I realized that it’s getting harder and harder to really “check out” of any kind of job these days. The ubiquitousness of BlackBerries, Wi-Fi, cell phones, and other devices designed to keep us forever in touch with each other make it impossible to really escape. As a doctor, I face an added difficulty in taking a break from my work—the inescapable urge to diagnose disease in random passersby. Read More

No Evidence Breast Self-Exams Cut Cancer Deaths

(HealthDay News) -- Updated findings from an analysis of existing research continue to suggest that the oft-touted monthly breast self-exam may actually do more harm than good.

There is no evidence that the practice actually decreases deaths from breast cancer while it may actually double the number of unnecessary biopsies in women who do the exam compared with women who don't.

"At present, screening by breast self-examination or physical examination [by a trained health worker] cannot be recommended," two of the study authors, Jan Peter Kosters and Peter Gotzsche of the Nordic Cochrane Centre, stated in the review.

The current review, published in the most recent issue of The Cochrane Library, updates and corroborates information from a 2003 review of studies.

The American Cancer Society revised its guidelines five years ago based on emerging evidence and no longer recommends monthly breast self-exams. The monthly exam is now considered "an option" for women starting in their 20s.

The current review included two studies of almost 400,000 women in Russia and China. Women who did self-exams had 3,406 biopsies compared with only 1,856 biopsies in the group that did not do the exams. Differences in biopsy rates did not translate into differences in breast cancer mortality.

The China study found that rates of mastectomy and lumpectomy (or "breast-conserving" surgery) were similar regardless of whether women were doing self-exams or not.

As always, however, women who detect any change in their breast need to consult a doctor.

More information
Visit the National Cancer Institute for more on breast cancer.

Yes, Fecal Transplants: This *!^# Saves Lives!

By Theresa Tamkins

Salmonella-contaminated tomatoes. E. coli-riddled beef. These are just two recent outbreaks that have made headlines and basically ruined carefree burger-eating for the rest of the summer. Bacteria-laden feces are the probable source of both.
But sometimes a stool can save a life. I know, yeccccccchhhhhh, but it turns out that doctors can actually transfer fecal material from a healthy donor to patients sick with C. difficile, a potentially life-threatening germ that strikes when antibiotics kill off the good bacteria that live in the gut. It’s called a fecal transplant or fecal bacteriotherapy.
A friend who works at a hospital recently told me (without revealing the patient’s identity or personal information) that such a transplant had saved a patient’s life. My thought was: Why hadn’t I heard about this therapy before?
Read More

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Father's Age a Factor in Infertility

(HealthDay News) -- Among couples with fertility problems, those in which the man is over the age 35 have lower pregnancy rates and increased chances of miscarriage, a new study shows.

To come to this conclusion, French researchers looked at more than 12,000 couples who went to a fertility clinic in France.

In most of the cases, the couples were being treated due to the man's infertility. The couples underwent a total of 21,239 intrauterine inseminations (IUIs).

The researchers found that women over age 35 had a pregnancy rate of 8.9 percent, compared to 14.5 percent in younger women.

"But we also found that the age of the father was important in pregnancy rates -- men over 35 had a negative effect. And, perhaps more surprisingly, miscarriage rates increased where the father was over 35," study author Dr. Stephanie Belloc, of the Eylau Center for Assisted Reproduction in Paris, said in a prepared statement.

This is the first study to document such a strong paternal effect on reproductive outcomes. The findings were presented Monday at the European Society of Human Reproduction and Embryology annual conference, in Barcelona.

"How DNA damage in older men translates into clinical practice has not been shown up to now. Our research proves for the first time that there is a strong paternal age-related effect on IUI outcomes, and this information should be considered by both doctors and patients in assisted reproduction outcomes," Belloc said.

"We believe that the use of IVF or ICSI should be suggested to infertile patients where either party is over 35 years of age," she added.

More information
The American Society for Reproductive Medicine has more about infertility.

Breakthroughs Offer Hope to MS Patients

(HealthDay News) -- There's no one single way to suffer from multiple sclerosis.

Every patient exhibits different symptoms as the disease gnaws away at the nerve endings in the brain, the spinal cord and even the eyes.

Doctors aren't even sure what causes MS, or what makes one person more likely to get it than another.

"I have a patient who is 6 years old," said Dr. Daniel Kantor, director of the Comprehensive Multiple Sclerosis Center at the University of Florida. "I have a patient who is 71 years old. I have patients from all walks of life, all ages."

But, the recent discovery of a second gene linked to Multiple sclerosis -- hailed as a major breakthrough -- is giving researchers hope that they are zeroing in on useful treatments -- and, ultimately, a cure.

In what is considered the most significant genetic breakthrough in MS research in three decades, scientists last year announced they had found a gene that increases the risk of developing the disease by 30 percent.

"This discovery is very significant, because it is hopefully the first of many, and after more than 30 years of finding nothing," said Dr. Jennie Q. Lou, professor of public health and internal medicine at Nova Southeastern University in Fort Lauderdale, Fla.

"We will expect to find many more of these genes over the next few years. Either these genes, or genes related to them, may be an excellent target that researchers can use to develop treatments and cures for MS," she added.

The symptoms of multiple sclerosis are many and varied, as the disease attacks different parts of the nervous system.

One MS patient may have trouble walking, while another is wheelchair-bound. One person may experience terrible fatigue, while another might struggle with blurred or double vision. Still another might have slurred speech, tremors, stiffness and bladder problems, according to the National Multiple Sclerosis Society.

"A lot of the symptoms are invisible symptoms to an outsider," Kantor said. "Pain, extreme fatigue, memory problems -- these are problems you just can't see."

Multiple sclerosis is considered an autoimmune disease, because it attacks the central nervous system.

The nerve fibers of the central nervous system are surrounded and protected by a fatty tissue called myelin, which helps the fibers conduct electrical impulses. With MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. Sometimes, the fiber itself is harmed.

When myelin or the nerve fiber is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, producing the various symptoms of MS.

Most people with MS are diagnosed between the ages of 20 and 50, and twice as many women as men have the disease. About 400,000 Americans are known to have MS, and every week about 200 new cases are diagnosed. Worldwide, the MS toll may run as high as 2.5 million people, according to the National Multiple Sclerosis Society.

The exact cause of MS is unknown, but doctors suspect it comes from some combination of genetic and environmental factors, Kantor said.

"There's a genetic predisposition and then something happens, they are exposed to something, and it makes the body's defense system attack itself versus attacking a foreign invader," he said.
That's why the discovery of the second gene is so important. Researchers now know they have to cast a wider net.

"We've been looking at one gene the whole time, and we thought that was going to be the answer to understanding MS," Kantor said. "This is just telling us there's another part of the immune system that is important as well. It's made things more complicated, but if it's true, it's true."

The gene discovery is one of a number of advances that are occurring at a rapid pace.

Lou noted that new research has successfully used stem cells to help replace myelin in the brains of mice. "This discovery has shed light on the great potential of using stem cells in MS treatment," she said.

And last year, researchers proved that an experimental DNA vaccine to fight multiple sclerosis is safe and stands a good chance of being effective. The vaccine works by thwarting the immune system's attack on the myelin sheaths protecting nerve fibers.

Other advances noted by Lou include:

• Better and earlier diagnosis owing to advances in imaging technology.


• Improved drugs to reduce the frequency and severity of symptoms, and the accumulation of lesions in the brain and spinal cord.


• More aggressive rehabilitation programs developed specifically for MS patients.

"Every time we get our Journal of Neurology, more than half of it is about MS and how we can treat MS," Kantor said. "The MS of today is not the MS of even 15 years ago. We are learning more about it at a rapid rate."

More information
To learn more, visit the National Multiple Sclerosis Society.

Health Tip: Trying Pregnancy Again

(HealthDay News) -- Trying to get pregnant again after a miscarriage can be fraught with a host of emotional and physical concerns.

Here are suggestions when considering another pregnancy after a miscarriage, courtesy of the American Pregnancy Association:

• Doctors routinely recommend waiting six months to one year before trying to get pregnant again. This is to make sure that the woman's body to ready to handle another pregnancy.


• It's also important to make sure that you're emotionally ready to try again.


• About 85 percent of women who have had a miscarriage go on to have a successful pregnancy. Among those who have had more than one loss, the rate is about 75 percent.


• If you do get pregnant again, ask your doctor to help you more carefully monitor your health and progress.


• It's normal to still grieve for an earlier loss while celebrating the arrival of a new baby.
  It's common to be hesitant in bonding with your new baby, fearing another loss.


• Talk to your doctor about counselors or support groups if you are having a difficult time with your pregnancy or new baby.

Activity-Linked Heat Illness Needs Prompt Attention

(HealthDay News) -- As the mercury continues to rise, people of all ages should take precautions to ward off heat-related illness while exercising, playing or taking part in any kind of physical activity outside.

"Many cases of heat illness are preventable and can be successfully treated if such conditions are properly recognized and appropriate care is provided in a timely manner," Brendon McDermott, a certified athletic trainer with the University of Connecticut, said in a prepared statement. "We're hoping to educate athletes, coaches, parents and health care providers about what can be done to prevent and treat heat illnesses."

The National Athletic Trainers' Association (NATA) recently issued recommendations to help guard against illness related to warm-weather activity:

• Don't start at full tilt. Gradually increasing the intensity and duration of activity helps ready your body for the heat.
• Take rest breaks. Add them to the activity and get adequate rest between bouts of exercise. Good sleeping habits also cut your risk of heat-related trouble.
• Stay hydrated. Drink water or sports drinks well before and throughout physical activity in the heat. If your urine turns a darker color -- more like apple juice than lemonade - that's a quick indicator of dehydration.
• Timing helps. When possible, exercise during the cooler portions of the day -- early morning or late evening.

Back off at signs of trouble. If you don't feel well, reduce the intensity or length of your activity, for example, walk instead of run. If you have symptoms of an illness (e.g., fever, diarrhea, extreme fatigue, etc.) don't exercise at all. These conditions can decrease your body's tolerance for heat and increase your risk of a heat illness.

Even if you think you are prepared, always listen to your body. If you start to feel ill or strange, stop immediately and seek medical attention.

Here are some heat-related ailments to watch for in yourself and others when working or playing in the warm weather:

Exertional heat stroke can result in death unless quickly recognized and properly treated. Watch for an increase in core body temperature (usually above 104 degrees F/40 degrees C); altered consciousness, seizures, confusion, emotional instability, irrational behavior or decreased mental acuity, nausea, vomiting, or diarrhea; headache, dizziness, or weakness; increased heart rate; decreased blood pressure or fast breathing; dehydration; and combativeness. Seek emergency medical treatment immediately; if you are waiting for medical help to arrive try immediate whole-body cooling, preferably through immersion in cold water.

Heat exhaustion is moderately serious, usually resulting from fluid or sodium loss in the heat. Loss of coordination; dizziness or fainting; profuse sweating or pale skin; headache, nausea, vomiting or diarrhea; stomach/intestinal cramps or persistent muscle cramps are its signs. Heat exhaustion patients need to move to a cool, shaded environment, with feet elevated, and be given fluids. If their condition worsens or does not improve shortly, get them to an emergency room. Even if the patient does improve, NATA recommends having a doctor evaluate them.

Heat cramps often occur in people who perform strenuous exercise in the heat. Signs and symptoms include intense pain (not associated with pulling or straining a muscle) and persistent muscle contractions that continue during and after exercise. When heat cramps occur, stop activity immediately, eat salty food, consume a sports drink and stretch the affected muscle. If cramping getting worse or spreads, head to the emergency room.

Hyponatremia happens when a person's blood sodium levels decrease to a potentially fatal level. Over-hydration, inadequate sodium intake or both can cause it, with the result possibly being cerebral and/or pulmonary edema. Signs and symptoms include excessive fluid consumption to the point of weight gain during activity; increasing headache; nausea and vomiting; and swelling of the hands and feet. If the condition involves mental confusion and intense headache, see a doctor. A doctor should also be consulted before resuming outdoor activity in the heat.

More information

Do Difficult Patients Get Bad Medical Care?

By Dena Rifkin, MD

A question that has received a lot of attention in the doctor community is whether patient attitude affects the quality of care they receive. In an effort to tackle it, let’s take a look at two of my past patients.
Case Study #1: No matter how late I was to see him, or how bad the news was when I did see him, Mr. X was unflaggingly polite. He had a quiet, gentle voice, and his “Yes, doctor” and “Thank you, doctor” responses were kind and reassuring. He is the only patient who ever thanked me for offering him dialysis. He chose home dialysis, learning the mechanics of the system quickly and managing the multiple medications we prescribed without any problems. Read More

Health Tip: Symptoms of a Social Phobia

(HealthDay News) -- A social phobia occurs when a person has unusually high anxiety before a social situation, such as going to a party, giving a speech, or going to a job interview.

It may include some or all of these physical symptoms, says the American Academy of Family Physicians:

• Blushing.
• Sweating.
• Feeling nauseous.
• Trembling or shaking.
• Having trouble talking to or making eye contact with another person.

If you have these symptoms, a doctor should evaluate you for a social phobia. The physician can also recommend treatment options, including medication and/or behavioral therapy.

What a Teaching Hospital Is All About

By Dena Rifkin, MD

My last post about how doctors learn from patients inspired a lively (sometimes heated) discussion, and I read the response to it with great interest. I think some good points were made. Notably, one reader took issue with my statement that a patient who helped me learn by letting me practice drawing blood from him “understood what a teaching hospital is all about.”
Read More

How Doctors Learn From Patients

By Dena Rifkin, MD
I need to learn a new technique for inserting a large intravenous line. As a resident, I learned how to place these lines (used for medications and dialysis) in the groin or neck by locating the arterial pulse with my fingers, looking at the anatomical landmarks nearby, and then calculating in my mind where the vein ought to be. After a while I could reliably get a needle into the vein by ‘feel.’

Since then, a bedside ultrasound device has become part of the procedure, allowing you to actually ‘see’ the vein you are aiming for—a pretty amazing difference from the way I learned. I’m told it’s awkward the first few times you try it, since you have to juggle the ultrasound and the needle while keeping everything sterile. So, I asked my colleagues to teach me.
Read More

Go Ahead, Email Your Doctor...As Long As It's Not Serious

A near-death experience taught me the perils of online communication with my patients
by Dena Rifkin, MD

I read a news item today reporting that only one in three U.S. doctors communicate with patients via email. We doctors were accused of lagging behind other professionals in online communication.

Well, I am one of the physicians already communicating with patients via email. Like everything else about the digital world, it has its benefits and its drawbacks. I fully agree that simple things, like prescription refills, routine lab reports, and so forth can be handled best by email—often, these do not even require the intervention of a physician.

It's when we get into questions about health problems that email can be problematic.

I returned from a holiday weekend at home to find an email from a patient waiting for me. It had been sent late on Friday night. "Dear Doctor," my patient wrote. "I am very worried." He went on to describe bleeding, fatigue, and weakness. He asked me to call him when convenient. Then he ended the message: "I hope you have a good holiday."

Three days had passed. My heart was racing as I called his home phone number. Fortunately, he was still alive, but he had not sought any other medical help. I sent him directly to the emergency room and he spent several days in the hospital recovering from a serious intestinal bleeding episode.

All of our patients are asked to sign a consent form before we communicate via email, and part of that consent involves agreeing not to use email for acute health problems requiring urgent attention, like this one. But it is so easy to send an email—much easier than calling the on-call physician or going to an emergency room. I've had other, less extreme encounters where patients emailed about issues that really needed to be addressed in person.

If you choose to email your own doctor, realize that these e-encounters are probably best reserved for administrative problems or minor updates to ongoing discussions (like telling the physician that a recent medication worked well or didn't work), rather than new medical problems. At the very least, you'll save your doctor a Monday morning heart attack like the one I nearly had.

Chemotherapy Has Turned Me Into a Bloodhound

Cancer drugs scramble the signals that the nose and tongue send to the brain, with bizarre results by Jason Carpenter

When one of the doctors offhandedly mentioned that my sense of taste or smell could be affected by the high-dose chemotherapy treatments I was getting in my battle against multiple myeloma, I didn't pay much attention. Not until I found I could detect the slightest whiff of anything from 20 feet. Not until anything I put in my mouth had a taste so intense that I vomited every meal for two weeks.

It was a horrible cycle that I could not break: When a meal came back up, it smelled awful and made me puke more. My mom, who spent some time at the hospital with me and at my house after I was discharged, developed a two-puke-pan routine: She would remove one pan on my command, then slip another one under me so I didn't have to endure the output.

While in the hospital, I developed a vomit association with just about everything the institution stocked for supplies: bathroom soap, hand soap, paper towels, hand sanitizer, toilet paper, and even facial tissue (I could smell tissues rippling in the air across the room). Clearly, some of this was in my head, but a good portion of it was not, according to breastcancer.com.

Thirty-two days after my transplant, I cannot smell hospital supplies without gagging. Because I need to constantly disinfect my hands and face (trying to banish germs that could attack my weakened immune system), I've had to switch to neutral-smelling antibacterial baby wipes. Things are somewhat better: I gag but don’t usually vomit, though I do risk hurling on my laptop just writing this down. I'm told this will slowly ebb over the next weeks or months.

Even my sense of touch has been affected. For the first few post-op visits to the hospital, I nearly jumped out of my skin with pain when the nurse drew blood. I have had my blood drawn hundreds of times, and it's never hurt like this. The nurse noticed and said, "Your nerves are sensitive because of the chemo. It's completely normal."

Normal, my ass. I'm a bloodhound; my food tastes as if someone turned the volume to 11; and I screech like a little girl when I have my blood drawn. But I’ll say it again: I'll take all these wacky side effects over cancer.

As to my progress, I went to the doctor today and my white blood count is back up to 4.1 (close to the low end of normal), my platelets are good, and my red blood cells are charging back. The doctor is so pleased with my recovery that I don't need to see her for three weeks. She even said that I can start to ease the restrictions of being around people. Which means I’m planning to play poker again, tonight, latex gloves and all.

See Jason Carpenter's ongoing video postings about his life with cancer. Warning: Some expletives.

Stem Cell Transplant Update: Advice On Hair Falling Out

When You Really Need Your Doctor...and She's in Fiji

How to get great medical care from the doctor on call (from a doctor on call)
by Dena Rifkin, MD

A couple of my colleagues were out of town this week, so I’ve been taking care of some of their patients for them. This is known as covering, and we do it all the time: nights, weekends, holidays, vacations.

The days when doctors were on call 24 hours a day, seven days a week, are, by and large, gone with the horse-drawn ambulance and the once-ubiquitous black bag.

How does coverage work? Well, a lot depends on the system. Some practices cancel everything but urgent care while they are away. For others, the practice must continue—for instance, dialysis patients must come three times a week, every week. Some practices have electronic medical records that make it easy to look up old records if a patient calls in with a new problem.

The hospital where I work has an electronic-record system, and I can access it from home, which makes taking care of urgent calls much easier. But still, there are times when it’s pretty hard to figure out what’s going on when an unknown patient with a complicated history calls. Patients often call for reassurance about a new symptom—they don’t want to have to go to the ER (who would?). Sometimes we can provide that reassurance, and sometimes we can’t.
Continue reading »

The Soaring Cost of Dental Care Is Nothing to Smile About

Let’s drill down into why it’s so expensive to have a healthy mouth
by Amy O'Connor

This is me holding my $1,200 crown (it recently popped out, hence this blog), my husband’s $450 mouth guard, and the retainer I have worn since I was a teenager.

Notice that I am not smiling. We spend far more on dental care and devices than we do on doctors, and it’s getting more expensive as we get older. Continue reading »

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Meet the War Doctors Saving Our Soldiers' Lives

A new documentary film puts a face—and a price—on battlefield medicine
by Sally Chew

The original inspiration for the new documentary Fighting for Life was a pre-Iraq War threat in Congress to shut down the Uniformed Services University in Bethesda, Md., which has trained one of every four current active-duty military physicians. It’s hard to imagine lawmakers will try that again anytime soon, considering the tens of thousands of Iraq vets who will likely need physical and/or psychological care for decades to come, but director Terry Sanders won’t rest easy. He wants those of us caught up in our own health issues or waiting for the next installment of House to appreciate the brutality and the accomplishments of modern military medicine while getting to know a few of these docs, along with their shrapnel-pocked charges.

Among the latest high-tech advances in battlefield care is the ability to move patients neatly and quickly in mobile hospitals (aka airplanes): Continue reading »