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My medical heroes

On New Year’s Eve when many people are drinking champagne and worrying about who they should kiss at midnight, Dr. Brian Fennerty, Section Chief of Gastroenterology at Oregon Health & Science University is fighting to keep patients alive in the Intensive Care Unit. Severe internal bleeding has put these patients’ lives in jeopardy, and Dr. Fennerty stays with them all night, ordering blood transfusions and tamponading their bleeding.

Dr. Jack Cook, US Navy veteran and former submarine commander, is under a mountain of medical charts. At 67, he is spearheading the transition from paper records to an electronic medical records system for his group practice of primary care physicians in Virginia. He wants his patients to have the opportunity to experience chart portability – something he believes might save their lives in cases where they are brought to the ER in an unconscious state. Although this project will take his group 2 years to complete, and cost untold hours in lost wages (with no clear reimbursal benefit for his practice) he is making the investment for his patients’ sakes.

In the middle of a teleconference, Dr. Iffath Hoskins, Chair of Ob/Gyn at Lutheran Medical Center in Brooklyn, excuses herself to perform an emergency C-section on a young woman with a complicated pregnancy. Against all odds she saves both mother and baby, and reschedules the teleconference for late that evening so she can complete her interview on time for a feature article at Revolution Health.

Just returning from Africa, Dr. Leo Lagasse, Vice Chairman of Ob/Gyn at Cedars-Sinai Medical Center, is preparing for his next mission’s trip with medical residents and faculty. His non-profit organization, Medicine for Humanity, has been behind countless trips to Afghanistan, Kenya, and Eritrya – serving impoverished women with medical problems. Dr. Lagasse takes time out to explain to me the link between smoking and cervical cancer for an article I’m preparing.

Dr. Charlie Smith is spending the afternoon with his son Jordan in Arkansas. Jordan was accidentally shot in the chest by a child with a BB gun, tearing a hole in his heart that caused him to go into cardiac arrest. He was rushed to the hospital where surgeons resorted to cardiac massage to keep him alive – he survived the ordeal, but his brain never fully recovered from the temporary lack of oxygen. He was rendered permanently bed-bound, and raised at home by his loving parents. Dr. Smith created a company called eDocAmerica to allow him to work from home and spend more time with Jordan. eDocAmerica is devoted to answering consumer medical questions via email.

At Harlem Hospital, Dr. Olajide Williams works tirelessly to raise awareness of stroke symptoms in a high risk inner city population. He organizes outreach through musical youth initiatives, lectures nationally to narrow the racial gap in quality care, and declines all prestigious medical recruitment offers. He is steadfast in his devotion to his community – no matter what the cost. Dr. Williams spends part of his weekends preparing blog entries for Revolution Health.

These are only a handful of the wonderful physicians associated with Revolution Health. I hope you’ll enjoy getting to know them through their blogs, articles, and future contributions. They are here for you… to support your need for credible information, to answer your questions, and to help guide you towards optimum health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Thin People More Likely To Die

Just when you thought being super thin was best for your health… the Mayo Clinic published a short news brief in their December newsletter, “Mayo Clinic Connection” that casts some doubt on the benefits of being thin:

“Whereas obesity is a strong risk factor for heart disease, the standard test for measuring obesity – Body Mass Index (BMI) – may be of little use in predicting the risk of death. Results from studies involving 250,000 heart patients showed that those with the lowest BMIs had the highest risk of death. People who were overweight – but not obese – had a lower risk.”

Having a low amount of body fat has its advantages (like for rock climbing or marathon running) but being ~10 pounds overweight may actually be advantageous for your heart health. This is not an invitation to gain weight – just a little encouragement that “pleasantly plump” is not always such a bad thing. At least, that’s what I tell myself!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Is bleeding after intercourse a sign of cervical cancer?

I’d never really thought about this issue until I read a study from the American Family Physician where some hardy souls sifted through the world literature for the answer to this very question. Their conclusion was that one out of every 220 women experiencing post coital bleeding has invasive cervical cancer.

The general prevalence of cervical cancer (in the US) is about 10 in 100,000.

So, if you’re experiencing bleeding after sexual intercourse, you should follow up with your Ob/Gyn to determine the cause. Also, regular pap smears are important in sexually active women as most cases of cervical cancer have no symptoms at all.

(How common is post-coital bleeding? About 1% of women report this problem.)

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Herbs & Vitamin Supplements: A Word Of Caution

Complementary and alternative medicine (CAM) is important and popular, but ignorance about its potential harms can be dangerous to consumers. Physician passivity about the subject may also be doing consumers a disservice. Two interesting articles underscore this:

From the NIH:

In spite of the high use of complementary and alternative medicine (CAM) among people age 50 or older, 69 percent of those who use CAM do not talk to their doctors about it…

A telephone survey, administered to a nationally representative group of 1,559 people age 50 or older, revealed some reasons why doctor-patient dialogue is lacking. Respondents most often did not discuss their CAM use with doctors because the physicians never asked (42 percent); they did not know that they should (30 percent); or there was not enough time during the office visit (19 percent).

From MSNBC:

If you’re banking on a daily vitamin to make up for any deficiencies in your diet, you may be getting a whole lot more — or less — than you bargained for.

Of 21 brands of multivitamins on the market in the United States and Canada selected by ConsumerLab.com and tested by independent laboratories, just 10 met the stated claims on their labels or satisfied other quality standards.

Most worrisome, according to ConsumerLab.com president Dr. Tod Cooperman, is that one product, The Vitamin Shoppe Multivitamins Especially for Women, was contaminated with lead.

The same product also contained just 54 percent of the 200 milligrams of calcium stated on the label.

The analysis also showed that Hero Nutritionals Yummi Bears, a multivitamin for children, had 216 percent of the labeled amount of vitamin A in the retinol form, delivering 5,400 International Units (IU) in a daily serving. That’s substantially more than the upper tolerable level set by the Institute of Medicine of 2,000 IU for kids ages 1 to 3 and 3,000 IU for those 4 to 8.

Because too much vitamin A can cause bone weakening and liver abnormalities, the Yummi Bears “could be potentially doing more harm than good,” Cooperman said. “Vitamin A is one of those vitamins where you really don’t want to get too much.”

It’s important for physicians to educate themselves about CAM therapies and make it a part of their practice to ask their patients about the supplements they take. The Natural Standard databases are a great resource for physicians and consumers, and will be available soon at Revolution Health. Natural Standard, initially created by a team of Harvard physicians, systematically reviews the evidence behind the efficacy claims of various herbal remedies and supplements.

What resources do you use to evaluate the safety and efficacy of the herbs and supplements you’re taking?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Conflicting research studies: how do I know what’s true?

Consumers often express frustration with new research findings reported to them by the media.  One day a medicine is being promoted on TV as the cure for arthritis pain, the next it is being removed from the market by the FDA, citing increased risk of death.  One day margarine is considered a healthy alternative to butter, the next day trans fats are being banned from entire states.  And so medical research is eyed with suspicion and people are left to wonder about the safety of their food, medications and treatments.

I sympathize with the confusion and frustration.   Here’s part of what fuels it:

1)  Clinical trials are designed to answer very specific questions under a set of limited conditions. They have to be designed this way in order to prove a cause and effect.  The results should be repeatable, given the same conditions.  Sometimes when a drug is used in a different way (like, at a higher dose or for a longer period of time, or in older patients) it has different or more frequent side effects.  It’s important not to generalize efficacy or safety to use cases outside those tested in a clinical trial.  What’s good for the goose is NOT necessarily good for the gander.

2)  Large observational studies can often pick up trends that might not have been noted in a clinical trial. This is why previously unknown (or rare) side effects are sometimes detected after clinical trials seem to indicate that a drug or treatment is safe and effective.

3)  We are all tempted to over-simplify research data, especially the media. How many of us would like to read a headline that says, “Drug X may reduce your arthritis pain by 10% if you are over 80, have no history of high blood pressure or diabetes, use it 3 times a day at 10mg doses and take it on an full stomach” versus “Drug X can cure your arthritis!”  Yup, we just want something easy to understand, and so we opt for statement #2, even though it’s not accurate.  Inaccurate statements generate a lot of confusion and lead to unwarranted hype.

So, what is a consumer to do? My opinion is that the educated consumer’s best friend is an educated physician.  Doctors are natural skeptics – they are formally trained (for a minimum of 7-10 years at good schools) to understand the limitations of research studies and effectively communicate all the caveats that are so critical for informed decision making.  If you’re having a hard time figuring out if a drug or treatment is right for you, ask your doctor (wow, did that sound like a TV ad!)  Or better yet, keep reading the physician blogs and medical news commentary at Revolution Health.  We are committed to translating research news into a format that you can understand and use.  We’ll do our best to cut through the hype and give you the real facts.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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