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Latest Posts

Product Used For Poison Ivy Skin Reaction Undergoes Price Increases

I recently received a note mailed to health care providers from Steve Sisler, Vice President of Sales Development for Zanfel Laboratories, Inc. Zanfel is a product used to decrease the skin reaction attributable to poison ivy and similar plants (e.g., poison oak and sumac). Here is an edited part of the note that I received:

While attending the recent American Academy of Family Physicians trade show, numerous health care professionals stopped by the Zanfel Laboratories booth to ask questions and gain additional knowledge regarding the Zanfel product and the overall disease state of urushiol-induced allergic contact dermatitis. Additionally, a great many prescribers voiced concern over the recent price increases of Zanfel Poison Ivy Wash. The conversations were very specific in that the retail price for Zanfel had increased to $42.99, $44.99 and even as high as $48.99 plus tax. These prescribers are aware of the retail price increases because their patients are calling them back after visiting CVS and Walgreens pharmacies. Their patients are aware that Zanfel had previously been sold for approximately $39.99 plus tax. These patients are upset because they believe that Zanfel Laboratories has initiated a retail price increase.

Zanfel Poison Ivy Wash has not had a cost increase in over Read more »

This post, Product Used For Poison Ivy Skin Reaction Undergoes Price Increases, was originally published on Healthine.com by Paul Auerbach, M.D..

Is A Compressed Spinal Nerve Causing Itchy Arms?

Medical science is getting closer to understanding one of the most common causes of chronically itchy arms called brachioradial pruritus.

This means we’re also getting closer to helping people who suffer from this extremely frustrating condition!

A new study exploring the cause of brachioradial pruritus was just reported in the October issue of the Journal of the American Academy of Dermatology.  The authors used MRI imaging to look at the cervical spine of 41 patients suffering from chronic itching of what was otherwise normal appearing skin on the outer surface of their forearms arms (called brachioradial pruritus).  MRI imaging showed a very strong correlation between the itch and nerve compression in the patient’s neck. In fact, the exact site of the itch on the skin correlated precisely with the spinal location in the neck where the nerve resides that supplies that part of the arm skin (we call this a dermatome*).

What’s so interesting is that Read more »

*This blog post was originally published at Dr. Bailey's Skin Care Blog*

Could Your Swimming Pool Give You A Rash?

Allergic to Swimming? We’re in the dog days of August and summer continues to hold on. What better way is there to relax than in your nice, cool pool? Unless you’re allergic to it, of course.

I had a patient this summer who developed an itchy rash all over. He thought it might be due to his pool, but insisted that he kept it immaculately clean. Ironically, that might have been the trouble.

Some people are allergic to Read more »

*This blog post was originally published at The Dermatology Blog*

How To Soothe That Itchy Sunburn

Have you ever had a sunburn? First it hurts. Then it itches. And itches. And itches.

Why is that?

Sunburn is caused by ultraviolet (UV) radiation damage to your skin. Too much UV damages your skin cell’s DNA, and your immune system responds by killing off the bad cells. Because UV radiation doesn’t penetrate (unlike X-rays for example), it damages only the surface layer of your skin. This outermost layer happens to be loaded with special nerve fibers called C-fibers which are responsible for itch.

Itch is a mechanism to Read more »

*This blog post was originally published at The Dermatology Blog*

Pregnant And Itchy? It Could Be A Dangerous Liver Problem

If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.

The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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