October 4th, 2007 by Dr. Val Jones in Announcements
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Well, I had a great time at the Revolution Health booth at the AAFP meeting today. Hundreds of people stopped by for a chat and to get to know what Revolution Health is about. I handed out golf towels (well, they were little white hand towels that I used to give out as gym towels, but with the doctor audience I changed the pitch to golf. How cliche of me. Ha!) Some of the notable guests included:
Bob Rakel, MD – author of my most favorite medical textbook in the world: Saunders Manual of Medical Practice
David Rakel, MD – Bob’s son, and the author of my second most favorite medical textbook: Integrative Medicine
Len Fromer, MD – past president of the California Academy of Family Physicians. His wife is an actor – and we had a great chat about how we both miss New York City.
John Pfenninger, MD – author of the coolest book for outpatient medical procedures
Todd Dicus, JD – deputy executive VP of the AAFP and a really friendly lawyer.
Marianne Walters, MD – an urgent care physician in California who taught me that surfers’ wet suits are like Petri dishes for MRSA (a really nasty bacterium). Ew.
Allan Harmer, ThM – from the Christian Medical Association, who told me that the story of how he accidentally attended a medical conference about HIV and ended up involved in medical groups for the rest of his career (even with no previous medical training).
Joe Scherger, MD – the hardest working man on the Revolution Health expert team. He gave a lecture about how to use email and online help as an integral part of one’s medical practice – and the audience was riveted.
Tomorrow’s going to be fun, I can just tell. And the best part is that I can wear sneakers with my business suits – all the family physicians are doing it themselves! I’ve never seen more Birkenstocks in one place before… I think Michelle Au might have been right about family docs – see her cartoon.
See you tomorrow at Revolution Rounds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 1st, 2007 by Dr. Val Jones in Health Tips
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A dear friend of mine sent me a panicked, cryptic email late on a Friday night: “call me immediately” (followed by her cell phone). As a doctor, I usually know that these kinds of requests are triggered my medical emergencies, so I anxiously picked up the phone and called my friend, hoping that I wasn’t going to hear some alarming story about a tragic accident.
And low and behold the story was this: “I got home from work late and picked up the mail. There was a letter in there from the radiologist’s office. It said that my mammogram was abnormal. Do you think I have breast cancer? Am I going to die?”
Remaining calm, I asked what sort of abnormality was described. She read the letter to me over the phone:
“Dear [patient],
Your recent mammogram and/or breast ultrasound examination showed a finding that requires additional studies. This does not mean that you have cancer, but that an area needs further evaluation. Your doctor has received the report of your examination. Please call us at XXX to schedule the additional examinations.”
I knew immediately that this was a form letter (heck the letter didn’t even distinguish between whether or not my friend had had a mammogram or an ultrasound) and it made me angry that it had frightened her unnecessarily. I knew that as many as 40% of women who have mammograms have some sort of “finding” that requires further testing. Usually it’s because the films are too dark or too light, the breasts are particularly large or dense, or there is some cyst, calcification, lymph node, or shadow that the radiologist picks up. And in a litigious society, a hint of anything out of the ordinary must be reported as an abnormal “finding” until proven otherwise.
I did my very best to reassure my friend – to tell her that if the radiologist were truly concerned about what he or she saw on the mammogram s/he would have called the physician who ordered the test right away. Receiving a vague letter like this is reassuring, because it’s an indication of a low index of suspicion for a malignancy. I also told my friend that if a true mass were found on the mammogram, that a biopsy of that mass still has an 80% chance of being normal tissue.
But even though I did my very best to reassure her, my poor friend didn’t sleep well that night, and worried all weekend until she could speak to her physician on Monday. As I thought about her experience, and the unnecessary fright that she was given… I began to wonder about how common this experience must be. How many other women out there have lived through such anxiety?
Personally, I think that women who get mammograms should be warned up front that there is a high chance that the radiologist will find something “abnormal” on the test, and that these abnormalities usually turn out to be any number of typical breast characteristics. They should be told not to worry when they receive a letter about the abnormality, but come back for further testing in the rare event that the finding is concerning.
I decided to do a little research about this phenomenon (women receiving scary letters out of the blue about their mammogram results) and interviewed Dr. Iffath Hoskins (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) about her experiences.
Please listen to the audio file for the full conversation. I will summarize her opinions here:
Q: How common are abnormal mammograms?
Mammograms are considered “abnormal” in some way in up to 40% of cases.
Q: What sorts of things are picked up as abnormal without being true pathology?
Overlapping tissues in women with larger or heavier breasts, fibrocystic breast tissue, calcium deposits or the radiologist doesn’t have the last mammogram to compare the new one to and sees some potential densities.
Q: What happens next when a woman has an abnormal mammogram?
It may take a week or two for the patient to get scheduled for follow up tests. Usually the physician will choose to either repeat the mammogram with targeted views of the area in question, request a breast ultrasound, biopsy the mass, or remove the concerning portion of the breast tissue surgically.
Q: When would a physician choose a biopsy?
A biopsy is indicated if the mammogram and follow up tests all are consistent with the appearance of a concerning lesion. Sometimes the physician will do a biopsy on a lump if a woman says that it’s unusual, new, or tender and the mammogram result is equivocal.
Q: What percent of biopsies confirm a malignancy?
It varies from physician to physician because some have a lower threshold for performing biopsies (so therefore the percent of biopsies that are malignant is lower). But on average only 10% of biopsies pick up an actual cancer.
Q: What does a radiologist do when he or she finds an abnormality on a mammogram?
First of all, the patient must be notified of the abnormality. Secondly, the radiologist reports the abnormality to the referring physician, usually by fax. They do it either in batches, or one at a time. If the person reading the film has a serious concern about the breast tissue – or if it appears to have the characteristics of a malignancy, the radiologist will personally call the referring physician right away.
Q: What advice would you give to a woman who receives a letter in the mail indicating that she’s had an abnormal finding on her mammogram?
Please try not to be concerned yet. Wait for the doctor to fully evaluate the mammogram and do further testing before you make any assumptions about the diagnosis. Although it’s almost impossible not to feel anxious, you must understand that the vast majority of “abnormal findings” on a mammogram are NOT cancer.
Listen to the full interview here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 30th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Less than a year ago, I didn’t even know what a blog was. Many physicians still don’t know about them, and yet (according to Wikipedia’s September ’07 figures) there are over 106 million blogs currently online. A recent article about medical blogs suggests that the number of health professionals blogging may be in the order of 100’s. Therefore, medical blogs are only a tiny drop in the blogosphere bucket.
As with IT initiatives in general, the medical world is sorely lagging behind. However, there is a small group of pioneers who are already making a difference in the lives of patients and colleagues around the world. I have witnessed with my own eyes how cancer patients are being directed towards optimal care through blogs like those of Dr. Heinz Josef Lenz. Although he practices in southern California, his blog has been discovered by colon cancer patients across the country – and he has a loyal following who learn about cutting edge research and clinical trial information three times a week. These patients would never have access to this kind of information without his blog – they would have to wait for research to be published in a peer-reviewed journal, and then hope that the media would faithfully translate the findings into consumer language. (Good luck with that.)
Some blogs are being used to educate peers about surgical techniques. Dr. Bates has a wonderful, detailed blog about how to correct cosmetic defects, and a group blog called Inside Surgery has information for surgeons about difficult or unusual cases.
Dr. Rob, our Grand Rounds host this week, does a wonderful job of educating others about primary care, physical exam basics, and the broken healthcare system. He does it with flair – and a whimsical approach that is very entertaining. Where else can you learn about the healthcare system AND the lifestyle habits of llamas, goats, and accordion players?
If you want to keep up with healthcare news – KevinMD is a one-man news feed of all the most interesting goings on. If you need to keep up with advances in the medical device industry, MedGadget is your one stop shop.
Of course there are many other great medical blogs out there as well (and so many nursing blogs, like Emergiblog are outstanding)- but what excites me the most is when I see patients benefiting from the information they receive directly from healthcare professionals. Blogs can truly improve access to the minds of medicine, and even save lives – Medical blogs have the power to:
1. Educate patients about their health
2. Debunk medical myths
3. Cut through the media spin associated with research and health news
4. Influence health policy
5. Instruct other healthcare professionals
6. Expose dishonest medical schemes
7. Increase awareness of clinical trials and important research
8. Provide emotional support
9. Create a networking opportunity for professionals, advocates, and patients
10. Help people navigate the broken healthcare system
If you haven’t already, I hope you’ll add your voice to the medical blogosphere, and be part of a movement to change healthcare – one blog post at a time.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 29th, 2007 by Dr. Val Jones in Quackery Exposed, True Stories
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As some of you faithful readers of Dr. Val may know – I’m a huge fan of massage. Consider it my
addiction, I suppose – it could be worse! And so it may come as no surprise that I had a massage every day of my vacation (7 days in Southern California – sorry I haven’t been blogging as much lately). Yes I’m well and truly tenderized from head to toe. But I have to say that some of the therapists’ chatter was quite amusing to me. I was unsuccessful at completely removing my doctor hat during the experience, and tried not to look quizzically at them as they explained what they were up to and what I needed.
Those of you with healthcare backgrounds may especially appreciate this dialog:
Therapist (scrutinizing my back as I’m face down on a
table): have you seen a chiropractor recently?
Dr. Val: Um, no. Why?
Therapist: Well, two of your ribs are out.
Dr. Val: They’re ‘out?’
Where did they go?
Therapist: A chiropractor can put them back for you so your
muscles won’t pull in the wrong direction.
Dr. Val: Will a chiropractor be able to fix this
permanently?
Therapist: No, you’ll have to keep going. (Adds some eucalyptus lotion). This will bring your red blood cells to the
surface, and the cooling brings white blood cells to the area.
Dr. Val: (considering what a collection of white blood cells
actually do – yuck). Hrmph. That’s a nice massage technique. What are you doing?
Therapist: I’m using my elbows to stimulate repair cells.
Dr. Val: Ahum…
Therapist: You have lactic acid build up in your shoulders
so we have to flush the toxins out with special oils. You should also drink a lot of water.
Dr. Val: What sort of toxins?
Therapist: Like, dirt and metals and stuff that you’ve been
exposed to. You might have eaten fruit
with pesticides on it. Do you eat
organic food?
Dr. Val: Sometimes.
Therapist: Oh, you should only eat organic food. Then you won’t have as many toxins built up.
Dr. Val: How do I know how many toxins I have in my body?
Therapist: Well, your shoulders are really tight and your
ribs are out so I think you probably have a lot. You’ll need a lot of massage and you need to
see a chiropractor. The oils I used on
you will have a calming effect, though.
You’ll probably sleep really well tonight.
Dr. Val: I see (inhaling, exhaling). I hope I do.
** 15 minutes post massage – back at the hotel room **
Husband: You smell funny – like an almond.
Dr. Val: That’s “the calming oil that flushed the toxins out
of my body” today. I have to drink
water.
Husband: Well we’re driving 2 hours up to L.A. so don’t drink too much or we’ll have to
stop along the way.
Dr. Val: The therapist said 2 of my ribs were out and that I
need to see a chiropractor.
Husband: There’s nothing wrong with your ribs. Don’t be silly. Why do you keep getting these massages?
Dr. Val: They feel good.
Husband: I could give you a back rub for free.
Dr. Val: It’s not the same, though.
Husband: Why, because I don’t tell you your ribs are out of
whack?
Dr. Val: Well, they have a proper table…
Husband: I don’t understand you.
Dr. Val: But you like almonds (hugs him).This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 27th, 2007 by Dr. Val Jones in Health Tips, News
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Heart disease is the number one killer of Americans, and high cholesterol levels are a primary contributor to heart disease. But the cholesterol story is a bit complicated – some of it is damaging to blood vessels (Low Density Lipoproteins or LDL is considered “bad” cholesterol) and some of it is restorative (High Density Lipoproteins or HDL is “good” cholesterol). Most medications are aimed at lowering the “bad” cholesterol, and this strategy has been very helpful in reducing heart disease and atherosclerosis. But what about raising the good cholesterol as part of a heart healthy strategy?
A new study in the New England Journal of Medicine suggests that having low levels of HDL can put people at risk for heart disease and heart attacks, even if the LDL is well controlled. This is the first study to show that low LDL does not erase heart disease risk if the individual’s HDL is also low. In fact, each increase of 1 mg in HDL cholesterol is associated with a decrease of 2 to 3% in the risk of future coronary heart disease. So lowering LDL with statins (if lifestyle measures fail) is only half the battle for those who also have low HDL.So how do you increase your HDL levels?The most effective medicine for raising HDL is a type of Vitamin B called niacin. Taken in the quantities required to have an effect on HDL, though, there are usually unpleasant side effects: flushing (redness or warmth of the face), itching, stomach upset, mild dizziness, and headache.
Perhaps the best way to increase HDL is to lose weight and exercise regularly.? In fact, the list of HDL-raising “to do’s” reads like a healthy living manual:
1. Avoid trans fats
2. Drink alcohol in moderation
3. Add fiber to your diet
4. Use monounsaturated fats like olive oil where possible
5. Stop smoking
6. Lose weight
7. Engage in regular aerobic exercise
So next time you see your doctor, make sure you review your cholesterol levels, and discuss some strategies to get your levels of HDL and LDL in the optimal zones for a healthy heart.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
