March 18th, 2011 by John Mandrola, M.D. in Health Tips
Tags: Healthy Living, Kidneys, Nephrology, Protect Your Kidneys, Save Your Heart, World Kidney Day
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In the better-late-than-never category comes my shout out for World Kidney Day, which was March 10th.
I love their slogan: “Protect your Kidneys, Save your Heart.”
As an organ, the kidneys are a lot like offensive lineman in football; they do all the hard work but remain mostly anonymous. They sit motionless in the back of the body,quietly and humbly filtering salt, water and toxins from our bodies. Though some may think that pee smells bad, or is gross, not having “healthy” pee is a real problem. No one ever thinks of their kidneys until they malfunction.
Though the inner workings of the kidney–with all its convoluted loops, capsules and ion exchangers–are more complicated to understand than the heart, keeping your kidneys healthy is simple: just make heart-healthy choices. Read more »
*This blog post was originally published at Dr John M*
March 17th, 2011 by Shadowfax in Health Tips, True Stories
Tags: Crepitus, Dermatology, Elderly, Emergency Medicine, Flesh Eating Bacteria, Geriatrics, Mental Status Change, Necrotizing Fasciitis, Physical Exam, Radiology
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I’ve remarked in the past how rarely I ever learn anything useful from physical exam. It’s one of those irritating things about medicine — we spent all that time in school learning arcane details of the exam, esoteric maneuvers like pulsus paradoxus, comparing pulses, Rovsing’s sign and the like. But in the modern era, it seems like about half the diagnoses are made by history and the other half are made by ancillary testing. Some people interpreted my comments to mean I don’t do an exam, or endorse a half-assed exam, which I do not. I always do an exam, as indicated by the presenting condition. I just don’t often learn much from it. But I always do it.
The other day, for example, I saw this elderly lady who was sent in for altered mental status. There wasn’t much (or indeed, any) history available. She was from some sort of nursing home, and they sent in essentially no information beyond a med list. The patient was non-verbal, but it wasn’t clear if she was chronically demented and non-verbal or whether this was a drastic change in baseline. So I went in to see her. I stopped at the doorway. “Uh-oh. She don’t look so good,” I commented to a nurse. As an aside, this “she don’t look so good” is maybe 90% of my job — the reflexive assessment of sick/not sick, which I suppose is itself a component of physical exam. But I digress. Her vitals were OK, other than some tachycardia*. Her color, flaccidity and apathy, however, really all screamed “sick” to me. Of course, the exam was otherwise nonfocal. Groans to pain, withdraws but does not localize or follow instructions. Seems symmetric on motor exam, from what I can elicit. Belly soft, lungs clear. Looks dry. No rash. Read more »
*This blog post was originally published at Movin' Meat*
March 17th, 2011 by ChristopherChangMD in Health Tips, Opinion
Tags: Antibiotics, Culture, Family Medicine, Infection, Pediatrics, Positive Strep Test, Sore Throat, Strep Throat, Test, What To Do
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Occasionally, I see patients who have received throat swabs for strep that have come back positive… even if they have no signs or symptoms of pharyngitis.
In this situation, there are 2 main actions a physician may take (I am biased towards one):
1) Prescribe antibiotics until throat cultures are normal
2) Do nothing
Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for??? Read more »
*This blog post was originally published at Fauquier ENT Blog*
March 16th, 2011 by Davis Liu, M.D. in Health Tips, Opinion
Tags: American Cancer Society, American College of Gastroenterology, Annals Of Internal Medicine, Blood in the Stool, Colon Cancer Screening, Colon Health, Colonoscopy, Colorectal Cancer, Confused Patients, Dr. Davis Liu, Dr. John Abramson, Family Medicine, Fecal Immunochemical Test, Fecal Occult Blood Test, Fit, Flexible Sigmoidoscopy, FOBT, General Medicine, National Cancer Institute, New York Times, Oncology, Preventive Health, Preventive Medicine, Preventive Screening, Primary Care, Saving Money and Surviving the Healthcare Crisis, Screening Guidelines, Stool Test
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Colon cancer screening has a particular personal interest for me — one of my colleagues in residency training had her father die of colon cancer when she was a teenager.
No one should lose a loved one to a disease that, when caught early, is often treatable. But for both men and women, colon cancer is the third most common cancer behind lung cancer and prostate cancer in men, and behind lung cancer and breast cancer in women, it’s the second most lethal.
The problem is that patients are often confused about which test is the right one. Is it simply a stool test? Flexible sigmoidoscopy? Colonoscopy? Virtual colonoscopy? Isn’t there just a blood test that can be done? (No.)
In simple terms, this is what you need to know:
All men and women age 50 and older should be screened for colon cancer. Even if you feel healthy and well and have no family history, it must be done. Note that Oprah’s doctor, Dr. Oz, arguably a very health-conscious individual learned that he had a colon polyp at age 50 after a screening test. Left undetected, it could have cut his life short. This wake-up call caused him to abort his original second season premier on weight loss and instead show the country why colon cancer screening matters. He admitted that if it wasn’t for the show and the need to demonstrate the importance of screening to America, he would have delayed having any test done.
The least invasive test is a stool test. If it is to screen for colon cancer, then the test is done at home and NOT in the doctor’s office. Either the fecal occult blood test (FOBT) or the fecal immunochemical test (FIT) are available to screen for unseen microscopic blood that could be a sign of a colon polyp or cancer. Research shows that when a stool test is done annually, the risk of dying from colon cancer can fall by 15 to 33 percent. If you don’t want any fiber optic cameras in your rectum and lower colon, this is the test for you. You must do it annually.
The next two tests are similar but often confused: The flexible sigmoidoscopy and the colonoscopy. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
March 15th, 2011 by PJSkerrett in Health Tips, News
Tags: Chernobyl, Endocrinology, Failing Nuclear Power Plant, Harvard Health Blog, Harvard Health Publications, Harvard Heart Letter, Harvard Medical School, Harvard University, Iodine-131, Japan, Oncology, PJ Skerrett, Potassium Iodine Pills, Potassium-Rich Diet, Radiation Exposure, Radiation Risks, Radiation-Induced Thyroid Cancer, Radioactive Fallout, Radioactive Steam, Radioactive Substance, Seafood-Rich Diet, Thyroid Gland, Thyroid Hormone
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One of the most abundant substances in the cloud of radioactive steam released by a failing nuclear power plant is iodine-131 — a radioactive form of the element iodine that is found throughout nature. Iodine-131 poses a special health risk because of its cancer-causing effect on the thyroid gland.
The small, butterfly-shaped thyroid sits just below the voice box. From this perch, it controls how fast every cell in the body changes food into energy. The gland’s main product, thyroid hormone, governs the function of the digestive tract, brain, heart, nerves, muscles, bones, skin, and more.
Iodine is a key ingredient that goes into making thyroid hormone. We get this element from ocean-caught or ocean-farmed fish and shellfish, milk, cheese, yogurt, eggs, and fruits and vegetables grown in iodine-rich soil.
The human body is surprisingly good at absorbing iodine and storing it in the thyroid gland. That’s a problem when iodine-131 is released into the atmosphere. The thyroid stores it as readily as natural, non-radioactive iodine. As iodine-131 builds up in the thyroid gland, it emits bursts of radiation that can damage DNA and other genetic material. Such damage can remove the normal limits to cell growth and division. Unchecked growth of thyroid tissue is thyroid cancer.
Iodine-131 gets into the body several ways. A person can breathe in radioactive steam released by a nuclear power plant. Fallout — radioactive particles that fall out of the atmosphere and settle onto plants, soil, and water — further adds to the burden when a person eats iodine-131 enriched fruits and vegetables or drinks water containing the isotope. Milk is another vehicle — cows that eat grass sprinkled with iodine-131 make milk that contains it. Read more »
*This blog post was originally published at Harvard Health Blog*
