June 12th, 2008 by Dr. Val Jones in News
4 Comments »
TRUE: New York City adults have more genital herpes than the national average (26% versus 19%). One commenter replied, “Well, that’s what you get from ‘Sex in the City.'”
FALSE: A practical joke sparks Internet health myth: cell phones can cook an egg or pop popcorn. People really will believe anything.
FALSE: Some folks in India swallow live fish to stimulate coughing and to “clean the esophagus” and cure asthma. Must be an interesting feeling to have a live fish swimming around one’s stomach! Of course this doesn’t work. h/t to Happy Hospitalist
TRUE: More and more Muslim women are having their hymens restored so that they will appear to be virgins on their wedding night. I wonder about those women who are born with small or nearly absent hymens? Will they be punished? And what about the men who made the women non-virgins? This NYT story is quite upsetting.
TRUE: The media misrepresents health information 2/3 of the time. Fewer and fewer people are willing to take the time to get a story straight. When perception is nine-tenths of reality, science and truth are in jeopardy.
TRUE: Marijuana smokers enjoy lax laws in Mendocino County, California. It’s legal to keep up to 2 pounds of marijuana and 25 live plants in one’s home. How much marijuana does one really need for medical purposes?
FALSE: Gummy bears do not have internal organs. However, this artist has a wonderful imagination.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 24th, 2008 by Dr. Val Jones in True Stories
5 Comments »
One of my colleagues at Revolution Health has a daughter who is a freshman in college (we’ll call her Julie). Julie has been struggling with a very sore throat for many months, and her mom would occasionally ask my opinion about her care.
Julie initially believed that she had a viral throat infection and tried to wait it out. Several weeks later the pain was quite severe and worsening instead of improving, so she sought help at the student health service at her university. The nurse reassured her and told her to wait a little bit longer and come back in a couple of weeks if things weren’t improving.
Two weeks later Julie was back, and was offered a monospot test (which was negative). The nurse practitioner gave her some samples of Keflex to treat her presumed strep throat, and was told to return in 2 weeks if her symptoms hadn’t resolved. Julie’s mom asked me if I thought that was ok, and I mentioned that drug resistance was not uncommon to Keflex, but that it was really cheap. I explained that Julie’s throat had been sore for an awfully long time, and that if the Keflex didn’t improve her symptoms within a few days, she might want to try something stronger.
Guess what? A week later Julie went back to the student health service with continued symptoms, and their response was to continue the Keflex for a full 10 days. Julie asked if a different antibiotic might be appropriate, and they simply replied that the health service only carried Keflex.
Julie completed the full course of antibiotics with no improvement. She called her mom to ask what she might do next and I suggested that she consider seeing a physician about an antibiotic with a lower resistance profile (like azithromycin). She was unable to get an appointment for a couple of weeks. The student health service nurse said that Julie’s throat did not appear concerning.
As it happened, Julie began having difficulty swallowing, was unable to sleep because of her throat pain, and had a low grade fever. I worried about a peritonsillar abscess (pus trapped in the deep tissues of the throat) and counseled Julie’s mom to get her to a physician right away. Julie flew to DC to be with her mom for the weekend, and was able to get an appointment with a primary care physician who gave her some azithromycin and steroids and said that there did not appear to be any visible signs of a peritonsillar abscess.
Again, Julie’s pain continued unabated. Her throat became even more swollen – and at that point I encouraged them to go to the ER to rule out an abscess. Julie was seen by an affable young ER physician who promptly ordered a CT scan of her neck. Several hours later the diagnosis was confirmed: Julie had pus trapped in the deep recesses of her throat. The ER doc numbed up the tonsil area and inserted a needle into the pus and pulled out several cc’s of thick green goo.
Man I wish I could have been there. (I know that’s a weird response, but docs LOVE pus.)
As I thought about this case, I wondered if we’ve gone too far in withholding antibiotics from deserving patients in our quest to reduce resistant bacterial strains. For every Julie there’s probably 100 others receiving (quite inappropriately) azithromycin for a viral throat infection… but Julie’s case may represent a new kind of provider problem: their own resistance to antibiotics.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 24th, 2008 by Dr. Val Jones in True Stories
4 Comments »
I was participating in morning rounds with a team of internal medicine residents. That day was the beginning of a rotation change, and a new “house attending” (the doctor in charge of the inpatients who had no primary care physician) was getting to know his patients. The residents who had been caring for the patients took turns explaining (near the bedsides) what had gone on since their admissions to the hospital, and described their treatment plans.
One intern presented a case of a patient with “fever of unknown origin” (FUO). This particular diagnosis will make any internal medicine specialist delirious with curiosity and excitement, since it means that all the previous attempts at discerning the cause of the patients fever have failed. Generally, a fever only receives this exciting honor when it has gone on for at least 3 weeks without apparent cause.
The intern explained (in excruciating detail I might add) every single potential cause of the fever and how he had ruled them out with tests and deductive reasoning. The attending was hanging on every word, and nodding in approval of some real zebras (rare and highly unlikely causes for the fever) that the intern had thought to consider and disprove.
I must admit that my mind wandered a bit during this long exercise, and instead I looked at the patient, smiled, and examined his thick frame with my eyes. Of course, an attending has a keen sense for wandering minds, and so to “teach me a lesson” he abruptly stopped the intern’s presentation and looked me dead in the eye. You could have heard a pin drop.
“So, Dr. Jones” he snarled. “You seem to have this all sorted out, don’t you. Apparently you have determined the diagnosis?”
“Well, yes, I think I may have.” I replied calmly.
The attending’s face turned a slightly brighter pink. “Well, then, don’t withhold your brilliance from us any longer. You’re a rehab resident, are you not?” He made a dismissive move with his right hand and rolled his eyes.
“Yes, I am.” (Snickers from the internal medicine residents.) I shot a glance at them that shut them up.
I continued, “Well, Dr. ‘Attending,’ as the intern was reviewing the potential causes of FUO, I took a look at the patient. It seems that there is a pus stain on the bottom of his right sock. I didn’t hear the intern describe the patient’s foot exam.”
The intern’s face went white as a sheet.
The attending turned to the intern with an expression of betrayal. “Did you examine this patient’s feet?”
“Well I uh… well, no.” Stammered the intern. “I guess I forgot to remove his socks.”
The attending marched over to the bedside and quickly removed the patient’s right sock, a small snow storm of dried skin flakes fell gently to the hospital floor. A festering foot ulcer proudly displayed itself to the team.
The attending gingerly nodded at me. He turned to the intern and announced that he would be given an extra night of call this month so that he’d have time to examine his patients’ bodies from head to TOE.
The patient was treated with antibiotics and sent home.
The intern later went on to become a radiologist.
I am working on improving patient empowerment on a national basis through Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 11th, 2008 by Dr. Val Jones in News
1 Comment »
I was surprised by recent recent findings from the CDC’s National Health and Nutrition Examination Survey– one in four teenage girls (ages 14-19, chosen at random in the US) tested positive for some sort of sexually transmitted disease, most commonly HPV (human papilloma virus) (18%), followed by chlamydia (4%), trichomonas (2.5 %), and herpes (2%).
I asked Revolution Health expert, 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.) what she thought of this news.
“This relatively high infection rate is cause for concern. We need to increase our education efforts so that teenagers are more aware of the risks of sexually transmitted diseases, especially since women’s reproductive futures are at stake. Chlamydia infections can substantially decrease fertility rates, long after the infection has been fully treated with antibiotics.
As far as the high HPV rates are concerned, I’m not surprised since previous research has estimated that 80-90% of adults have been infected with at least one of 80 subtypes of this very common virus. Only 6 of these 80 are known to predispose women towards cervical cancer. But the HPV vaccine can substantially reduce the risk for contracting those 6, so it’s important to vaccinate young girls against this virus.
No teenage girl should be walking around with chlamydia or trichomonas. They are treatable with antibiotics.”
The study also found racial differences between STD infection rates in teenage girls, with blacks being infected at twice the rate of white or Hispanic girls. The CDC is calling for educational outreach to at-risk groups, and the American Academy of Pediatrics supports confidential teen screening.
I hope that these staggering statistics act as a wake up call to health care providers who may not have thought to screen their teen patients for STDs. Apparently, these infections are more common than we realized.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 22nd, 2008 by Dr. Val Jones in Expert Interviews, News
1 Comment »
Some Hollywood celebrities are up in arms after having been notified of their exposure to hepatitis A through an infected bartender at a trendy New York City club. Those who come in contact with a known virus carrier may prevent infection if they’re vaccinated early. Hepatitis A causes less severe liver disease than its blood-bourne cousin, hepatitis C, but it’s still a formidable foe. (For more information about hepatitis A and its symptoms, check out this article.)
I interviewed Revolution Health consultant and world-renowned liver expert, Dr. Emmet Keeffe, about this outbreak:
Dr. Val: What is the likelihood that people could catch hepatitis A from an infected bartender?
Dr. Keeffe: The hepatitis A virus is transmitted between persons by the fecal-oral route (think unwashed hands after a bathroom break, or drinking water that has come in contact with human sewage). Also this particular virus is very hardy and can live on counter tops and surfaces outside the body for longer than many viruses. Because hepatitis A is found in very high concentrations in an infected persons’ stool, a tiny bit of stool on the hands actually contains large amounts of the virus and can therefore be quite infectious. Although previous outbreaks have primarily been associated with food handlers, there is no reason why a bartender might not also spread hepatitis A virus.
Dr. Val: Yuck. Would a vaccine be effective in preventing hepatitis A after someone’s already been exposed? How quickly after exposure should one get the vaccine?
Dr. Keeffe: The standard recommendation for individuals potentially exposed to hepatitis A is passive immunization using immune globulin administered within 2 weeks of exposure, which is 85% effective in protecting against illness. This is the recommendation for household or sexual exposure, but not generally recommended for “common source outbreaks” (like exposure to food handlers or bartenders), which are usually recognized only after they are well into their course. However, with early recognition, such as the NY case, immune globulin may make good sense. After hepatitis A vaccination, protective levels of antibodies to hepatitis A virus do not appear until 2-4 weeks after vaccination. Thus, active immunization with hepatitis A is used for preexposure prophyaxis, such as in international travelers to areas where hepatitis A is common, but not for postexposure prophylaxis.
Dr. Val: What is the hepatitis A vaccine exactly?
Dr. Keeffe: Hepatitis A vaccine is an injection, which is administered at baseline followed by a booster in 6 to 18 months. Two relatively similar and effective vaccines are licensed in the United States: Havrix and Vaqta.
Dr. Val: What should the bartender do if he has hepatitis A? Can he still work? When can he come back to work?
Dr. Keeffe: To protect the public, the bartender should not work until he has fully recovered. He is most infectious during the late incubation and early illness stage, when excretion of hepatitis A virus in feces is the highest.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
