Friday, December 19, 2014
The Dr. Oz Show and "The Doctors" may not be as accurate as you think
It seems that most doctors these days cannot go a day without having patients mention Dr. Oz or The Doctors TV show. Patients will often tell their doctors that they read about a specific test or treatment on one of these shows and would now like to try them. This can sometimes lead to frustration for the patient and the doctor. The question is, are these shows correct in their medical recommendations?
The British Medical Journal just released a study that looked at claims made by The Dr. Oz Show and The Doctors. They randomly selected 40 episodes of each show and evaluated all of the recommendations made in these episodes. They found that there was evidence for only 54% of the 160 total recommendations in medical literature. On The Dr. Oz Show, there was no evidence for 39% of claims and 15% of the claims were actually the OPPOSITE of true medical recommendations. On The Doctors, 63% of the recommendations were supported by medical literature and 14% of the recommendations were again opposite of medical standards.
If those numbers aren't shocking enough, there is one more important number. The study found that "Disclosure of potential conflicts of interest accompanied 0.4% of recommendations." This number indicates the honesty of these shows in promoting products that they are affiliated with. For instance, if Dr. Oz is promoting a new type of herbal tea for weight loss and he is the spokesperson for that tea, he should be disclosing this information. However, only in 0.4% of the cases was this ever disclosed. In fact, Dr. Oz was summoned by Congress for his promotion of the green coffee bean diet for these very reasons.
Health is a very sensitive topic because it can be a roller coaster of emotions. Patients go to their doctors and ask for advice under the assumption that their advice is based on at least some type of evidence. Often times a doctor may make a recommendation and may tell the patient that there is not enough evidence for this yet but that isolated cases have shown positive results. This is perfectly acceptable because not every recommendation has a large number of studies to back it up. However, making claims on national television that are not supported or are at times completely incorrect is unethical. Be an advocate for your health and form a trustworthy relationship with your doctor. They would be happy to answer your questions and work with you. The doctor-patient relationship is a sacred one, not one that can be had with a television set. So the next time you watch one of these shows, do your own research or ask a doctor with an unbiased opinion. It may save you a few bucks, and your life!
Wednesday, December 17, 2014
Think young, live longer
At a certain point in life, many people feel they are younger than their actual age. It turns out this may actually have a relationship with how long they may live down the line. A recent study in the UK by Dr. Steptoe and Dr. Rippon tracked 6489 patients with an average age of 52. These individuals were asked how old they felt and the results were classified into 3 groups: 1) those that felt close to their actual age (1 year older to 2 years younger), 2) those who felt more than 1 year older than their actual age, and 3) those that felt 3 or more years younger than their actual age. This seems rather silly at first, but the results that followed were pretty astonishing.
These three groups were then followed for 99 months. It turns out that the crude mortality (death) rate was 14.3% in those who felt younger, 18.5% in those who felt about close to their actual age, and 24.6% in those that felt older than their age. This indicates that those who felt younger had a lower rate of death than those who felt older. So is this a simple case of mind over matter? Yes and no.
I think it is important to take a look at why people feel the way they do. Those that felt younger than their actual age likely had reasons to feel that way. They may have exercised, had less stress, enjoyed life more, and had a better outlook. On the other hand, those that felt older may have led a sedentary lifestyle, gotten less sleep, had more stress, etc. Having said that, the perception that you are younger than your actual age definitely has benefits. It likely causes you to be more active, eat better, and want better for yourself. While this sounds logical, it had never before been demonstrated in such a large study. So the bottom line is: live forever young and it may help you live longer.
Thursday, December 11, 2014
Flu vaccine may be less effective this year
The Centers of Disease Control (CDC) put out a health advisory to physicians last week in regards to this year's influenza (flu) vaccine. The advisory stated that the vaccine this year may be less effective than usual because of antigenetically different or "drifter" strains that have surfaced. What does this mean? A quick run down on the influenza virus and vaccines in general will make this clear.
The influenza virus has many strains. These strains are structurally different just slightly, but enough to have their own identity. It's almost like hair color. It's still hair, but it can be black, red, brown, or even blue in some teenagers. In the same way, the influenza virus has differences. Every year, the flu vaccine is developed in order to provide immunity against the most common strain for that year. However, this is somewhat of a guessing game. The flu vaccine is actually developed earlier in the year with only a very small sample size of influenza strains that have been captured. For that reason, a flu vaccine does not cover every single strain of the flu, only the one(s) that we predict will be the most common this year.
That takes us back to this year's flu vaccine. This year it was predicted that a specific type of H3N2 strain of the flu would be the most common. So they developed the vaccine that was appropriate. Now they have discovered that as many as 50% of the strains in the population may be different than the strain that the flu vaccine covers. The strain is still H3N2, but it's like instead of having brown hair, you've thrown in red highlights. This subtle change is enough that the body will not be able to form antibodies to it and it can still lead to an infection.
The flu vaccine is never perfect because there are so many different strains and it is almost impossible to protect all of them. Even if the flu vaccine covers 100% of the most common strain for the year, you can still get the flu from uncommon strains. So the question is, do we vaccinate? The recommendation from the CDC is still to receive the flu vaccine because protecting against 50% of the strains is better than not protecting against any. What we will see though is that the flu season this year may be pretty bad in most parts of the country and more people will need anti-viral medications at the first onset of the flu. So remember to get your flu shot this year, just be aware that a brunette with red highlights may still spoil the party.
Have you or will you get a flu shot this year?
Tuesday, December 2, 2014
CDC says circumcision may be beneficial
Circumcision is an age old practice throughout the world and has become common practice in the United States as well. It is a procedure in which excessive foreskin from a newborn is surgically removed at birth. The thought is that removing the skin prevents germs from causing infections as a child and as an adult.
How is it done? Within a couple days of birth, a newborn is given sugar water to suck on and remain distracted. Then a small needle is used to inject numbing medicine at the base of the penis to make the entire penis numb. This works very well if done correctly. A special tool is then used to protect the penis and cut off the excess skin. The entire procedure takes 10 to 20 minutes to complete.
Anti-circumcision groups have said that this practice is inhumane and painful to a newborn. In reality, how much more painful is this compared to blood draws and vaccines? The most painful part is the injection for numbing, but this is again no different than shots and needles used to draw blood. The other question was, is it effective in preventing infections?
Today the CDC released guidelines that show circumcision can:
These are pretty significant points that the CDC is making. However, opposition groups will surely make a lot of noise to refute this. Personally, I have seen many patients that wish they were circumcised. Some patients get fungal infections frequently due to moisture, some with those infections mentioned by the CDC. In the end, every parent has a choice to make and nobody can fault them for their decision in either direction. With these new facts, it will also be interesting to see if insurance companies will have to cover the procedure as a standard of care. If this happens, expect more individuals to make the choice to circumcise.
How is it done? Within a couple days of birth, a newborn is given sugar water to suck on and remain distracted. Then a small needle is used to inject numbing medicine at the base of the penis to make the entire penis numb. This works very well if done correctly. A special tool is then used to protect the penis and cut off the excess skin. The entire procedure takes 10 to 20 minutes to complete.
Anti-circumcision groups have said that this practice is inhumane and painful to a newborn. In reality, how much more painful is this compared to blood draws and vaccines? The most painful part is the injection for numbing, but this is again no different than shots and needles used to draw blood. The other question was, is it effective in preventing infections?
Today the CDC released guidelines that show circumcision can:
- Cut a man's risk of getting HIV from an infected female by 50 to 60 percent
- Reduce the risk of herpes and HPV by 30 percent or more
- Lower the odds of urinary tract infections in infancy and penile cancer in adulthood
These are pretty significant points that the CDC is making. However, opposition groups will surely make a lot of noise to refute this. Personally, I have seen many patients that wish they were circumcised. Some patients get fungal infections frequently due to moisture, some with those infections mentioned by the CDC. In the end, every parent has a choice to make and nobody can fault them for their decision in either direction. With these new facts, it will also be interesting to see if insurance companies will have to cover the procedure as a standard of care. If this happens, expect more individuals to make the choice to circumcise.
Thursday, November 13, 2014
Mumps in the Anaheim Ducks locker room
Two Anaheim Ducks players, Corey Perry and Francois Beauchemin, have just been diagnosed with Mumps. This is a condition that is caused by a virus and presents with fever, headache, muscle ache, fatigue, and swelling of salivary glands. The most textbook presentation is a large swelling of the neck. Once a person is diagnosed with Mumps, the treatment is just supportive fluids, anti-inflammatory medications, and rest. Patients should be isolated for 5 days after they notice the symptoms to prevent its spread. Rarely, Mumps can lead to an inflammation of the testicles, ovaries, breasts, and in severe cases even infection of the brain or spinal fluid. Luckily, those are very rare cases and most patients will recover without any problems.
So why do we care about Mumps? Most people have never heard of it and most doctors will never see it in their careers so it should be relegated to textbooks right? The reason we rarely see Mumps in this country now is because of vaccination. Whether you remember it or not, almost all of us in the United States received the MMR vaccine which immunizes us against Measles, Mumps, and Rubella. Great, so if we are all vaccinated, why are we still talking about this? The reason is that there is a growing movement against childhood vaccines. For this reason, we are starting to see diseases such as Mumps and Measles again. The debate behind vaccination is something I will leave for another day, but I will say this. We are seeing diseases in the United States that were practically eradicated due to vaccines, and that is not a good path to head down. The Anaheim hockey team players will be just fine, but lets make sure to keep our ducks in a row when it comes to vaccination!
So why do we care about Mumps? Most people have never heard of it and most doctors will never see it in their careers so it should be relegated to textbooks right? The reason we rarely see Mumps in this country now is because of vaccination. Whether you remember it or not, almost all of us in the United States received the MMR vaccine which immunizes us against Measles, Mumps, and Rubella. Great, so if we are all vaccinated, why are we still talking about this? The reason is that there is a growing movement against childhood vaccines. For this reason, we are starting to see diseases such as Mumps and Measles again. The debate behind vaccination is something I will leave for another day, but I will say this. We are seeing diseases in the United States that were practically eradicated due to vaccines, and that is not a good path to head down. The Anaheim hockey team players will be just fine, but lets make sure to keep our ducks in a row when it comes to vaccination!
Wednesday, November 5, 2014
How many hours of sleep do you need every night?
For as long as I can remember, I was told that you need 8 hours of sleep a night. This was a common belief from mothers to doctors. But over the past several years, many studies have emerged that are changing that recommendation.
It turns out that 7 hours of sleep is the new magic number. Studies have shown that cognitive performance peaks at 7 hours of sleep and may deteriorate after. Additionally, some studies show that those that get 7 hours of sleep have lower mortality rates. These various studies provide strong support for the notion that "Seven is the new Eight."
I think these studies provide us with some solid guidelines on the number of hours we sleep, but are we getting seven solid hours of sleep? The answer to that question is much more important than the number of hours we sleep. Many people will feel that even though they sleep 7 hours a night, they still feel tired the next day. Unfortunately, sleeping 8 hours sometimes doesn't seem to be any better. The reason for this is obvious: sleep hygiene. Getting good sleep is better than getting more sleep. Here are some tips on getting better sleep.
Cell phone hibernation: You hate to leave your phone for a second, we all do. Putting your phone on silent and leaving it away from your bed is important to avoid its sounds and lights.
Water unloading: You're going to bed, not to a desert in Africa. No need to gulp a whole bottle of water before you try to catch some z's. Use the bathroom before bed and you'll avoid waking up in the middle of the night.
Early dinner: Eating dinner at least 2 hours before bed will prevent a heavy stomach and heartburn. Having a snack such as fruit is acceptable, but a bag of Cheetos probably isn't.
Treat weekends like weekdays: Long gone should be the days of summer in high school where sleeping in until noon or 2 pm was okay. If you sleep longer on weekends to make up for the previous week or the previous night, it may throw your sleep schedule off. Instead, go back to bed earlier that night and get your 7 hours.
Don't sleep in a sauna: Sleeping in a cooler room will provide better sleep than sleeping in a room that is warm. You can always pile on bedding if it's too cold, but colder temps will help you sleep much better.
I know all of these things are much easier said than done, but those should become eventual goals. Sleeping well will undoubtedly lead to more productivity the next day and likely reduce stress as well. Not only will you feel better, but you'll look better when you aren't caught sleeping in a meeting or in class. Sleep tight!
It turns out that 7 hours of sleep is the new magic number. Studies have shown that cognitive performance peaks at 7 hours of sleep and may deteriorate after. Additionally, some studies show that those that get 7 hours of sleep have lower mortality rates. These various studies provide strong support for the notion that "Seven is the new Eight."
I think these studies provide us with some solid guidelines on the number of hours we sleep, but are we getting seven solid hours of sleep? The answer to that question is much more important than the number of hours we sleep. Many people will feel that even though they sleep 7 hours a night, they still feel tired the next day. Unfortunately, sleeping 8 hours sometimes doesn't seem to be any better. The reason for this is obvious: sleep hygiene. Getting good sleep is better than getting more sleep. Here are some tips on getting better sleep.
Cell phone hibernation: You hate to leave your phone for a second, we all do. Putting your phone on silent and leaving it away from your bed is important to avoid its sounds and lights.
Water unloading: You're going to bed, not to a desert in Africa. No need to gulp a whole bottle of water before you try to catch some z's. Use the bathroom before bed and you'll avoid waking up in the middle of the night.
Early dinner: Eating dinner at least 2 hours before bed will prevent a heavy stomach and heartburn. Having a snack such as fruit is acceptable, but a bag of Cheetos probably isn't.
Treat weekends like weekdays: Long gone should be the days of summer in high school where sleeping in until noon or 2 pm was okay. If you sleep longer on weekends to make up for the previous week or the previous night, it may throw your sleep schedule off. Instead, go back to bed earlier that night and get your 7 hours.
Don't sleep in a sauna: Sleeping in a cooler room will provide better sleep than sleeping in a room that is warm. You can always pile on bedding if it's too cold, but colder temps will help you sleep much better.
I know all of these things are much easier said than done, but those should become eventual goals. Sleeping well will undoubtedly lead to more productivity the next day and likely reduce stress as well. Not only will you feel better, but you'll look better when you aren't caught sleeping in a meeting or in class. Sleep tight!
Thursday, October 23, 2014
Doctor being tested for Ebola
A doctor who participates in Doctors Without Borders is being tested for Ebola in New York City today. Craig Spencer, from Harlem, is awaiting results of his Ebola testing after he recently worked in an Ebola-affected country. He returned to the US within 21 days and has now developed a fever. The 21 day period is very important because this is the incubation period for Ebola and represents the time in which a person would present with symptoms. The fact that the patient has a fever does not alone mean he has Ebola since he could have a fever from a cold, stomach flu, etc.
Of note is that we still have not had a single person in the United States with Ebola that was infected outside of a hospital setting. The two nurses that are currently infected were both caring for a very sick Ebola patient and this patient was in close contact with Ebola patients in West Africa. This should come as somewhat of a reassurance that the general public is not contracting Ebola. While this is something that could change, Ebola seems to be pretty well contained in the United States.
The media has been hyping Ebola on an hourly basis, but I can't say that the public fear is entirely unrealistic. This is a deadly virus and it is now in the United States. It is, however, very important to remember that we only have 3 diagnosed cases and possibly one new one. Unless you travel to West Africa, this is still a contained disease and officials are cautiously optimistic that an outbreak is unlikely.
Of note is that we still have not had a single person in the United States with Ebola that was infected outside of a hospital setting. The two nurses that are currently infected were both caring for a very sick Ebola patient and this patient was in close contact with Ebola patients in West Africa. This should come as somewhat of a reassurance that the general public is not contracting Ebola. While this is something that could change, Ebola seems to be pretty well contained in the United States.
The media has been hyping Ebola on an hourly basis, but I can't say that the public fear is entirely unrealistic. This is a deadly virus and it is now in the United States. It is, however, very important to remember that we only have 3 diagnosed cases and possibly one new one. Unless you travel to West Africa, this is still a contained disease and officials are cautiously optimistic that an outbreak is unlikely.
Are you worried about Ebola?
Thursday, September 11, 2014
Domestic violence resurfaces in the NFL
This week's most popular news story has been the video tape of Ray Rice, an NFL football player, physically hitting his wife in an elevator. There has been a lot of discussion about the NFL's role in correctly punishing Ray Rice in a timely manner. The general population is rightfully furious about the gentle punishment Ray Rice initially received for knocking his wife out into unconsciousness. This type of violence cannot be tolerated in our society, and especially against women.
The National Coalition Against Domestic Violence estimates 42.4 million cases of domestic violence in the United States and 1 in 3 women will experience physical violence by an intimate partner. These are staggering numbers which need to be recognized by everyone in the community, but particularly by the NFL. Why should the NFL be recognizing this more than most other organizations or sports leagues? Because there may be some connection between on the field and off the field violence.
I did some thinking about how our minds work, and it seems very unlikely that our minds simply "shut off" once we leave the workplace. As a physician, I am around patients all day long and have the responsibility of figuring out what is wrong with them. This is a constant thought process with no breaks, even during lunch. When I'm not at work though, I watch sports religiously. I always find myself trying to diagnose an injury a player just had on the field, even when I'm not doing it intentionally. "Did he tear his ACL? I doubt it, he walked off the field, it's probably a bone bruise or he tore his meniscus." We as physicians do this all day long, whether it is physical health or mental health. Our minds never shut off. So the question is, does a football player have a switch that he immediately turns off when he leaves the field?
Football today is much faster and harder hitting than it has ever been. This can be seen in college football and also in the NFL. The game has changed so much since it started that we have gone from leather "helmets" to helmets that now try to detect physical force by computerized sensors. Clearly, the level of physicality has increased dramatically. So it makes me wonder, if these players are constantly hitting in practice, physically imposing their will in games, how do they shut off that switch of violence? This is where the NFL has a real problem. They want their players to be more physical, yet they have not done much to help them control this physicality off the field. Of course in the case of Ray Rice, it is not the NFL's fault that he brutally abused his wife. But was this a case of Ray Rice not being able to shut off the switch? What can the NFL do about this?
I think this goes back to the lack of attention paid to mental health in our country. Diseases such as depression and anxiety are somewhat taboo, and most people don't like talking about their feelings. We have no problem talking about how we fractured our arm or how our knee swells up, but talking about mental health seems to be such a touchy subject. If we, as ordinary people in society, feel so hesitant to talk about it, how does a massive NFL player talk about it? I think the NFL and college football really need to start addressing the mental health needs of their players. We can't expect them to tackle and sack players on the field and then expect them to just walk away and leave their aggression at the stadium. It's easy to say that most NFL players don't have a history of violence outside of the home, but that's not the point here. Most people also do not have cancer or pneumonia, but isn't that what we are also trying to catch before it worsens? It's about time the football organizations in this country spend time with their players and medical professionals to address violence and mental health. If they do that, we can all just sit back and enjoy the great game of football.
The National Coalition Against Domestic Violence estimates 42.4 million cases of domestic violence in the United States and 1 in 3 women will experience physical violence by an intimate partner. These are staggering numbers which need to be recognized by everyone in the community, but particularly by the NFL. Why should the NFL be recognizing this more than most other organizations or sports leagues? Because there may be some connection between on the field and off the field violence.
I did some thinking about how our minds work, and it seems very unlikely that our minds simply "shut off" once we leave the workplace. As a physician, I am around patients all day long and have the responsibility of figuring out what is wrong with them. This is a constant thought process with no breaks, even during lunch. When I'm not at work though, I watch sports religiously. I always find myself trying to diagnose an injury a player just had on the field, even when I'm not doing it intentionally. "Did he tear his ACL? I doubt it, he walked off the field, it's probably a bone bruise or he tore his meniscus." We as physicians do this all day long, whether it is physical health or mental health. Our minds never shut off. So the question is, does a football player have a switch that he immediately turns off when he leaves the field?
Football today is much faster and harder hitting than it has ever been. This can be seen in college football and also in the NFL. The game has changed so much since it started that we have gone from leather "helmets" to helmets that now try to detect physical force by computerized sensors. Clearly, the level of physicality has increased dramatically. So it makes me wonder, if these players are constantly hitting in practice, physically imposing their will in games, how do they shut off that switch of violence? This is where the NFL has a real problem. They want their players to be more physical, yet they have not done much to help them control this physicality off the field. Of course in the case of Ray Rice, it is not the NFL's fault that he brutally abused his wife. But was this a case of Ray Rice not being able to shut off the switch? What can the NFL do about this?
I think this goes back to the lack of attention paid to mental health in our country. Diseases such as depression and anxiety are somewhat taboo, and most people don't like talking about their feelings. We have no problem talking about how we fractured our arm or how our knee swells up, but talking about mental health seems to be such a touchy subject. If we, as ordinary people in society, feel so hesitant to talk about it, how does a massive NFL player talk about it? I think the NFL and college football really need to start addressing the mental health needs of their players. We can't expect them to tackle and sack players on the field and then expect them to just walk away and leave their aggression at the stadium. It's easy to say that most NFL players don't have a history of violence outside of the home, but that's not the point here. Most people also do not have cancer or pneumonia, but isn't that what we are also trying to catch before it worsens? It's about time the football organizations in this country spend time with their players and medical professionals to address violence and mental health. If they do that, we can all just sit back and enjoy the great game of football.
Friday, August 22, 2014
Torn ACL vs. Torn Meniscus
Knee injuries in sports are incredibly common because the knees are weight-bearing joints. Most sports require running and pivoting of the foot in order to change directions quickly. This can unfortunately lead to various types of knee injuries. I am always asked by patients and athletes the symptoms of knee injuries. Two very common injuries that athletes are curious about are a torn ACL and a torn meniscus. Both of these structures are very different and when injured, each have a unique presentation.
The ACL (Anterior Cruciate Ligament) is one of 4 important ligaments in the knee along with the PCL (Posterior Cruciate Ligament), MCL (Medial Collateral Ligament), and LCL (Lateral Collateral Ligament). It is responsible for holding the knee in place while also providing flexibility. The meniscus is cartilage that functions to cushion the inside of the knee. Here is a picture for some clarity (Photo credit fpnotebook.com):
The ACL (Anterior Cruciate Ligament) is one of 4 important ligaments in the knee along with the PCL (Posterior Cruciate Ligament), MCL (Medial Collateral Ligament), and LCL (Lateral Collateral Ligament). It is responsible for holding the knee in place while also providing flexibility. The meniscus is cartilage that functions to cushion the inside of the knee. Here is a picture for some clarity (Photo credit fpnotebook.com):
The classic presentation of an ACL tear is a buckling and hyperextension (bending back) of the knee with a pop. The pop in the knee can either be heard or felt by the athlete. Since the ACL has a very rich blood supply, it will bleed quickly and will lead to immediate swelling of the knee. The athlete is generally not able to keep playing that day once the ACL tears.
The meniscus, on the other hand, tears due to a twisting type injury where the two bones rub against the meniscus and cause a tearing. There is usually no pop in the knee. The meniscus has a poor blood supply and so it will bleed much more slowly and athletes will usually report swelling later that evening, 4 to 5 hours later. Many times an athlete is able to keep playing through the injury and it is only diagnosed a few days later.
Over the next few days, the symptoms are also very different. Those with an ACL may report that the knee feels unstable or feels like it will give out. The swelling may resolve and they may actually even be able to play again since the knee feels better. This may, of course, lead to further injury since the athlete is unaware of the underlying injury. An individual with a meniscus tear will have symptoms of pain, locking, or catching of the knee. They may also feel pain with activity as the torn meniscus continues to grind in the knee joint.
These are the basic signs and symptoms of an ACL tear vs. meniscus tear. These injuries can also get very complicated based on location of tear, degree of tear, and multiple injuries at the same time. As always, have your doctor evaluate your injury to avoid further damage!
Tuesday, August 19, 2014
What is ALS?
Recently, the ALS Ice Bucket Challenge has taken the nation by storm due to social media. It begins by an individual or a group pouring a bucket of ice on their head and then calling out 3 others to do the same. They then hashtag it with #alsicebucketchallenge or #icebucketchallenge. With this raised awareness, the ALS Association has received over 22 million dollars in donations. The challenge is fun to watch as your favorite celebrities and athletes take part, along with your neighbor next door. Everyone knows about the ice bucket challenge, but very few know about the disease itself. Here is a brief rundown:
What is ALS?
ALS stands for Amyotrophic Lateral Sclerosis. It is a disease that affects the motor neurons in our body. Motor neurons control muscle function, whereas sensory neurons allow you to feel things. In ALS, motor neurons slowly begin to die and patients begin to have muscle weakness and eventually loss of muscle function.
What are the symptoms of ALS?
The symptoms of ALS are not simple like the symptoms of a cold or flu. Each person can have very different symptoms. Some may have severe symptoms, other will start with very minor changes. These can include, weakness in one limb, trouble swallowing or breathing, slurred speech, or twitching or cramping of muscles. As the disease progresses, patients will have significant trouble breathing, chewing, swallowing, or speaking. These symptoms are very broad and can be caused by various other diseases, making the diagnosis of ALS a very tough one early on.
Who gets ALS?
Is there a cure for ALS?
There is no cure for ALS. There is a medication called riluzole which can help slow down the progression of ALS, but it is eventually a fatal disease.
How can you help?
Spreading the word is important, but donating to the cause at the same time is invaluable. You can donate to the ALS Association at http://www.alsa.org/. Your contributions will contribute to ALS research and hope to one day treat this debilitating disease.
In the end, I wanted to post a very funny Charlie Sheen #alsicebucketchallenge and also one by the Ohio State Buckeyes football team. Both are unique and entertaining.
Now it's your turn to take the challenge and make a donation!
What is ALS?
ALS stands for Amyotrophic Lateral Sclerosis. It is a disease that affects the motor neurons in our body. Motor neurons control muscle function, whereas sensory neurons allow you to feel things. In ALS, motor neurons slowly begin to die and patients begin to have muscle weakness and eventually loss of muscle function.
What are the symptoms of ALS?
The symptoms of ALS are not simple like the symptoms of a cold or flu. Each person can have very different symptoms. Some may have severe symptoms, other will start with very minor changes. These can include, weakness in one limb, trouble swallowing or breathing, slurred speech, or twitching or cramping of muscles. As the disease progresses, patients will have significant trouble breathing, chewing, swallowing, or speaking. These symptoms are very broad and can be caused by various other diseases, making the diagnosis of ALS a very tough one early on.
Who gets ALS?
- Higher incidence in men by about 20%
- Most commonly found in ages 40 to 50
- Only about 5% report a family history. Most cases are random.
- 5,600 people diagnosed annually with ALS in the United States
- Unclear who will get ALS and why. Research studies are ongoing.
Is there a cure for ALS?
There is no cure for ALS. There is a medication called riluzole which can help slow down the progression of ALS, but it is eventually a fatal disease.
How can you help?
Spreading the word is important, but donating to the cause at the same time is invaluable. You can donate to the ALS Association at http://www.alsa.org/. Your contributions will contribute to ALS research and hope to one day treat this debilitating disease.
In the end, I wanted to post a very funny Charlie Sheen #alsicebucketchallenge and also one by the Ohio State Buckeyes football team. Both are unique and entertaining.
Now it's your turn to take the challenge and make a donation!
Friday, August 15, 2014
Sunscreen and sun damage
This is a great video of how sun damage looks on the human skin and how sunscreen can help protect you. If you need help figuring out what type of sunscreen to buy, check out my earlier post at How to buy sunscreen. Feel free to ask any questions or comment below!
Wednesday, August 13, 2014
STD Tests
Sexually transmitted diseases, or STDs, are becoming increasingly common. I often see patients who would like to be tested for "all STDs". There are very different tests for the various STDs and it is important for patients to be aware of them. This is a simple breakdown of the various types of tests we currently use for the most common diseases.
Gonorrhea and Chlamydia - Urine test for men, urine or vaginal swab for women. Some women are able to have this during their PAP test but urine testing is available at all other times.
HIV - Blood test for screening. If this test is positive, a test to confirm the disease is also done through blood testing.
Herpes - There are two types of testing for this. The screening test is a blood test that tells you if you have ever been exposed to HSV (Herpes Simplex Virus), Type 1 or Type 2. It used to be that one type of herpes was found in the mouth and the other was genital herpes. However, that has now changed and either strain can be found in either site. Therefore, having a blood test to screen is not very useful because it will be positive even if you have ever had a cold sore. It does not indicate the presence of an STD.
The better test for herpes is a viral culture. This is when a patient has a fluid-filled blister that is popped open by the doctor and the fluid is sent for a culture to see which virus grows from it. This is a definitive test and much better than the inconclusive blood test
HPV - Human Papilloma Virus has many strains that can lead to genital warts in men and women, or cervical cancer in women. In women, HPV testing is done during a PAP test and can indicate which strain they are carrying. For warts, there is no blood or genital test for men or women.
Hepatitis - Blood testing is possible for Hepatitis A, B, and C.
Syphilis - A blood test is used for screening.
Trichomonas - Much more commonly tested in women if they have vaginal discharge or itching. Testing is done by a vaginal swab in women and a urethral swab in men.
STD testing is very important in sexually active individuals and has become easier than ever before. The topic may be somewhat taboo in the community and causes patients to withhold information from their health care provider. It should be treated as any other disease and tested for as soon as possible to prevent person-to-person transmission. See your doctor and get tested. It could save your life or the life of someone else!
Gonorrhea and Chlamydia - Urine test for men, urine or vaginal swab for women. Some women are able to have this during their PAP test but urine testing is available at all other times.
HIV - Blood test for screening. If this test is positive, a test to confirm the disease is also done through blood testing.
Herpes - There are two types of testing for this. The screening test is a blood test that tells you if you have ever been exposed to HSV (Herpes Simplex Virus), Type 1 or Type 2. It used to be that one type of herpes was found in the mouth and the other was genital herpes. However, that has now changed and either strain can be found in either site. Therefore, having a blood test to screen is not very useful because it will be positive even if you have ever had a cold sore. It does not indicate the presence of an STD.
The better test for herpes is a viral culture. This is when a patient has a fluid-filled blister that is popped open by the doctor and the fluid is sent for a culture to see which virus grows from it. This is a definitive test and much better than the inconclusive blood test
HPV - Human Papilloma Virus has many strains that can lead to genital warts in men and women, or cervical cancer in women. In women, HPV testing is done during a PAP test and can indicate which strain they are carrying. For warts, there is no blood or genital test for men or women.
Hepatitis - Blood testing is possible for Hepatitis A, B, and C.
Syphilis - A blood test is used for screening.
Trichomonas - Much more commonly tested in women if they have vaginal discharge or itching. Testing is done by a vaginal swab in women and a urethral swab in men.
STD testing is very important in sexually active individuals and has become easier than ever before. The topic may be somewhat taboo in the community and causes patients to withhold information from their health care provider. It should be treated as any other disease and tested for as soon as possible to prevent person-to-person transmission. See your doctor and get tested. It could save your life or the life of someone else!
Wednesday, August 6, 2014
Cervical cancer screening and HPV guidelines
The American Cancer Society estimates that 12,360 women will be diagnosed with cervical cancer in 2014. While rates of cervical cancer have declined over the years due to better screening measures, some women are not sure when they should begin the screening process. Cervical cancer is caused by a virus known as Human Papilloma Virus or HPV. The virus causes changes in the cells of the cervix and may lead to cancer. Fortunately, a PAP smear is a basic test for women that can detect these changes early and lead to more effective treatment. So when and how often do women need a PAP smear?
In 2013, ACOG (American College of Obstetricians and Gynecologists) released updated guidelines for cervical cancer screening as follows:
Cervical cancer is one type of cancer that can have a good outcome if proper screening practices are followed. We know that it is caused by a type of virus and we have ways to detect the virus and treat the disease if it has led to biologic changes. While many cases are detected in women without easy access to gynecological care, there are too many cases where patients have not followed up with their testing or are too hesitant to have a PAP smear. Physicians, male and female alike, recognize the fact that women find a PAP smear uncomfortable and this is completely understandable. However, if we do not take advantage of these great screening tools, we will lose to a disease that is preventable. So please see your doctor and get tested!
In 2013, ACOG (American College of Obstetricians and Gynecologists) released updated guidelines for cervical cancer screening as follows:
- Cervical cancer screening should start at age 21. This is different than previous guidelines that recommended starting at age 18.
- Women aged 21-29 should have PAP smears ever 3 years. This is different than yearly PAP smears which was recommended for a long time. Women may still need annual screening if they have any cervical changes present.
- Women aged 30-65 should have a PAP smear and HPV testing every 5 years or a PAP every 3 years.
- Women should stop having PAP smears after the age of 65 if they have not had any moderate to severe cervical changes
Cervical cancer is one type of cancer that can have a good outcome if proper screening practices are followed. We know that it is caused by a type of virus and we have ways to detect the virus and treat the disease if it has led to biologic changes. While many cases are detected in women without easy access to gynecological care, there are too many cases where patients have not followed up with their testing or are too hesitant to have a PAP smear. Physicians, male and female alike, recognize the fact that women find a PAP smear uncomfortable and this is completely understandable. However, if we do not take advantage of these great screening tools, we will lose to a disease that is preventable. So please see your doctor and get tested!
Friday, July 25, 2014
Gonorrhea and Chlamydia rates out of control
Gonorrhea and Chlamydia are very common sexually transmitted diseases in the United States. In fact, Chlamydia is the most commonly reported notifiable disease in the United States. Most commonly, these disease are spread by unprotected sexual intercourse. So how common are they?
According to the CDC, in 2010 there were a total of 1,307,893 cases of chlamydia reported in the United States. This accounts for 426 cases out of 100,000 population and an increase of 5.1% over the period 1990-2010. Gonorrhea came in as the second most common STD with 334,826 cases in 2012. The rate increased 4.1% since 2011 but decreased 2.9% between 2008-2012. These numbers are staggering!
These numbers may be rising in part due to the fact that we have better screening techniques to detect these diseases. At a doctor's visit, most adolescents and young adults will be recommended to have a screening exam for these diseases as long as they are agreeable to it. There are two types of testing: urine and swab. The urine test is for males and females and results are available within 1 to 2 days. The swab can be used for women when they are already having a PAP smear.
The problem is that those in their teens or twenties are either not seeing a doctor for symptoms, not being screened during routine visits, or are not taking their treatment medication. Treating these two diseases is not especially difficult as we have very effective antibiotics against them. Both the patient and their partner must be treated to prevent spread of the disease between individuals.
I think the battle we are losing is prevention. We are noticing that people are sexually active at a younger age now and with more partners. When we couple that with lack of protection or incorrect use of protection, we are headed for trouble. High schools still offer sex education, but the problem continues to grow. The responsibility is that of parents and the youth themselves. Parents must be ready to have those difficult conversations regularly as their children continue to grow. They should also ask that their children get tested and make it easy for them to do so by allowing them to speak to the doctor privately. Although privacy in STD transmitting is required by law, some parents try to stay in the room with their children when the doctor asks them to leave to discuss personal matters. This makes the child uncomfortable and may lead to the child withholding information.
We may never fully eradicate these two diseases, but we have to recognize their wildfire-like spread. Taking an active role in testing is the only chance we have to make a difference. Until we make screening for STD's as important as screening for cancers, we will continue to lose this uphill battle. Spread the word, not the disease.
According to the CDC, in 2010 there were a total of 1,307,893 cases of chlamydia reported in the United States. This accounts for 426 cases out of 100,000 population and an increase of 5.1% over the period 1990-2010. Gonorrhea came in as the second most common STD with 334,826 cases in 2012. The rate increased 4.1% since 2011 but decreased 2.9% between 2008-2012. These numbers are staggering!
These numbers may be rising in part due to the fact that we have better screening techniques to detect these diseases. At a doctor's visit, most adolescents and young adults will be recommended to have a screening exam for these diseases as long as they are agreeable to it. There are two types of testing: urine and swab. The urine test is for males and females and results are available within 1 to 2 days. The swab can be used for women when they are already having a PAP smear.
The problem is that those in their teens or twenties are either not seeing a doctor for symptoms, not being screened during routine visits, or are not taking their treatment medication. Treating these two diseases is not especially difficult as we have very effective antibiotics against them. Both the patient and their partner must be treated to prevent spread of the disease between individuals.
I think the battle we are losing is prevention. We are noticing that people are sexually active at a younger age now and with more partners. When we couple that with lack of protection or incorrect use of protection, we are headed for trouble. High schools still offer sex education, but the problem continues to grow. The responsibility is that of parents and the youth themselves. Parents must be ready to have those difficult conversations regularly as their children continue to grow. They should also ask that their children get tested and make it easy for them to do so by allowing them to speak to the doctor privately. Although privacy in STD transmitting is required by law, some parents try to stay in the room with their children when the doctor asks them to leave to discuss personal matters. This makes the child uncomfortable and may lead to the child withholding information.
We may never fully eradicate these two diseases, but we have to recognize their wildfire-like spread. Taking an active role in testing is the only chance we have to make a difference. Until we make screening for STD's as important as screening for cancers, we will continue to lose this uphill battle. Spread the word, not the disease.
Wednesday, July 23, 2014
How do you become a Doctor?
I often get asked by patients, friends, and family members - How do you become a doctor? How long do you have to go to school? I had similar questions before I entered the medical field and thought I would break down the numbers first.
1. 4 years of college. Your major actually does not matter as long as you take prerequisite courses that all medical school hopefuls take (i.e. 1 year of biology, 1 year of chemistry, 1 year of math, etc.)
2. 4 years of medical school. Everybody goes through the same general training where the first 2 years are spent in the classroom and the last 2 years are clinical with patient interaction.
3. Residency training, variable, 3-7 years. Once you finish medical school, you have to complete specific training in a residency program. These include Family Medicine, Internal Medicine, General Surgery, OBGYN, Pediatrics, etc. There are many types of residencies and you have to decide what you want to practice. Hopefully medical school gave you enough of an idea of what you like at this point.
4. Fellowship, optional, 1+ years. This is where you get to further specialize. Lets say you wanted to become a cardiologist. This would require you to first complete a 3 year residency in Internal Medicine, followed by a 3 year fellowship in Cardiology. This can get very confusing to say the least because you can specialize for years and years.
The variables are residency and fellowship, which can add up to up to 10 years. This is why most doctors will never be practicing independently until the age of 28 or 29, and some as late as 34 or 35. There you have it, the basic steps to becoming a doctor.
1. 4 years of college. Your major actually does not matter as long as you take prerequisite courses that all medical school hopefuls take (i.e. 1 year of biology, 1 year of chemistry, 1 year of math, etc.)
2. 4 years of medical school. Everybody goes through the same general training where the first 2 years are spent in the classroom and the last 2 years are clinical with patient interaction.
3. Residency training, variable, 3-7 years. Once you finish medical school, you have to complete specific training in a residency program. These include Family Medicine, Internal Medicine, General Surgery, OBGYN, Pediatrics, etc. There are many types of residencies and you have to decide what you want to practice. Hopefully medical school gave you enough of an idea of what you like at this point.
4. Fellowship, optional, 1+ years. This is where you get to further specialize. Lets say you wanted to become a cardiologist. This would require you to first complete a 3 year residency in Internal Medicine, followed by a 3 year fellowship in Cardiology. This can get very confusing to say the least because you can specialize for years and years.
The variables are residency and fellowship, which can add up to up to 10 years. This is why most doctors will never be practicing independently until the age of 28 or 29, and some as late as 34 or 35. There you have it, the basic steps to becoming a doctor.
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