The 10 most common reasons for visiting a doctor

Ever wonder why the doctor's office or urgent care is always so busy?  I thought it would be interesting to look at the most common chief complaints that patients present with at their doctor's visit.  I left out things such as "physical exam" and "prenatal exam" because those will obviously be significantly more common than medical problems.  According to the CDC, the most common chief complaints for which individuals saw a physician in 2008 were:

• Cough
• Symptoms referable to sore throat
• High blood pressure
• Knee symptoms
• Fever
• Skin Rash
• Abdominal pain
• Back symptoms
• Visual problems
• Earaches

To put the first two symptoms in perspective, it's interesting to look at the total number of visits for those complaints.  Cough accounted for over 26 million visits and sore throat accounted for over 17 million visits.  Of course these two conditions can also be attributed to things such as acid reflux, emphysema, smoker's cough, etc.  However, the majority of them are due to the common cold.  We also know that 90% of all colds are caused by viruses and resolve by themselves with symptomatic treatment that does not involve antibiotics.  So the next time you catch a cold, give it some time to resolve.  The guy with high blood pressure and knee pain thanks you.

Soccer player "Dead" for 78 minutes.

Fabrice Muamba is a soccer player who recently collapsed during a soccer match.  He suffered cardiac arrest on the field and CPR was begun immediately.  The medical staff worked on him for 48 minutes before he reached the hospital.  Resuscitation at the hospital continued for another 30 minutes until his heart began to beat independently.  This was also 15 shocks later from a defibrillator.  Fabrice is now in the ICU and has spoken his first words.  If you didn't believe in miracles or medical marvels, now is the time to think again.

This healthy and fit athlete is one of many that have suddenly collapsed during a sporting event, but his story of survival is certainly not the norm.  I assume he has hypertrophic cardiomyopathy (an enlargement of a portion of the heart) or one of several other conditions that can lead to sudden collapse.  With increased knowledge and improved response protocols, some of these athletes do survive this type of collapse.  The fact that Fabrice was shocked 15 times suggests that his heart did not necessarily stop completely for 78 minutes.  This is because the shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.  Without getting into the details of these, they both imply that the heart is pumping irregularly and ineffectively.  They do not indicate that the heart completely stopped.  Regardless of the details and actual events that took place, the story of Fabrice Muamba is pretty amazing.

Fabrice's survival was dependent on two things: his willpower and that of the medical team.  For a team to  perform CPR and resuscitation for 78 minutes is remarkable.  Even if individuals are switching off on CPR, those of us that have done chest compressions will tell you that it is exhausting!  It is also mentally challenging to continue when the outlook for resuscitation is dismal.  At the same time, I don't believe this type of resuscitation would have been successful in most individuals.  Whether Fabrice survived due to his level of fitness or due to his willpower or simply by luck, his story is one of encouragement.

With all the bad publicity that athletes and the medical field receive these days, this is an example of why we each do what we do.  Whether you believe in modern medicine or miraculous feats of survival, there is no denying the intentions of the medical team and that of a young man who refused to give up.  I'm not sure Fabrice will ever play soccer again or what his mental capacity will be, but at least he will have the opportunity to see another day.  He may not be Kobe Bryant and the Black Mamba, but he is Fabrice Muamba...and he has the heart of a champion.

Color Blind St. Patty's Day: I hope this is green!

If you can read the number "45" in the image on the right, you belong to the approximately 93% of the world that is not color blind.  For the rare 7% of us, that image is nothing but a circle of scattered, colored dots.  I know, it's hard to believe that some of us cannot see a number that is clearly sitting smack in the middle of that circle.  Welcome to the world of color blindness.

When those with color blindness tell their friends about their unique dilemma, the first two questions are: 1) "So you can't see any colors?" and 2) "What color is that over there?"  Color blindness is somewhat of a misnomer because true color blindness, the inability to see anything but black and white, is almost non-existent.  Instead, most people are red-green color blind.  This usually means that when the colors red and green are held together closely or presented in certain shades, an individual may be unable to differentiate between them.  I know that sounds ridiculous to those with normal color vision, but the problem is actually biologic.  Those with color blindness have defects in photopigments in their retina and are therefore unable to perceive certain colors correctly.  Furthermore, it is actually a genetic issue since the genes for these photopigments are on the X chromosome.  Without getting into the the mechanism of gene transmission, just know that this makes color blindness predominantly a male condition.  It is inherited from mothers that function as carriers but don't actually have the condition.

You might be wondering how people with color blindness can actually function normally.  After all, how do they know when to stop at a stop light?  Rest assured, there is a reason we pass our driver's tests and don't run into intersections on a daily basis.  The reason is that a stop light "red" actually does look red and the "green" does look green.  These shades are generally very easy to differentiate as are those of roses, plants, strawberries, blood, spinach, and apples.  The trouble arises with man-made objects: clothes, Google Maps traffic (come on Google, help us out!), confetti, school mascots, and TV.  So on this day, St. Patrick's day, don't discriminate against the guy at the bar and his brown t-shirt.  He just didn't have the luck of the Irish.

Wish you were a little bit taller? Hold that thought.

Limb-lengthening is a complicated procedure that is performed by various surgeons around the world, and now by several in the US.  It was initially intended for those with short stature or dwarfism, but it has now developed a cosmetic niche as well.  That's right, for $85,000 you can grow 6 inches in 3 months.  Sounds too good to be true?   That's because it probably is.

The process of limb-lengthening begins with a surgeon breaking your lower leg (shin) bones and then inserting telescoping rods into the space.  The rods then extend by about a millimeter a day, allowing new bone, nerves, and tissue to regenerate around it.  If that sounds reasonable, just think about it one more time.  Another individual actually breaks your bones and hopes that equally sturdy bone will form in its place.  While the procedure does work, it is not without complications.  A study in the journal International Orthopaedics found there to be frequent complications with this procedure (2006 study) including nerve damage, unequal lengthening, paralysis, and hip problems.  That does not include the possibility of weaker bone formation and possible fractures in the future.

If that didn't sound bad enough, how about the inability to use anti-inflammatory medications because they may suppress bone growth?  As a result, patient's end up on high doses of narcotics such as Vicodin, Morphine, etc.  I assume a portion of them now have to deal with addiction issues and withdrawals.  Not only that, but some individuals that travel overseas for the procedure return home and have to adjust these rods themselves by some sort of leg maneuver.  Tell me THAT doesn't sound painful!

I think cosmetic surgery has come a long way and has become very mainstream.  While no procedures are entirely safe, some are safer than others.  When someone undergoes rhinoplasty (a nose job), the surgeon has to break their nose and readjust it.   This is clearly not on the level of having your legs broken for 3 months and having to undergo strenuous physical therapy to try to get your function back.  I can understand the medical uses of the procedure, but the cosmetic use is certainly extreme.  The obsession with cosmetic surgery continues to grow, but its complications are often overshadowed by its glamour.  In the case of limb-lengthening, it's hard to imagine the benefits outweighing the risks, some of which are unknown.  Besides, longer pants are so much harder to find.

Core Exercise: Your body is asking for it!

What is your core and why is it so important?  The core is a group of muscles that functions to provide you stability, strength, and balance.  It is made up of your abdominal muscles, your back, and your pelvis (buttocks, etc.).  It seems like the term is thrown around by those that work out regularly and are in tune with their fitness, but the general public remains largely unaware of its importance.  You don't get a solid core by curling the biggest weights at the gym or running 3 marathons in 4 days.  They don't necessarily show up as the glamour muscles (biceps, triceps, chest, shoulders), but they may be the key to avoiding physical ailments in the future.

Think of your core as the foundation of a building.  You can build nice stairwells, add fancy windows, and throw on a ton of marble. However, if your foundation is weak, it is only a matter of time before everything falls apart.  This is essentially what happens as we age or fail to maintain a strong core.  Most people will develop arthritis in their back, have their back go out on them, become hunched over, or have trouble strengthening other parts of their body.  Even the most highly trained athletes work on their core because it allows them to lift heavier, be more flexible, and avoid long-term injuries.  This is the reason you'll notice some of the most popular workout videos now include core stability.  So pick something you like, whether it is cardio core, pilates, or even just planks to get started.  Here is a website that shows you basic core positions:

Basic Core Demonstrations

If you're looking for a fun cardio core workout, this one is free, fun, and intense:

Cardio Core Home Workout 101

It doesn't matter where you start, but it is important to include a Core workout in your routine.  Most of it can be done at home without any equipment so there is no reason to procrastinate.  And hey, if in the process you end up with a flat stomach or a 6-pack, so be it!

Smoking Hookah: Harmless or Toxic?

I frequently get asked if smoking hookah is harmless or just as detrimental as smoking cigarettes.  Hookahs have become increasingly popular in the United States and worldwide because of their social implications.  It usually involves sitting together with a group of friends, sharing one mouthpiece, and finding the best hookah bar or hookah party.  Unlike cigarettes, the tobacco used in hookahs comes in various flavors such a strawberry, mango, cappuccino, etc.  This flavor appeal has made it popular and given the impression that it is entirely harmless.  Its easy to see that cigarettes are harmful, but how can something that taste like watermelon be a bad thing?

So here are the facts, directly from the CDC (Centers for Disease Control) website.  They site various studies on their fact sheet (CDC Hookah Fact Sheet) and can be summarized as follows:

• Hookah smokers may absorb higher doses of the toxins found in cigarette smoke.
• A 1-hour long hookah smoking session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
• Charcoal used to heat the tobacco in a hookah produces high levels of carbon monoxide, metals, and cancer-causing chemicals.
• Hookah smoking can cause the same medical conditions and cancers as cigarette smoke.
• Second-hand smoke from hookahs contains smoke from the hookah and charcoal, posing an even higher risk for nonsmokers.

Before I read up about hookah smoking, I also figured that it couldn't be as harmful as cigarette smoking because hookah is smoked much less frequently than cigarettes.  However, doing the math suggests otherwise.  If smoking hookah for an hour involves inhaling 150 times the smoke from a cigarette and you only smoke it once a month, that is still equivalent to about a 150 cigarettes per month.  Thats about 3 cigarettes per day.  Then I think about the smoke from the charcoal that is used to heat the tobacco.  Would anybody sit and inhale the charcoal smoke from their barbecue for an hour?  Would you also share the same straw as 8 other people in one sitting?  I highly doubt it.  

It looks like Washington has taken note of the facts laid out by the CDC because hookahs are now receiving the same treatment as cigarettes.  There are many proposals to ban hookah bars and limit its use in public establishments.  We know one thing, and that is that hookahs will never become as popular as cigarette smoking.  Afterall, its not often that you see a person driving and smoking their hookah.  Driving while eating a bowl of cereal?  That's for another day.