10 New Year’s Resolutions For Doctors And Patients

#1 Doctor: Resolve to let patients speak without interruption and describe their symptoms.

Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15-minute office visit.

#2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend phone calls from the answering service, patients, or nurses.

Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling, and to use night and weekend phone calls for emergencies only.

#3 Doctor: Resolve to exercise a minimum of??four times a week for better health.

Patient: Ditto.

#4 Doctor: Resolve to train my staff and model excellent customer service for patients.

Patient: Resolve to understand that getting an instant referral, prescription, note for jury duty, or letter to my insurance company??from??my doctor is not my God-given right and I will stop??[complaining] if it doesn’t happen the day I request it.

#5 Doctor: Resolve to give at least one compliment a day to my office staff, child, and spouse.

Patient: Ditto.

#6 Doctor: Resolve to apologize when I am late seeing a patient who has been waiting.

Patient: Resolve to understand that when the doctor is late?? another human being needed attention. It might be me in the future who needs extra time.

#7 Doctor: Resolve to do one new thing a month that is novel (??See a??play? Travel? Do a special activity with a child or spouse? Learn a new computer skill? Play music? See a friend?)

Patient: Ditto.

#8 Doctor: Resolve to review all insurance payers and drop contracts that are not paying market rates for my skills and education. I will not go bankrupt.

Patient: Resolve to try and understand the medical economics that require my doctor to drop my insurance. If my doctor isn’t worth paying a little more for the visit, I will find a new doctor.

#9 Doctor: Resolve for each new prescription I write I will explain five things: The name of the medication, the reason for the medication, the side effects, how to take it, and how long to take it.

Patient: Once the doctor has prescribed a medication, I will take it as prescribed or let the doctor know right away if I am stopping it.

#10 Doctor: I will give thanks that I have a wonderful profession where I can help people in a special way.

Patient: I will not underestimate the many years of training and sacrifice my doctors have gone through and I will appreciate that they are trying their hardest to help me stay healthy.

                       

Your Hydration Needs Monitored By An Intelligent Water Bottle

Imagine a water bottle that knows how hard and how far you are running, how much you’re drinking, what’s the outside temperature, and, based on all these variables, the device calculates when you need to have a drink. Cambridge Consultants have developed the i-dration bottle that does just that.

From the press release:

Intelligent sensors in the i-dration bottle can be used to monitor the external temperature, drinking frequency and quantity, and this data is then sent via Bluetooth to its usera??s smartphone. The phonea??s inbuilt accelerometer and gyroscope can measure exercise levels, and by “fusing” the data from a heart rate chest-band and information pre-entered using the smartphone interface (such as height, age and weight), the application can perform an assessment of a usera??s hydration levels. The i-dration bottle then responds accordingly by flashing a blue light if the athlete needs to drink more.

i-dration demonstrates the work that Cambridge Consultants is currently undertaking in bringing mobile applications to life. a??Most people still perceive an a??appa?? to be something that performs a certain task, whether ita??s checking the weather or the latest sports results, in a virtual world. However, we believe that in the next 12 to 18 months we will see a plethora of new dedicated a??hardware apps,a?? such as the i-dration drinks bottle, that will work in tandem with a smartphone to enhance a range of consumer products and services ,a?? said Rachel Harker, Business Development Manager at Cambridge Consultants.

Press release: Real-time hydration advice from new ‘smart’ drinks bottle …

                       

The Key To Killing Common Warts: Patience

Ia??m sure I dona??t see as many patients with common skin warts as my family practice or dermatology colleagues, but these patients still make it to my office.?? Sometimes ita??s the primary complaint, sometimes ita??s an afterthought.?? In reviewing the topic, it occurred to me that most patients dona??t need to see any of us for this problem.?? They mostly need to accept the fact that the treatment takes TIME.?? So if you will persist, then you will often be successful without the expense of seeing a doctor.?? (photo credit)

Common warts (Verruca vulgaris) are caused by the human papillomavirus (HPV).?? Warts on the hands or feet do not carry the same clinical consequences of HPV infection in the genital area.?? It is estimated about 10% of children and adolescents have warts at any given time.?? As many as 22% of children will contract warts during childhood.

Common warts can occur anywhere on the body, but 70% occur on the hand.?? Often they will disappear on their own within a year.?? Even with treatment, warts can take up to a year to go away.

Before heading to the doctor, there are treatments you can try at home:?? salicylic acid or duct tape.

When using the 17% salicylic acid gel (one brand name: Compound W), it must be applied every day until the wart is gone.?? Only apply to the wart, not the skin around the wart.?? This treatment is enhanced by covering the wart with an occlusive water-proof band-aid or duct tape after applying the acid.?? It can also be enhanced by gently filing the wart with an emery board daily to remove the dead cells prior to applying the salicylic acid.?? Treatment can take weeks to months.?? Dona??t give up early.

Duct Tape can take weeks or months to be effective.???? Apply the duct tape to the wart and?? keep it in place for six days.?? After removing the tape, soak the wart, and pare it down with a filing (emery) board.?? Repeat the above until the wart disappears.?? Once again, dona??t give up early.

The two?? treatments (salicylic acid and duct tape) can be combined.?? Apply the salicylic acid liquid to the wart before bedtime.?? After letting it air dry for a minute or so,?? then apply the duct tape over the wart, completely covering the area. Remove the duct tape the following morning. Each time you remove the tape, you will be debriding some of the wart tissue. Repeat the application each night, until there is no remaining wart tissue.?? As with using only one treatment, dona??t give up early.

If the above dona??t work or you just dona??t want to take the time, then you may wish to see your physician for removal.?? He can use cryotherapy to destroy the wart.???? This method may involve repeated treatment over several weeks.?? You can do the following to a??get the wart ready for removala?? and make the cryotherapy more effective:

1. 
   Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel (one brand name: Compound W) on it.
   


2. 
   After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
   


3. 
   Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor’s office.
   


4. 
   After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.
   

If none of the above work, then your wart may need to be removed surgically.?? Remember the above all take time, so give them time to work.?? Even if the wart disappears with any of the above treatments, it may recur later.

Sources

Treatment of Warts; Medscape Article, May 27, 2005: W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD

What Can Be Done About a Hand Wart That Keeps Reappearing After Removal?; Medscape Article, May 31, 2007; Richard S. Ferri, PhD, ANP, ACRN, FAAN

Duct tape and moleskin equally effective in treating common warts; Medscape Article 2007; Barclay L.

Duct Tape More Effective than Cryotherapy for Warts; AAFP, Feb 1, 2003; Karl E. Miller, M.D.

                       

Brush Up On Heart Health

The British Medical Journal reported on a study of??toothbrushing and found that people with poor oral hygiene had an increased risk of cardiovascular disease and heart attack.

We’ve known for the last two decades that inflammation plays an important role in atherosclerosis.??Markers of low-grade inflammation like C-reactive protein are also shown to be higher in heart disease.

The Scottish Health researchers looked at the general population and followed a large subset with questions about their oral health.??They asked about frequency of dentist visits, toothbrushing, and controlled for many co-variables such as general activity, hypertension, smoking, height and weight.??They also collected blood for studies of??C-reactive protein as a marker of inflammation.??They removed from the analysis participants who had no natural teeth (edentulous) and??those with existing cardiovascular disease.

This elaborate and lengthy study showed that toothbrushing is associated with cardiovascular disease, and that subjects who brushed their teeth less than once a day had a 70 percent??increase in heart disease compared with people who brushed twice a day. The inflammation that periodontal disease causes is directly related to increased C-reactive protein and increased heart attacks.

Leave it to the Scotts and the Brits to remind us to brush and floss every day.

REFERENCE: British Medical Journal, 2010; 340: c2451.

                       

New Research On Alzheimer’s Disease

Data presented at the International Conference on Alzheimer’s Disease in Honolulu this week indicated that exercise and adequate vitamin D levels could help reduce risk for the disorder. Framingham Heart Study researchers found that risk for dementia was halved in “moderate to heavy exercisers” compared with more sedentary people, while researchers on a separate study found that vitamin D deficiency can greatly increase risk for mental impairment.

Another study found that injecting the compound florbetapir into the brain of patients with dementia and then performing a PET scan could help pinpoint the size and location of plaques.

Researchers also reported that tea consumption was linked to a slower rate of cognitive decline in older adults without cognitive impairment, but there was no dose response and more studies will need to be done to determine a definitive link. (CBS News, Wall Street Journal, Medscape)

                       

Driving Safe Cars Can Save Lives

New England Patriots NFL quarterback Tom Brady was on his way to practice when he crashed into a minivan which allegedly ran a red light.??His Audi S8 car T-boned the other vehicle a few blocks from his home.??A relieved New England Patriots owner Bob Kraft noted after the accident:

“[Tom] arched and prepared himself and we’re just lucky with the glass and angles. We have a lot to be thankful for. It was really a miracle…We’re very, very lucky. Patriot Nation is lucky he had his seatbelt on.”

Was it simply luck or good car design and mechanical engineering???Crumple zones and the passenger cage of a car when built for maximum safety decrease injury.??Yet, unfortunately, there is significant variability among safety in cars.??Brady walked?? away from the accident for a variety of reasons.

As a future hall of fame quarterback, Brady has lightning fast reflexes when analyzing defensive blitzes and options when throwing the football.??Quickly bracing himself for impact may have helped.??Wearing a seatbelt definitely helped. What may have helped the most was the type of car he drove.

Audi cars were recently recognized by the Insurance Institute of Highway Safety as Top Safety Picks with the manufacturer recognized with more models than any other luxury German car brand. Earning a Top Safety Pick requires that the vehicle receive a good rating in each of these categories — high-speed front and side crash tests, a rollover test, and protection against neck injuries after rear impact with evaluations of seat/head restraints.??Perhaps had celebrity Dr. Frank Ryan driven a top safety pick car despite his vehicle’s rollover, he might be alive today.??There is tremendous variability in a vehicle’s ability to protect its occupants which vary among manufacturers as well as models and model year.

Driving a safe vehicle should be as important as exercising regularly, eating healthy, and maintaining a good weight.??Much like quitting smoking or losing weight, the goal is to prevent premature death or disability.??Unintentional injuries are the leading cause of death for those under the age of 34 and the third leading cause of death for people between ages 45 to 54.??Motor vehicle accidents account for the majority of unintentional injuries.??In that moment, all of those healthy habits become meaningless, even for a superstar athlete.??You can do everything right, like Dr. Oz, and discover that you still can have a precancerous colon polyp.

Life happens.??Simply bad luck???Perhaps.??What can you do to mitigate the risk or bad luck further?

Plan for it the best you can.??In this case, having a car brand that is among the safest in the world, helps.??His car saved his life and saved his career.??It protected him from needing an emergency room visit and evaluation.??As a result, Brady simply walked away from the accident.??He made his practice a little while later and finished his drills with teammates.??He displayed no sign of injury or diability.

Was all of that worth the time and effort to find a car that is fun to drive and yet incredibly safe? You bet.??Don’t believe me? Ask his wife, Gisele Bundchen, and his sons Benjamin and John.??I’m sure they are glad to have him home safe and sound, even as he takes his hits on Sunday as the premier quarterback in the NFL.

                       

Nutritional Supplements: Do They Really Help Prevent Disease?

(Guest post submitted by MD Anderson Cancer Center)

Aisles in grocery stores and pharmacies are stacked with vitamins, minerals, herbs or other plants that you take in pill, capsule, tablet or liquid form. And, many of us buy these supplements and take them regularly, hoping to lower our chances of getting cancer and other diseases.

But do supplements really work wonders? Should you take them to help prevent cancer? Our experts say beware.

a??Dona??t be fooled by the label on the bottle,a?? says Sally Scroggs, health education manager at MD Andersona??s Cancer Prevention Center. a??Researchers are still unsure about whether or not supplements actually prevent cancer.a?? Some studies have suggested that supplements may actually increase cancer risk by tilting the balance of nutrients in the body.

Results from the Womena??s Health Study and The Physiciansa?? Health Study II found that vitamins E and C do not prevent cancer. The Selenium and Vitamin E Cancer Prevention Trial showed similar results, suggesting these supplements didna??t help prevent prostate cancer.

a??If you eat lots of vegetables, fruits, whole grains and beans, you should get the nutrients, including fiber, vitamins and minerals, your body needs to lower your chances of getting diseases like cancer,a?? Scroggs says. a??Taking a pill cana??t replace a healthy diet.a??

Not sure which foods get the job done??? See our list of recommended foods packed with cancer-fighting nutrients.

Supplements may benefit some

More research is needed to truly understand the relationship between supplements and cancer risk, according to the American Institute for Cancer Research.

Still, there are some situations when taking a supplement might do your body good. This is especially true for men and women who are not getting enough nutrients because of food allergies, genetics or chronic illnesses.

Here are a few examples of when supplements may be right for you:

• Women who are pregnant or breastfeeding


• People at risk for vitamin D deficiency


• People at risk for osteoporosis


• People at risk for B-12 deficiency


• People age 50 or older


• Vegans who consume no animal foods

Get professional advice

Thinking about taking supplements?

Speak with your doctor or a registered dietitian first. He or she can decide which pills you really need and what dose you should take. Keep in mind that there is no vitamin or supplement thata??s good for everyone.

A registered dietitian also can tell you what to look for on supplement labels. This is important because some supplement labels can be confusing or misleading. Many companies claim their pills can cure cancer when, in fact, they dona??t, according to a recent Congressional study.

a??Remember, supplements are just that a?? supplements,a?? Scroggs says. a??Even if your doctor recommends them, your top priority should be getting the nutrients you need from the food you eat.a??

Do your research and talk to your doctor before you add supplements to your diet

This article originally appeared on MD Anderson Cancer Centera??s Focused on Health e-newsletter. To read the full newsletter, click here. To subscribe to future issues, click here.

REFERENCES:

American Institute of Cancer Research

Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Journal of American Medical Association. 2009 Jan 7; 301(1):39-51.

Herbal Dietary Supplements: Examples of Deceptive or Questionable Marketing Practices and Potentially Dangerous Advice. U.S. Government Accountability Office. 26 May 2010.

Downloaded at http://www.gao.gov, 13 September 2010.

Physiciansa?? Health Study II: Vitamin E, Ascorbic Acid, Beta Carotene, and/or Multivitamins in Preventing Cancer and Cardiovascular Disease in Older Healthy Male Doctors

Vitamin E in the primary prevention of cardiovascular disease and cancer: the Womena??s Health Study. Journal of American Medical Association. 2005 Jul 6, 294 (1): 56-65.

a??

We would love to hear from you.?? Do you take vitamin and supplements??? Do you eat fresh fruits and vegetables??? How do you maintain a healthy diet?

[Image:?? Provided by MD Anderson Cancer Center]

                       

When Your Teen Starts Dating

healthline.com/blogs/teen_health/" target="_blank">

After you get over the urge to run and hide, lock your teen in the bathroom, shave his or her head, and save yourself, take a deep breath and think about what is important here.  You are likely panicked because you know that sooner or later someone will break your teens heart - and there is nothing you can do about it, or is there?

Talk to your teen and share what you are feeling as well as what you know. Being new to the world of love/lust/hormones, there are some really great conversations to be had now about balance, friendship, and healthy relationships! First, your teen may be overwhelmed with how wonderful it feels to be in love and you can help remind your teen about balance, and the importance of not losing themselves for love. Your teen needs to stay “true to self” instead of becoming an appendage to the new love. Encourage your teen to stay connected to friends, school, outside activities, family, and sports, while making room for the new love.

You might mention that if that becomes an issue, you can help by setting limits on the amount of hanging out at home, phone, text, and computer time,  to help her learn to balance life and love/lust/hormones. This is not a threat - just a supportive way to help your teen transition in the world of love!

Together you can set the expectations that honor this new part of life, make your teen feel listened to and involved with the new contract - the new couple spends time with the family, grades stay up, activities continue, chores, whatever else her life includes must all continue - because your teen has to be a “person” first before a girlfriend or boyfriend.  The We’re Talking web site has a great section called the abcs of healthy relationships, which will provide many reminders about knowing when a relationship is not healthy.

Along those same lines, it is important to talk about the importance of friendship - and how you want the first few months together to be spent with family - because early in relationships the goal is to learn to trust each other, find things that you have in common, and become parts of each others lives. Friendship is stronger in the long run than hormones - and if either member of the couple is motivated by anything else other than love - s/he will not make it through the “getting to know all about you” phase.

P.S. Remember that the greater the age difference, and the more time alone they share, the more likely teens will take new love to sexual realms, so be aware and good luck!

                       
                       

This post, healthline.com/blogs/teen_health/2009/06/when-teens-start-dating.html" >When Your Teen Starts Dating, was originally published on
                        healthline.com/"  target="_blank">Healthine.com by Nancy Brown Ph.D..

How To Track Epilepsy Online

Ia??ve written about several sites that let users track parameters related to their health management.

Here’s another example, SeizureTracker.com, that tracks seizure activity, appointments, and medication schedules through a simple calendar interface. You can download printable seizure logs or receive customized reports which include graphs comparing seizure activity and medication dosages.

SeizureTracker.com is dedicated to providing people living with epilepsy and their doctors with free comprehensive tools to help understand relationships between seizure activity and anti-epileptic medications.

Our hope is that this website will empower people with epilepsy to become active leaders in their own treatment, working hand-in-hand with doctors.

The reports generated by SeizureTracker.com become a valuable communication aid when meeting with doctors because all the necessary information is in one brief report.

                       

Same Sex Vs. Opposite Sex: What’s The Rule On Friendship?

I’m stealing a post from Jay at Two Women Blogging entitled “Was Harry Right?” Here’s their post, and I discuss it below:

Was Harry Right?

Bluemilk got me started thinking about this. I first heard Harry’s thesis advanced by the resident I worked with on my med school psych rotation. She assured me that while I might think I had platonic friendships with men, the men didn’t see it that way. I was pretty sure they did see it that way. I wasn’t naive, I was engaged to be married and had done my share of dating and flirting — I knew what it felt like when a man was interested in me sexually and I knew the difference. I still know the difference, and I still have men friends. For most of my life, my closest friends have been men.

I had a best girlfriend growing up, but we weren’t together very much — she lived in a different neighborhood and had a lot of afterschool activities and we weren’t usually in the same class at school. We didn’t trade sleepovers and call each other to check our outfits and have long closed-door talks like Eve does with her friends. My day-to-day best friend, the person I hung out after school with and rode bikes with and watched TV with and waded in the creek with, was the boy across the street. We were inseparable until he moved away when we were ten.

During that same psych rotation, we had a lecture on child development in which I learned that “all children” had a same-sex best friend during latency. I asked the lecturer afterwards what would happen if a child had an opposite-sex best friend during that period, and she said “gender development would become abnormal.” Perhaps that explains it.

I started to seek out and cultivate female friendships when I was in med school, but I find I still gravitate toward friendships with men. I am blessed, now, with wonderful women friends, and I’m deeply grateful for them, but I still think my psych resident — and Harry — were wrong.

************************************************

I picked this post to blog about because 1) I like the “When Harry Met Sally” clip and 2) these kinds of black-and-white statements about??”how life works”??come up all the time in therapy.

In the case above, the teacher tells the student that during latency one must have a same-sex best friend. “Must.” If not, the person grows up to be “abnormal” in their gender development. Show me the science. but first define for me “normal” in terms of gender development. And who out there has “normal” gender development? What’s the goal — Martha Stewart? Barbie? Elana Kagan? J Lo?

What comes up more often in therapy is the question of can you be friends with an ex-girlfriend or ex-boyfriend? An ex-husband or ex-wife? I tend to think that it’s usually hard, but there are people who do it, so counseling that “you can’t be friends with an ex” or “you can’t be friends with a member of the opposite sex” — or pretty much any??absolute –??seems, well, not evidence-based.

My personal favorite piece of advice to give along??this line is to tell people to stay away from the person they are so painfully breaking up with for a good long time, at least until all parties are no longer in love and have moved on with their lives. Now all I need is a movie scene.

                       

Consider Medical Conditions Before Jumping On The New Year’s Resolution Diet-And-Exercise Bandwagon

The first week of January was full of news reports of giving advice on your new diet and exercise program to help you lose the weight you’ve always wanted to. In a previous post and video I talk about some do’s and don’ts when planning for your weight loss New Year’s resolution.

In the video below, I talk about some medical issues to keep in mind before starting your program. For example,??do you have??a family history of medical problems like high blood pressure or diabetes? If so, you may want to schedule an appointment with your personal physician before jumping on the diet and exercise bandwagon.

If you find??this video helpful, I invite you to check out other TV interviews at MikeSevilla.TV. Enjoy!

                       

5 Tips On How To Be A Healthcare Survivalist

There are plenty of a??survivalistsa?? out there who stock their basements with canned goods, getting ready for some unexpected (and unlikely) apocalypse. Meanwhile there are things that are much more likely to happen to you — like getting sick — which many of us dona??t prepare for at all. So to help you get started, here are five important tips on how you can become a healthcare survivalist:

1.?? Take care of your chronic conditions. Whether ita??s high blood pressure, diabetes, high cholesterol, depression, asthma or any other kind of ailment, do what it takes to manage your own care.??Take your medications and follow your doctorsa?? instructions.??Why? Because if you dona??t, your condition can get worse and lead to even more serious problems.??As much of a pain as it may (literally) be, therea??s a reason the old saying a??an ounce of preventiona?? still resonates today — because ita??s true.

2.?? Live a healthy lifestyle. Everyone gives you this advice, but with studies showing that 42% of Americans will be obese by 2050, it doesna??t seem to be getting through.??Denial can wonderfully appealing;?? but when it comes to your health, it can also kill you.??Stop smoking, exercise, and eat right.??You may find that your employer has programs in place that will help you do all of those things, and many of them work. Why not give one of them a try???You cana??t improve your life all at once, but you can start.??Your life will be happier if you keep yourself healthy.??So rather than whistling past the graveyard, jog past it.

3. Make sure you are well-insured. You may not have the greatest insurance plan through your job, but there are things you can do to protect yourself on your own. For example, most insurance doesna??t pay the full cost of long term care.??This is the kind of care you might need if you end up needing home nursing care or have to live in an assisted living facility.??That can be very costly.??You should buy long-term care insurance to cover these expenses and serve as a cornerstone of your health care survival plan.??Studies show that 60% of seniors will need long-term care at some point in their lives — and Medicare doesna??t cover it.??Oh, and ita??s not just a problem of the elderly.??About 40% of people getting long-term care are between 18 and 64.

There are other kinds of insurance you can buy, too, depending on the state in which you live.??These might be plans that supplement your health coverage, or cover other expenses of illness.??The best advice:?? Research your options, find an insurance broker you trust, and figure out a plan that helps protect you from the financial toll of illness.??Also keep in mind that your employer may offer, on a voluntary basis, a number of these kinds of programs at cheap prices — check them out and see if they make sense for you.

4.?? Know your family history. Ita??s a little hard to believe in the 21st century, but it turns out that an old-fashioned knowledge of your familya??s medical history can be some of your best protection.??It can help your doctor know whether you have a higher risk for certain illnesses.??And it can also help him or her know whether that symptom youa??re complaining about is a sign of something other than what it seems to be.??A surprising study recently showed that a family history can be better than even genetic testing at predicting your likelihood of disease.????The Surgeon General has a neat tool that can help you get started. The more you know about your familya??s medical past, the better off you and your doctors will be in your medical future.

5.?? Ask Questions. No matter how well you prepare and try to protect yourself, at some point you may still end up seriously ill. Hopefully, if youa??ve taken good care of yourself and have all of your information in order, youa??ve put yourself in the best position to make it through.??But therea??s still so much more you can and should do.??The world is full of well-intentioned, highly skilled, and hardworking doctors.??The trouble is, they work in a system that makes it very difficult for them to do their jobs.??So, ask questions, and use every resource available to you to make sure youa??re getting the right medical care.

                       

Got GERD? Find Out If You’re At Risk For Esophageal Cancer

If you’re from a Western country, there’s a 10-20 percent chance that you suffer from classic symptoms of??acid reflux: chronic heartburn and/or acid regurgitation.

But if you don’t have those classic symptoms you may still have acid bubbling up from the stomach into the esophagus, a condition called “gastro-esophageal reflux disease” (GERD).  Over the past decade, research has suggested that acid reflux can cause atypical symptoms such as cough, hoarseness, sore throat, asthma, and even chronic sinusitis.??GERD can also cause chest pain, especially if the acid causes the muscle in the esophagus to go into spasm.

As an internist and gastroenterologist, I’ve seen patients who have suffered for years with atypical symptoms of GERD get better with treatment.  Although I usually prescribe acid-reducing medication, I try to avoid an approach that relies exclusively on “better living through chemistry.”  In fact, my goal is to treat the symptoms with life-style adjustments alone if possible.  Smoking and obesity both increase acid reflux and must be addressed.  I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods.  If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help.

The most serious consequence of chronic acid reflux is??esophageal cancer.  About ten percent of patients with long-standing acid reflux develop changes in the swallowing tube that increase the risk of developing adenocarcinoma, a deadly cancer with a 5-year survival rate of less than fifteen percent.  The condition is called “Barrett’s esophagus. “Fortunately, only about??one in 200 patients with Barrett’s esophagus develops cancer each year. And over the last year a treatment called??”radiofrequency ablation” has been found to be extremely effective in treating Barrett’s esophagus that is starting to show signs that it may turn into cancer.

It’s estimated that almost??15,000 Americans will die from esophageal cancer this year. Fifty years ago, more than 95% of esophageal cancers were “squamous cell” - the kind caused by smoking and excess alcohol use.  As smoking has declined, the incidence of squamous cell carcinoma has dropped.  But for reasons that are not clear, esophageal adenocarcinoma - the kind linked to acid reflux (and smoking) - has dramatically increased over the past forty years and now accounts for about half the cases of??esophageal cancer. From??1975 to 2001 there was a 600 percent rise in??esophageal adenocarcinoma. The obesity epidemic may well be playing a role by??increasing the number of adults with acid reflux.

Gastroenterologists can diagnose acid reflux by slipping a thin, flexible instrument (endoscope) through the mouth and down the esophagus.  It’s a lot easier than it sounds.  Patients are usually given sedation and the back of the throat is sprayed with numbing medicine to avoid gagging.  There’s no problem breathing because the tube doesn’t go into the breathing tube (the trachea).  Biopsies can be taken from the last part of the esophagus to look for microscopic evidence of Barrett’s and inflammation (esophagitis) caused by acid reflux.

There is currently a controversy about who should be endoscopically screened to look for evidence of Barrett’s esophagus.  Only a fraction of the millions of patients with chronic reflux will ever develop Barrett’s.  And many patients with Barrett’s have no symptoms at all. In a??study in Sweden, 1.6% of the population had Barrett’s but only about 40% had heartburn. And only about half of??esophageal adenocarcinoma is estimated to be a result of reflux.

The American College of Gastroenterology??recommends against screening the entire population but says it may be appropriate in certain populations at higher risk - such as Caucasian males over 50 with longstanding heartburn. That would be me.  So for this week’s episode of CBS Doc Dot Com, I underwent an upper endoscopy, explained and performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center.  For more information about the Jay Monahan Center,??click here.

For information about GERD from the American Society for Gastrointestinal Endoscopy,??click here.

To watch my upper endoscopy,??click here:

Watch CBS Videos Online

Mammography And Jack Black’s “Boob Saver 5K”

This video has been available for months, but I just saw it for the first time. I suspect many women would get a chuckle from seeing the always buffed, ripped, and jacked comedian Jack Black partially disrobe to put his breast in a mammography machine — or as he calls it, the “Boob Saver 5K.”

                       

Holding Hands Is Good For The Heart

A trained observer is what most electrophysiologists are. And being a trained observer carries over into real life, as would the handiness of??a plumber, or the strength of??a brick layer, or the wordsmithing of??a journalist.

Will and I drive??past our house.

“Where are we going now,” he asks in the exasperated tone of a 13 year old.

I need to take a picture.

Why?

Because middle-aged patients who’ve recently realized that their life is half over often seek clues to longevity.

Let’s take stressed-out, middle-aged patients who’ve??somehow been rendered free of AF (maybe by a skillful ablation, or more likely just happenstance). Let’s also say they don’t smoke, drink excessively, have normal blood pressure, normal blood sugar, and aren’t obese. Is there anything else they can do to live longer, they often ask? Yes, I believe there is.

It’s pictured here:

If the final common pathway of successful aging lies in soothing the effects of life’s inflammation, this picture speaks volumes. These two neighbors have been happily married for nearly 65 years. They walk by our house hand-in-hand nearly every day. They talk to each other and they like each other. Trained observer or not, this is obvious.

He’s had significant heart disease for a very long time, but miraculously it has remained strikingly dormant.

There are oodles of websites proclaiming that healthy relationships are a key component of longevity. This I believe. The anti-inflammatory effect of real companionship cannot be mathematically measured as yet, but it’s likely as equally potent as statins or beta blockers, and surely greater than stents.

You can stomp through life like Philip Roth’s??”Everyman” (who perhaps is not-so-ironically ravaged by vascular disease) or you can choose the picture above. Choices. Always, there are choices.

JMM

                       

All About Hands: Guidance And Germs

Some interesting items this week involving hands.??The one which has gotten much news coverage is the issue of handwashing. Take a look at some of the headlines:

High five! Handwashing on rise (Chicago Sun-Times)

For Many, ‘Washroom’ Seems to Be Just a Name (The New York Times)

93% of women wash their hands vs. 77% of men (USA Today)

All the above are reporting on the same study, but the difference in presentation is amazing to me.

The study doesna??t involve handwashing in a hospital or doctora??s office setting.??The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of handwashing compliance is helpful or not.??Do we inflate our numbers to make ourselves look better?

Public reporting creates an incentive to maximize performance but does not specify the manner in which this is achieved. Broadly speaking, 2 approaches are possible. Hospitals can adopt evidence-based strategies designed to improve patient outcomes that will also improve the publicly reportable indicator, or they can adopt indicator-based strategies designed to improve the reported indicator that may not improve outcomes and may even cause harm. Evidence-based improvement strategies would be favored in an environment in which organizations focus on improving patient outcomesa??when such strategies exist and are easy to implement. Conversely, indicator-based improvement strategies would be favored in an environment in which the hospital focuses on protecting its reputation, when evidence-based improvement strategies are unproven or resource intensive, or when measurement of the indicator is easily manipulated to show improvement.

I wish copyright laws would allow me to reproduce the entire essay from a recent issue of JAMA (first reference below).??The essay is written by Ariela Zenilman about her fathera??s hands.??An excerpt:??

Between the scrapes from paper cuts, the finger on which a ring is worn, and the color of nail polish, the hands of the human body tell a story. They are the most mysterious reflection of character. The hands…surgeons are blessed with steady hands for a reason: They reduce the trembling in the hands of worried family members, counteract pain and destruction, and alter creation for the better by fixing fault and disease within the body. A surgeon has the remarkable gift of a set of multifunctional and dexterous hands.

I have always admired my father’s hands. From a very early age I could tell his grace and dedication to detail were apparent in how he moved and touched, felt and experienced the world around him. His hands seemed inexplicably and effortlessly linked to his every thought: as a young child I always dreamed of having hands like his.

When I see my father’s hands…his hands are a mere reflection of his heart, an attribute I hope to see in my hands as I follow in his footsteps.

Hands reflect ability, accomplishment, and passion. I have learned to trust my instincts, follow my heart, and, most of all, not to underestimate the power of my own hands.

??I love hands.??I have been in love with the anatomy and mechanics of hands since medical school. Before then I just loved to watch them work (my mother making biscuits, my teachera??s writing, basketball players shooting baskets, pianists, etc).??

For the general public, wash your hands — flu season is upon us.

For us involved in patient care, wash your hands before and after each patient.??This is one — if not the best — of the best lines of defense in preventing the spread of infection.

REFERENCES:

The Hands That Guide Me; Ariela Zenilman; JAMA. 2010;304(10):1049. doi:10.1001/jama.2010.1291

Public Reporting of Hospital Hand Hygiene Compliancea??Helpful or Harmful?; Matthew P. Muller; Allan S. Detsky; JAMA. 2010;304(10):1116-1117.

Finger and Wrist Exercises (April 19, 2010)

                       

Friends And Searching For Health Information Online

Turning to friends for online information is the hot topic within the Web world, and in Mondaya??s New York Times Technology and Business section, Jenna Wortham writes about how a??Search Takes a Social Turn.a??

Online sites are taking notice of what people like.??Web companies are trying to make searching online for information more useful by tapping into the inner thoughts of what people like:

After a decade when search engines ruled supreme a?? tapping billions of Web pages to answer every conceivable query a?? many people now prefer getting their online information the old-fashioned way: by yakking across the fence.

Turning to friends is the new rage in the Web world, extending far beyond established social networking sites and setting off a rush among Web companies looking for ways to help people capitalize on the wisdom of their social circles a?? and to make some money in the process.

Listening and communicating

Listening and communicating with our friends can prove to be invaluable at times, and often they are our springboards for sharing our latest woes or trumpeting our successes.??Whatever the case, friends are ruling the social networking world and frankly their opinion matters. Friends can be invaluable, and the geniuses behind new technology companies are taking notice and creating online sites focused on what friends are sharing with friends.

Trust and better recommendations

We trust our friends, and one company taking notice of the friendsa?? trust factor and creating its content based on smart recommendations is a New York City start-up company, Hunch.

a??Hunch, a start-up based in New York, wants to go beyond cataloging the places and products for which your friends have already expressed affection. With some complex software, it tries to use that information to predict what other things you might like, even if nobody you know has ever offered an opinion on those things before,a?? writes Wortham.?? a??The service pulls in data about articles, topics and people that you and your friends have a??likeda?? on Facebook or follow on Twittera?|a??

Friendsa?? offer valuable information

While we value our friendsa?? opinions for the latest recommendations in movies, restaurants, hotels, TV shows, electronics and more, I was curious to find out if they are talking about health.

Health category

I dug a little deeper into Hunch and indeed, the health category is covered.??Sparingly, but people are talking about health.

From a??Ways to De-stress,a?? to a??Healthy Eating Habits,a?? to a??Exercises for Losing Weight,a?? and from Blood Pressure Monitors,a?? and a??Diabetes Monitoring Devices,a????to a??Cancer Specialist Hospitals,a?? to a??OTC Allergy Remedies,a?? and a??Yoga DVDs ,a?? to name a few; friends on are sharing their opinions, and Hunch has tapped into that.

The long-term goal is for Hunch is for a??a user to be able to come to Hunch looking for a smart recommendation on just about any topic, and after answering a handful of questions, get as good a recommendation as if she had interviewed a group of knowledgeable people or done hours of careful research online,a?? stated on the companya??s website.??a??Eventually, when Hunch gets good enough, we hope users will trust its recommendations without having to turn to lots of external time-consuming sources of information.a??

Friends are offering good recommendations to De-stress.??Take a vacation, read a good book and listen to music are the first three suggestions that round out the 49 recommendations.??Additionally, a??prosa?? and a??consa?? in some instances are mentioned and by clicking a??Learn morea?? you can find where the recommendation originates from.

Number 23 is from Andrew Weil, M.D. and offers the recommendation for a??Breathing exercisesa?? and thata??s a great tip to De-stress.

Be cautious

Caution comes when you get to number 49.??a??Take a Lorazepam,a?? that is the recommendation to De-stress.??While there is a a??cona?? listed that states, a??Cons: This is a powerful anti-anxiety pill that should not be taken unless a person has clinically diagnosed anxiety. There are very serious side effects including withdrawal once stopped,a?? it makes sense for you to be in charge of your health and research a little further.

Along the same line is a??OTC Allergy Remedies.a????While your friends may be taking something to help their allergies, it doesna??t mean ita??s right for you.

Finding out from friends about the best movies, restaurants and travel is extremely helpful.??Finding health information can be very useful as well, however you should always check with your healthcare provider before diving into uncharted territories.

Friendly reminder

Our friendsa?? opinions are important to us, but ita??s also helpful to go to more than one source when searching for health information.??There are excellent health sites and blogs online that offer extremely useful and accurate information.??Always take the extra step when it comes to your health to find out whata??s right for you.??Be in charge and be an empowered health consumer.

Turning to friends

Clamoring with our friends about the latest gadgets, the hottest fashions, the best movies, favorite places to visit and health topics have captured the attention of technology companies, so remember your suggestions can impact many, many people in the social world.??What you like is impacting the way companies are creating technology.??Simply, your opinion matters.

Your turn

How important do you think your suggestions and recommendations are to your friends?

[Image - iStockphoto]

                       

How Much Calcium Do Teen Girls Need?

healthline.com/blogs/teen_health/" target="_blank">

I went to a great grand rounds the other day about health-alliance.com/living/Women/women_05-01.html" >osteoporosis and learned that all teenage girls should be taking about 1,500 mg of calcium with Vitamin D a day in addition to a multivitamin. Three glasses of milk provide about 1,200 mgs, but most teens are not drinking that much milk. Dark green vegetables are another good source of calcium. Exercise and weight-bearing activity is also important in the prevention of osteoporosis.

Calcium is a mineral that gives strength to your bones. Calcium is also necessary for many of your body’s functions, such as blood clotting and nerve and muscle function. During the teenage years (particularly ages 11-15), your bones are developing quickly and are storing calcium so that your skeleton will be strong later in life. Nearly half of all bone is formed during these years.



Women develop most of their bone strength before they are between 25 and 35. After       that, bone is broken down faster than it is created, leading to a small loss of bone mass every year. For women, bone loss       accelerates during menopause, but slows       again around age 60.

There are specific risk factors for osteoporosis that teens should know:

• Being white;


• Having irregular periods;


• Doing little or no exercise;


• Not getting enough calcium in your diet; Being below a normal weight;


• Having a family history of osteoporosis;


• Smoking; and


• Drinking large amounts of alcohol.

Osteoporosis can be prevented, but teens need to start early.

                       
                       

This post, healthline.com/blogs/teen_health/2009/06/teenage-girls-and-calcium.html" >How Much Calcium Do Teen Girls Need?, was originally published on
                        healthline.com/"  target="_blank">Healthine.com by Nancy Brown Ph.D..

Treating Depression And Panic Disorder Via The Internet

According to a doctoral thesis to be presented by Jan Bergstr??m at the Karolinska Institutet in Sweden, cognitive behavioral therapy (CBT) via the Internet is just as effective in treating panic disorder as traditional group-based CBT. It’s also apparently efficacious for the treatment of mild and moderate depression.

Access to conventional CBT is limited in Sweden, so an Internet-based CBT was developed in which the patient undergoes an Internet-based self-help program and has contact with a therapist by email.

In a randomized clinical trial of 104 patients with panic disorder, both treatments worked very well and there was no significant difference between them, either immediately after treatment or at a six-month followup. Internet treatment was more cost-effective than group treatment.

Analysis of the results for the treatment of depression show that Internet-based CBT is most effective if it’s administered as early as possible. Patients with a higher severity of depression or a history of more frequent depressive episodes benefited less well from the Internet treatment.

Karolinska Institutet: Panic disorder and depression can be treated over the Internet…

Bergstr??m’s thesis: Internet-based Treatment for Depression and Panic disorder : From development to deployment…