CasesBlog - Medical and Health Blog

How to evaluate a patient with chronic cough?

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 21:52:55 PST

Initial evaluation of chronic cough (defined as more than 8 weeks' duration in adults and 4 weeks in children) should include a chest radiography (CXR) in most adult patients.

Patients who are taking an angiotensin-converting enzyme inhibitor (ACEi) should switch to a medication from another drug class.

Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).

The most common causes of chronic cough in adults are:

- upper airway cough syndrome (post-nasal drip)
- asthma
- gastroesophageal reflux disease (GERD)
- any combination of the above

If upper airway cough syndrome is suspected, a trial of a decongestant and an antihistamine is warranted.

The diagnosis of asthma can be confirmed with a clinical response to empiric therapy with inhaled bronchodilators or corticosteroids (spirometry is generally preferred though).

Empiric treatment for gastroesophageal reflux disease (GERD) should be initiated in lieu of testing for patients with chronic cough and reflux symptoms.

Patients should avoid exposure to cough-evoking irritants, such as cigarette smoke.

Further testing may be indicated if the cause of chronic cough is not identified and includes:

- high-resolution computed tomography (CT) of the chest
- referral to a pulmonologist or an allergist

In children, a cough lasting longer than 4 weeks is considered chronic.

The most common causes of chronic cough in children are:

- respiratory tract infections ("bronchitis" and pneumonia)
- asthma
- rhinitis with post-nasal drip
- gastroesophageal reflux disease (GERD)
- aspirated foreign body is relatively rare but must not be missed

Evaluation of children with chronic cough should include chest radiography (CXR) and spirometry (if older than 5 years of age). Skin prick test for environmental allergies can also be indicated.

References:

Evaluation of the patient with chronic cough. Benich Iii JJ, Carek PJ. Am Fam Physician. 2011 Oct 15;84(8):887-92.

Diagnosis of chronic cough in children

"Doctors make mistakes. Can we talk about that?" ED physician Brian Goldman's TED talk

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 05:45:00 PST

Dr. Goldman asks if you know your surgeon's "batting average" of operations with good outcomes. He mentions the three words you never want to hear: "Do you remember?" It's a good TED talk:

Every doctor makes mistakes (just like everyone does). But, says Dr. Goldman, medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve. Telling stories from his own long practice, he calls on doctors to start talking about being wrong.

Here are some simple steps to avoid medical errors from a patient's perspective (source: CNN):

1. Say: "My name is Mary Smith, my date of birth is October 21, 1965, and I'm here for an appendectomy."
2. Say: "Please check my ID bracelet."
3. Say: "Please look in my chart and tell me what procedure I'm having."
4. Say: "I want to mark up my surgical site with the surgeon present."
5. Be impolite (this particular piece of advice is obviously controversial).

References:

CNN video: Steps to avoid medical errors

The Rise of the ePatient - presentation by Pew Internet Project

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 24 Jan 2012 05:20:00 PST

Director Lee Rainie presented at Providence St. Joseph Medical Center in Burbank, California on January 12, 2012 on understanding social networking and online health information seeking:

The Rise of the e-Patient

View more presentations from Pew Research Center's Internet & American Life Project

Link via via e-patients.net

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

References:

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Blogging is good for you - and for most people who read blogs

noreply@blogger.com (Ves Dimov, M.D.) — Sat, 21 Jan 2012 09:36:18 PST

From The Economist:

"Academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record.

The back-and-forth between bloggers resembles the informal chats, in university hallways and coffee rooms, that have always stimulated economic research, argues Paul Krugman, a Nobel-prize winning economist who blogs at the New York Times. But moving the conversation online means that far more people can take part.

Despite the low barriers to entry, blogs do impose some intellectual standards. Errors of fact or logic are spotted, ridiculed and corrected. Areas of disagreement are highlighted and sometimes even narrowed."

Similar dynamics are in work on many medical blogs authored by physicians.

WIN-WIN, as the author of the blog "The Happy Hospitalist" likes to say.

References:

Economics blogs. A less dismal debate. The Economist, 01/2011.

Lung cancer - Lancet review

noreply@blogger.com (Ves Dimov, M.D.) — Fri, 20 Jan 2012 05:12:00 PST

Small-cell lung cancer

Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases.

Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities.

Patients often present with rapid-onset symptoms due to:

- local intrathoracic tumour growth
- extrapulmonary distant spread
- paraneoplastic syndromes
- a combination of these features

Staging aims ultimately to define disease as metastatic or non-metastatic:

- Combination chemotherapy (platinum-based plus etoposide or irinotecan) is the mainstay first-line treatment for metastatic small-cell lung cancer.

- For non-metastatic disease, early concurrent thoracic radiotherapy is indicated.

Prophylactic cranial irradiation should be considered for all patients, even without metastases, whose disease does not progress after induction chemotherapy and radiotherapy.

Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain.

Non-small-cell lung cancer (NSCLC)

The recently introduced 7th edition of the TNM classification relates better to other prognostic factors such as biological markers.

The advances in treatment include:

- a new generation of chemotherapy agents
- a proven advantage to adjuvant chemotherapy after complete resection for specific stage groups
- new techniques for radiotherapy
- new surgical approaches

References:

Small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1741 - 1755, 12 November 2011

Non-small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1727 - 1740, 12 November 2011

Image source: A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

Sleepwalking: Lee's story

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 18 Jan 2012 05:59:00 PST

From NHS Choices YouTube channel: Lee started sleepwalking at the age of four. In this video he describes his sleepwalking episodes, including doing artwork despite having no interest in art, plus the physical side effects when he wakes up.

Also watch Sleepwalking in children.

How to investigate mildly elevated liver transaminase levels

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 17 Jan 2012 05:39:00 PST

Mild elevations in the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) are commonly found in asymptomatic patients.

The most common cause is nonalcoholic fatty liver disease (sometimes called nonalcoholic steatohepatitis or NASH), which can affect up to 30% of the U.S. population.

Other common liver causes include:

- alcoholic liver disease
- medication-associated liver injury
- viral hepatitis (hepatitis B and C)
- hemochromatosis

Pale stool and dark urine (click to enlarge the images). This is an example of "obstructive" jaundice with the classic constellation of tea-colored urine and clay-colored stool.

Less common liver causes include:

- alpha-1-antitrypsin deficiency (AAT)
- autoimmune hepatitis
- Wilson disease

Extrahepatic conditions can also cause elevated liver transaminase levels:

- thyroid disorders
- celiac disease
- hemolysis
- muscle disorders

Initial testing should include:

- fasting lipid profile (FLP)
- measurement of glucose
- serum iron and ferritin; total iron-binding capacity (TIBC)
- hepatitis B surface antigen and hepatitis C virus antibody

If above test results are normal, a trial of lifestyle modification is appropriate.

Additional testing may include:

- ultrasonography (USG) of liver
- alpha-1-antitrypsin (AAT) and ceruloplasmin
- serum protein electrophoresis (SPEP)
- antinuclear antibody (ANA), smooth muscle antibody (ASMA), and liver/kidney microsomal antibody type

GI evaluation and possible liver biopsy is recommended if transaminase levels remain elevated for more than 6 months.

References:

Causes and evaluation of mildly elevated liver transaminase levels. Oh RC, Hustead TR. Am Fam Physician. 2011 Nov 1;84(9):1003-8.

Evaluation of suspected dementia: 2-visit approach is effective

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 16 Jan 2012 12:34:04 PST

Prevalence of dementia will increase as the U.S. and the world population ages. The text below is based on a recent review in the journal Am Fam Physician:

Risk factors for dementia include:

- age
- family history of dementia
- apolipoprotein E4 genotype
- cardiovascular comorbidities
- chronic anticholinergic use
- lower educational level

A two-visit approach is time-effective for primary care physicians.

During the first visit, the physician should administer a screening test such as:

- verbal fluency test
- Mini-Cognitive Assessment Instrument
- Sweet 16

The tests above have relatively high sensitivity and specificity for detecting dementia, and can be completed in as little as 60 seconds (Note by editor: this one-minute time estimate sounds too optimistic, it usually takes considerably longer).

If the screening test result is abnormal or another disease is suspected, laboratory and imaging tests should be ordered, and the patient should return for additional cognitive testing.

A second visit should include:

- Mini-Mental State Examination
- Geriatric Depression Scale
- verbal fluency
- clock drawing tests

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

Evaluation of driving risk in dementia (click to enlarge the image).

References:

Evaluation of suspected dementia. Simmons BB, Hartmann B, Dejoseph D. Am Fam Physician. 2011 Oct 15;84(8):895-902.

Premenstrual syndrome and premenstrual dysphoric disorder (review)

noreply@blogger.com (Ves Dimov, M.D.) — Fri, 13 Jan 2012 05:25:00 PST

Premenstrual syndrome

Premenstrual syndrome is defined as recurrent psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20-30% of premenopausal women.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder includes affective or somatic symptoms that cause severe dysfunction in social or occupational activity. It affects 3-8% of premenopausal women.

Proposed etiologies (causative factors) include:

- increased sensitivity to normal cycling levels of estrogen and progesterone
- increased aldosterone and plasma renin activity
- neurotransmitter abnormalities, particularly serotonin

The Daily Record of Severity of Problems is one tool with which women may self-report premenstrual symptoms.

Symptom relief is the goal, and there is limited evidence for the use of:

- calcium
- vitamin D
- vitamin B6 supplementation

Serotonergic antidepressants (SSRIs) (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.

References:

Premenstrual syndrome and premenstrual dysphoric disorder. Biggs WS, Demuth RH. Am Fam Physician. 2011 Oct 15;84(8):918-24.

Image source: OpenClipArt.org, public domain.

Scabies - NHS patient education video

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 21:52:38 PST

From the NHS Choices YouTube channel: Scabies is a contagious skin infection which itches intensely. A GP talks about the causes, symptoms and treatment.

From the memorable medical textbooks of the past: Medical textbooks were not always as dreary and as bland as they are now, according to BMJ.

Some examples of lively, first person didactic tone come from J L Burton’s Essentials of Dermatology: "The simultaneous occurrence of scabies in a doctor and a nurse may mean that they have shared nothing more exciting than a patient with Norwegian scabies."

References:

Memorable medical textbooks of the past

How to avoid hidden sodium - a Johns Hopkins dietitian walks through the aisles of a grocery store with you (video)

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 12 Jan 2012 05:38:00 PST

Join Johns Hopkins registered dietitian, Arielle Rosenberg, as she walks through the aisles and offers suggestions on how to lower salt intake -- but not compromise flavor.

Cutting U.S. salt intake by just half a teaspoon (3 grams) a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. A 3-gm per day reduction in salt (1,200 mg of sodium) will result in 6% fewer new cases of heart disease and 3% fewer deaths.

The average U.S. man gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.

77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.

Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.

References:

"Cutting Salt as Good as Quitting Smoking"

94% of Americans score at “poor” level on at least one of the 7 factors defining ideal cardiovascular health

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 11 Jan 2012 05:20:00 PST

More than 90% of Americans score poorly on at least one of the American Heart Association’s 7 factors defining ideal cardiovascular health.

The 7 factors (with lack of a diagnosis of heart or blood vessel disease) include:

- smoking status
- weight
- physical activity
- healthy diet
- cholesterol concentration
- blood pressure
- fasting glucose concentration

The new data by CDC and NIH show that 94% of US adults score at a “poor” level on at least one of those factors and that 38% have at least 3 factors at a poor level.

References:

US citizens score poorly on ratings of cardiovascular risk factors. BMJ 2012; 344 doi: 10.1136/bmj.e22 (Published 4 January 2012).

Depression treatment is as effective in older (over 65) as in younger adults

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 10 Jan 2012 05:50:00 PST

Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes.

Compared to younger adults with depression:

- cognitive and functional impairment and anxiety are more common in older adults

- older adults with depression are at increased risk of suicide

Depression is associated with cognitive impairment and an increased risk of dementia.

A selective serotonin reuptake inhibitor (SSRI) should be the first line pharmacological treatment for depression for most older adults.

Psychological and drug treatment is as effective in older as in younger adults

References:

Depression in older adults. Rodda et al. BMJ, 2011.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Why Mayo Clinic is a power user of social media: "Our patients are doing it, so this is where we need to be"

noreply@blogger.com (Ves Dimov, M.D.) — Sun, 15 Jan 2012 17:06:40 PST

Mayo Clinic's first-ever Social Media Residency took place October 20-21, 2011. At the end of the first day, the attendees went out on a video interview assignment. Check out some of the videos they returned with.

The best interest of the patient is the only interest to be considered

The Mayo Clinic CEO, John Noseworthy, M.D., pointed out recently that Mayo intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.

References:

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Hands-only CPR videos - The American Way vs. The British Way - Celebrity edition

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 05 Jan 2012 05:44:01 PST

The American Heart Association (AHA) recruited Kendrick Kang-Joh Jeong, MD (a trained physician and an actor from the Hangover) to demonstrate ‘hands only CPR’ to the metronomic beat of the Bee Gees 1977 disco hit ‘Stayin’ Alive’:

The British Heart Foundation recruited footballer-turned-actor Vinnie Jones to show how hard and fast hands-only CPR to Stayin' Alive by the Bee Gees can help save the life of someone who has had a cardiac arrest. The Hollywood hardman is starring in a TV advert urging more people to carry out CPR in a medical emergency:

Ken Jeong Behind the Scenes - AHA CPR video:

Comments from YouTube:

Sure, the beat to "Staying Alive" works, but so does "Another One Bites The Dust" by Queen......... just saying!

Related reading:

Disco Still Saves Lives. Life in the Fast Lane.

The Third Component of Genetic Blueprint - Writing in Pen (DNA) vs. Pencil (Epigenetics)

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 04 Jan 2012 09:04:04 PST

The term epigenetics refers to changes in phenotype (appearance) or gene expression caused by mechanisms other than changes in the underlying DNA sequence, hence the name epi- (Greek: over; above) -genetics. There is no change in the underlying DNA sequence of the organism; the phenotype is expressed by activating some genes while inhibiting others. Epigenetics includes changes in gene function that occur without a change in the sequence of DNA. These changes occur as a result of the interaction of the environment with the genome. Epigenetic determinants activate or silence fetal genes through alterations in DNA, histone methylation and acetylation.

DNA associates with histone proteins to form chromatin. Image source: Wikipedia, GNU Free Documentation License.

From the National Geographic magazine:

"Mother Nature writes some things in pencil and some things in pen. Things written in pen you can't change. That's DNA. But things written in pencil you can. That's epigenetics. Now that we're actually able to look at the DNA and see where the pencil writings are, it's sort of a whole new world."

If you think of our DNA as a piano keyboard and our genes as keys - each key symbolizing a segment of DNA responsible for a particular note, or trait, and all the keys combining to make us who we are - then epigenetic processes determine when and how each key can be struck, changing the tune being played.

Recent studis focuses on a particular epigenetic process called DNA methylation, which is known to make the expression of genes weaker or stronger.

The good news is that some of these processes, unlike our DNA sequences, can be altered. Genes muted by methylation, for example, sometimes can be switched back on again relatively easily. And though it may not happen soon, the hope is that someday epigenetic mistakes will be as simple to repair as a piano that's out of tune. "

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

References:

Twins. National Geographic magazine, 01/2012.

Portrait of twins: series one and series two from National Geographic.

Twins Data Reshaping Nature Versus Nurture Debate. NPR.

Epigenetics, Wikipedia.

"The online version is the official journal of record, not the print edition". Start a blog in 2012

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 03 Jan 2012 05:00:08 PST

"The online version is the official journal of record", wrote the Editor-in-Chief and the editorial staff of Pediatrics, the official journal of the the American Academy of Pediatrics:

"As we start 2012, and welcome the more than 6 million annual visitors to our journal's Web site, we remind our readers that the online version, not the shorter print edition, is the official journal of record. Is it time to do away with the print version? Probably not just yet, but it may not be long until we are heading in that direction.

If you are thinking, “there are so many options to peruse and so little time!” you will find some highlights of each issue in our blog - First Read - which contains previews of articles of interest selected by members of our executive editorial board. We are even running some of our most interesting “fillers” from the print journal in the blog so they are not missed by our online readers"

This is the URL of the blog which is hosted for free on Blogger.com by Google: http://pediatricsblog.blogspot.com

All physicians should consider starting a blog in 2012

I would encourage all physicians to start a blog in 2012 - here is why (quotes from an interview with Seth Godin and Tom Peters):

"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.

No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook. And it’s free."

Don't limit yourself to your blog - use Facebook, Twitter and Google Plus

Blogging can be great for personal growth but there is a lot more interaction on Twitter, Facebook and Google Plus nowadays as compared to blogs. If you have a blog, you must also have a Facebook "like" page (previously called "fan" page), a Twitter account, and probably a Google Plus page. These serve the dual purpose of distribution and commenting channels ("two-way street").

For example, Facebook pages get a lot more interaction than blogs for some medical journals - you can compare the number of comments on the NEJM Facebook updates (the range is 9-180) vs. their blog (0). The blog has comments enabled, of course.

Facebook is the clear "winner" in terms of commenting activity, it is not even close:

NEJM Facebook page vs. NEJM blog

This is a suggested simple project for all doctors in 2012:

1. Start on Twitter (microblog).
2. Continue on Blogger/WordPress.
3. Make an impact. Improve the quality of online health information and tell the public your side of the story.

How to Create a Blog on Blogger in 5 minutes (Google video):

Help your patients and your practice

I developed the concept of Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC):

References:

Taking the Pulse of Pediatrics. PEDIATRICS Vol. 129 No. 1 January 1, 2012, pp. 168 -169 (doi: 10.1542/peds.2011-3288).

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

noreply@blogger.com (Ves Dimov, M.D.) — Sat, 31 Dec 2011 08:44:15 PST

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."

Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

iPad app tests athletes for concussion - Cleveland Clinic video

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 27 Dec 2011 09:49:04 PST

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.

Mick Jagger (68) on staying fit: "Don’t look at the clouds of tomorrow through the sunshine of today"

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 26 Dec 2011 20:58:29 PST

Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."

In other news, you can do anything with a blog (full website and all) - the launch site of Mick Jagger's supergroup SuperHeavy is basically a blog: http://www.superheavy.com

Their new hit "Miracle Worker" plays with medical terminology:

"You have a medical condition.

In an emergency I'm very well prepared
My scalpel, mask and gloves; don't ever get too scared.

No need for anesthetics, I'll go check your charts

You're a Miracle Worker.
You're a surgeon of love."

-- Lyrics from SuperHeavy - Miracle Worker.

Mick Jagger is well-known as an exercise fanatic: "We were busy recording a song and Mick Jagger (68) was doing 120 situps and pushups and singing at the same time time", says Eurythmics founder Dave Stewart.

References:

Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.

Redefining age 65 - when your job description is "rockstar"

Paget's disease - NHS Choices video

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 26 Dec 2011 08:14:45 PST

From the NHS Choices YouTube channel: An expert describes the various areas of the body that can be affected by Paget's disease - a condition in which the normal cycle of bone growth is disrupted.

The earliest references to journal clubs are in the memoirs and letters of Sir James Paget, a British surgeon, who described a group at St. Bartholomew’s Hospital in London in the mid-1800s as “a kind of club … a small room over a baker’s shop near the Hospital-gate where we could sit and read the journals.”

Sir Paget (11 January 1814 – 30 December 1899) is best remembered for Paget's disease and is considered, together with Rudolf Virchow, as one of the founders of scientific medical pathology.

References:

When was the earliest journal club?
James Paget, Wikipedia.

George Michael, still breathless after pneumonia and tracheotomy, plans a show for his doctors (video)

noreply@blogger.com (Ves Dimov, M.D.) — Fri, 23 Dec 2011 13:13:12 PST

Video: George Michael: This has been the worst month of my life. ShowBiz411.

A thin and visibly weak George Michael (48) told reporters outside his home in London that he wasn't supposed to speak for very long and was still recovering from a tracheotomy: "I got streptococca-something... It's a form of pneumonia and they spent three weeks keeping me alive basically," Michael said of the doctors in the Austrian hospital where the singer has been receiving treatment since he fell ill in November.

He added that he also wanted to hold a special show for the Austrian doctors who treated him. "I've spent the last 10 days since I woke up literally thanking people for saving my life."

References:

Gaunt George Michael says "fortunate to be here". Reuters, 2011.

How to Stay Active With Osteoarthritis: "Motion is Lotion"

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 22 Dec 2011 08:46:20 PST

Dr. Daniel Montero, a sports-medicine physician within the Department of Orthopedics at Mayo Clinic in Florida discusses what kind of exercises are you should take part in if you suffer from joint pain. Remember, "motion is lotion", says Dr. Montero.

Exercises you may need to avoid if you have moderate or severe osteoarthritis of the knee or hip include:

- Running and jogging. The difference between how much force goes through your joints jogging or running, as opposed to with walking, is sometimes more than 10-fold your whole body weight

- Jumping rope

- High-impact aerobics

- Any activity where, at any time, you have both feet off the ground at once, however briefly (basketball, jumping)

Fortunately, that leaves a lot of activities that are OK for people with knee and hip osteoarthritis and that can help keep you mobile - see the list at WebMD.

References:

Knee and Hip Exercises for Osteoarthritis. WebMD.

40% of police officers have a sleep disorder according to a JAMA study

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 22 Dec 2011 10:19:34 PST

More than a third of police officers have a sleep disorder, and those who do are more likely to experience heart disease, problems with job performance and rage toward suspects and citizens, says the NYTimes, citing a study in the JAMA. That figure is at least double the estimated 15-20% rate of sleep disorders seen in the general population.

Having a sleep disorder raised the odds of heart disease by 45%, and the odds of depression by 120%. It also raised the odds of being injured on the job by 22% and falling asleep while driving by 51%.

The JAMA report video.

The officers who had sleep disorders reported more instances of “uncontrolled anger” toward suspects and citizens and serious administrative errors. Sleep deprivation may affect the amygdala, a part of the brain where emotion is governed.

Of the 5,000 study participants, 40% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously:

- 34% screened positive for obstructive sleep apnea
- 6.5% for moderate to severe insomnia
- 5.4% for shift work disorder

Not surprisingly, the police officer who had smaller body mass indexes were far less likely to have sleep apnea. System-wide practices can have a significant impact. For example, state police officers in Massachusetts are given one hour of paid exercise time four days a week to help them stay fit. They were less liekly to have sleep apnea.

References:

Sleep Problems in Police Officers Take Heavy Toll. NYTimes.
Sleep Disorders, Health, and Safety in Police Officers. JAMA.

Comments from Twitter:

WendySueSwanson MD (@SeattleMamaDoc): Geesh.

@CrumbedOxygen: wonder if EMS similar.

Dr John Weiner @AllergyNet: Can CPAP Cure Cops?

Martin Wilson @ChInspMWilson: what is CPAP then ...??

@DrVes CPAP (continuous positive airway pressure) is a treatment option for sleep apnea. Here is more info from the Mayo Clinic: http://www.mayoclinic.com/health/cpap/MM00716

Brand Identity

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 21 Dec 2011 08:52:22 PST

The image source is xkcd, of course.