Life of a Family Physician

Teach Your Child How to Swim!

2010-08-21T14:27:00.000-07:00

Recently, there have been news reports on accidental drownings of children. This should not happen but unfortunately it does and the statistics are staggering.

1. Drowning is the second leading cause of death in children ages one to nineteen.

2. In 2007, over 3000 people died due to unintentional drownings in the United States.

3. In 2006, over 1000 children died due to unintentional drowning.

4. For every one child who died from drowning, another four were treated in the ER for submersion injuries.

5. Most drownings occurred in a home swimming pool and were left unsupervised for less than five minutes.

The American Academy of Pediatrics recommend children as young as four to learn how to swim. Toddler aquatic programs such as "water-babies" are helpful in teaching children to enjoy the water but may not accelerate the learning process. Studies indicate children learn to be "good" swimmers at a mean age of five and a half.

The best prevention tip is supervision, supervision, supervision!!!
Parents should also learn basic CPR. Contact your local American Red Cross Chapter or hospital for more information.

There are many venues that offer swimming lessons. The YMCA, Boys and Girls Club, and local colleges/universities provide lessons. Salisbury University has a summer program, Sea Gull Swim School, that follows the American Red Cross Learn to Swim Program. The American Red Cross can also help locate a local swim instructor.

Let's keep our children safe! Thanks!

Newborn Sleep Safety Tips

2010-07-30T08:22:00.000-07:00

Here are some tips on newborns and sleep.

1. No Co-Sleeping!!! Do not bring your baby to bed with you. This can potentially be tragic. Babies can suffocate on the covers, pillows, or blankets. There is also a higher incidence for SIDS (Sudden Infant Death Syndrome). Place a Pack 'n Play next to your bed and have the newborn sleep there instead.

2. Develop a routine from the beginning. It may take several weeks but it will help in the long run!

3. No plush toys, pillows, blankets, or stuffed animals in the crib.

4. Bumper pads are questionable. If it is used, keep it tightly secured.

5. Babies need to be placed on their backs to sleep. This has reduced the incidence of SIDS dramatically.

6. Check the crib bars. The bars should be no more than 2-3/8 inches (6 centimeters) apart, so that babies can't get their heads caught between them.

7. The mattress should fit snug onto the crib. There should be no more than a 1½ inch (4 centimeter) gap between it and the side or end of the crib. Also use a firm mattress.

8. No items with strings, cords, or ties should be in the crib.

9. Do not have the baby sleep in a room where there is tobacco use.

10. Do not overheat the baby. Dress the baby in light clothing and keep the temperature comfortable. Do not over-bundle.

11. Use fitted sheets for the mattress.

Interesting fact: Newborns sleep on average about 16 hours per day!

Thank you and have a nice day!

Chiggers, Chiggers, Please Go Away...

2010-07-20T09:15:00.000-07:00

Chiggers are a type of mite in the Trombiculidae family which live in forests, fields, gardens, or areas with nearby lakes. They are also called red bugs, jiggers, berry bugs, and harvest mites. They tend to infect hunters, farmers, and fishermen, but anyone outdoors can be exposed. An interesting fact is the Spanish Moss on the trees in Savannah are inhabited by chiggers, so beware when walking through the squares.

Chiggers do not actually bite but inject enzymes to feed on the skin resulting in the itchy rash. They do not burrow under the skin but instead attach on top of it. The severe itch typically occurs within 24-48 hours. The rash and itch resolves with time, usually within two weeks.

Here are some tips for treatment:

1. Take a shower as soon as possible to wash away the chiggers.

2. Apply a steroid cream such as hydrocortisone to relieve the itching.

3. Calamine lotion can also help with the itch.

4. Oral Benadryl can also help with the itch.

5. Use insect repellent.

6. Keep the lawns cut low. Chiggers love high weeds/grass.

7. Don't forget to wash the clothes.

8. Some people have reported success with clear nail polish on the areas. In theory, it should not work but it can not hurt to try.

9. Watch for signs of infection.

10. If the rash/itch worsens, contact your health care professional for stronger steroids or possible antibiotics.

Have a great summer!

Tips for Summer Walking

2010-06-24T05:24:00.000-07:00

1. Wear comfortable walking shoes and socks. This does not include flip-flops or Crocs.

2. Make walking a family affair.

3. Encourage friends to walk. Find a walking buddy.

4. Eat a healthy snack before walking such as a piece of fruit or peanut butter sandwich for energy. Candy bars and energy drinks like Jolt are not recommended.

5. Bring a camera. You never know when it is a Kodak moment.

6. Wear sunscreen on a sunny day. SPF 30 or higher is best. Do not forget the ears, hairline, and lips.

7. Wear a hat with a brim.

8. Wear sunglasses.

9. Drink plenty of fluids such as water to stay hydrated.

10. Drink water prior to walking and during the walk. (at least 1 and ½ cups for a twenty minute walk)

11. Stretch your legs prior to walking. Focus on the calves, thighs (hamstring and quadriceps), and low back.

12. Swing your arms to maximize the workout.

13. Use good walking posture. Keep your head up and back straight.

14. Vary the route to keep from getting bored.

15. Stay on the walking paths.

16. Wear light colored or reflective clothes when walking in the dark.

17. Stay motivated and make goals. Reward yourself when a goal is achieved.

18. Use a pedometer to track your steps.

19. Start slowly (twenty minute walk) and gradually increase your time and pace.

20. Have fun!!!

Jellyfish Sting

2010-05-31T15:32:00.000-07:00

Beach season has begun and so has common beach medical problems. Here are some tips on jellyfish stings...

Jellyfish stings are common during the summer season especially for swimmers and divers. The tentacles have nematocysts which contain the venom that causes the painful stings.

The signs and symptoms include:
1. Intense pain at the site
2. Welts and blisters on the skin
3. Itchiness at the site
4. Burning sensation

The sting can be progressive and systemic with the following signs and symptoms:
5. Nausea and vomiting
6. Diarrhea
7. Numbness and tingling
8. Headache and body aches
9. Dizziness
10. Muscle spasm
11. Fever
12. Trouble breathing

The skin rash/hives/welts/blisters typically last for several hours and then resolves.

If the pain is persistent or if the signs and symptoms worsen, get immediate medical attention. Be aware that jellyfish stings can cause anaphylaxis which is a life-threatening condition that requires immediate medical attention.

Treatment includes:
1. Rinse the area with vinegar for at least thirty minutes
2. An alternative is salt or sea water. Do not use fresh water...it causes more stinging!
3. Remove the tentacles with tweezers and make sure gloves are on
4. Apply shaving cream or baking soda paste to the area and then shave the area with a razor or anything with an edge (credit card) to remove the nematocysts
5. Immerse the area with hot water for thirty minutes
6. Apply ice for the pain after the area is cleaned
7. Ibuprofen or acetaminophen can help with the pain
8. If the sting is in the mouth, mouthwash with a concoction of 1/4 cup vinegar and 3/4 cup water
9. Do not rub the area!
10. There is no scientific evidence that urine, ammonia, meat tenderizer, sodium bicarbonate, boric acid, lemon juice, steroid cream, alcohol, papaya, or hydrogen peroxide will stop further stinging of the jellyfish.

Follow up with your health care professional. Obtain a tetanus booster if it isn't up to date.

One interesting fact is the one of the most venomous jellyfish sting comes from
the Box jellyfish (commonly found in the Pacific Ocean and in Australia).

Talk to your healthcare professional for more information. Have a safe and fun summer!

Tips for Kidney Stone Sufferers

2010-05-21T13:22:00.000-07:00

Kidney stone(nephrolithiasis) is a very common medical problem. About 500,000 people go to the emergency room each year due to kidney stones. About one in ten people will develop a kidney stone in their lifetime. Here are some tips on treating/preventing this painful problem.

1. Drink fluids!!! At least 2 liters a day...approximately four water bottles a day.
2. Drink water and citrus drinks such as lemonade, orange juice, cranberry juice.
3. Take citrate either through lemonade or supplements (potassium citrate) to prevent formation of certain stones.
4. Maintain urine volume at greater than 2 liters per day.
5. Limit salt intake to 2 grams per day.
6. Cut back on red meat and animal protein to 8 ounces per day.
7. Avoid high oxalate foods to prevent calcium oxalate stones.

Foods high in oxalate include: Beets and beet tops, Black tea, Chocolate, Cocoa, Dried figs, Lambs, Nuts, Parsley, Poppy seeds, Rhubarb, Spinach, Strawberries, Soybeans.

8. Continue to eat dietary calcium but be careful with supplements. Maintain calcium intake to at least 1000mg/day.
9. Avoid excessive vitamin C. The US recommended daily allowance is about 75-90mg per day. Excessive amounts of >1500mg per day increases oxalate formation thus increasing the risk for stones.
10. Limit soda, tea, and coffee.
11. Exercise.
12. Increase fiber intake and add flaxseed to the diet.
13. Avoid sugar.
14. A glass of wine can decrease stone formation if adequately hydrated.
15. Lose weight and decrease fat intake.

Talk to your healthcare professional for more information. Knowing the type of kidney stone can help with developing a plan to prevent recurrence of the stone.

Thanks.

Tips for Allergy Sufferers

2010-04-18T07:50:00.000-07:00

Knoxville, TN was recently named the capital of allergies in America. I think there are many Eastern Shore natives that may disagree. According to reports, about 35 million Americans suffer from allergies. The pollen count is high in addition to mold making this a terrible allergy season. Here are some tips to help...

1. Wash/shower before bed to remove the pollen from your body
2. Keep windows and doors shut to prevent the allergens from coming into the home
3. Use the recirculating air setting in your car
4. Wear sunglasses/eyeglasses to prevent eye exposure to allergens
5. Keep your car windows rolled up during peak season
6. Stay indoors in the morning (9am-2pm) when pollen count is high
7. Clean air filters in your home and dust shelves, vents, and windows
8. Vacuum (HEPA filter preferably) at least weekly
9. Wash bedding weekly
10. Do not dry laundry outdoors during allergy season
11. Wear a mask when mowing the lawn
12. Saline wash/rinse your nose at least twice a day...a combination of warm water, about a quarter-teaspoon of salt, and a quarter-teaspoon of baking soda administered through a squeeze bottle can help
13. Over the counter anti-histamine medications such as Zyrtec, Claritin, or diphenhydramine can help with symptoms
14. Decongestants can help with stuffy noses but should be used with caution. Nasal decongestants should only be used for three days or less.
15. Try a neti-pot to help flush out the allergens...click here for more information
16. Know your triggers and avoid them...talk to your physician for guidance

There are prescription medications ranging from tablets to steroidal nasal sprays that can help with allergies. Immunotherapy or allergy shots can also help. It works by exposing small amounts of the allergen to your body thereby increasing your tolerance to the substances (allergens) that provoke the allergy symptoms.

Hope this was helpful. For more information, talk with your health care professional.

UTI

2010-04-05T10:12:00.000-07:00

Urinary tract infections are common infections, accounting for about 8 million physician visits each year. UTI's affect the urinary system which consists of the bladder, urethra, ureters (the connecting tubes), and kidneys. The most common area is the bladder. Women are at greater risk than men; at least one in five women will develop a UTI in their lifetime.

The most common bacteria cause of a urinary tract infection is E. coli. Other organisms involved include Staphylococcus, Chlamydia, Proteus, Klebsiella, and Herpes.

Risk factors include:
1. Female gender due to anatomy (shorter urethra)
2. Being sexually active
3. Men with enlarged prostates
4. Blockage in the urinary system such as a stone
5. Pregnancy
6. Catheters
7. Co-morbid conditions that decrease immune function such as diabetes and HIV
8. Diaphragm use
9. Vesicoureteral reflux
10. Neurogenic Bladder Dysfunction
11. Advanced age

Signs and Symptoms include:
1. Pain on urination (dysuria)
2. Urinary frequency
3. Blood in the urine (hematuria)
4. Urinary urgency
5. Foul smelling urine
6. Passing small amounts of urine frequently

Diagnostic tests for an uncomplicated UTI include a urinalysis and urine culture. Typically, tests are not necessary to treat for uncomplicated UTI's.

Treatment includes:
1. Antibiotics such as Bactrim, Ciprofloxacin, Nitrofurantoin, etc...
2. Good hygiene and proper wiping from front to back
3. Removing diaphragm and utilizing an alternative form of birth control
4. Drinking plenty of fluids
5. Avoiding coffee, alcohol, spicy foods
6. Stop smoking!
7. Analgesic to help with pain (Pyridium)
8. Heating pad for pain relief

There are different guidelines for the management of UTI's in children. It depends on the sex, age, and the frequency of the infections. In some cases, an ultrasound of the kidneys is necessary to evaluate pediatric UTI's.

Recurrent infections will need further evaluation and prophylactic treatment.

Preventative measures include:
1. Drink plenty of water
2. Urinate when you feel the need; don't resist the urge to urinate.
3. Wipe from front to back
4. Take showers instead of baths
5. Cleanse the genital area before sexual intercourse
6. Avoid using feminine hygiene sprays and douches
7. Drink cranberry juice

Talk to your health care professional for more information. Thank you and have a nice day!

Keep Those Teeth Clean or else...

2010-03-15T12:22:00.000-07:00

Several years ago I saw a patient in the hospital for bacterial endocarditis. Bacterial endocarditis is an infection of the heart lining or valves. It is a very serious condition requiring intravenous antibiotics for at least one month. The patient was a young male with a relatively unremarkable medical history. Upon examination, he was found to have multiple dental cavities with gingivitis. Poor dentition is a cause for infective endocarditis! Then, several months ago, I was involved in a young female who was admitted due to strokes from endocarditis. After an extensive evaluation, it was presumed that the infection was from her oral cavity.

Infective or bacterial endocarditis affects about 29,000 individuals yearly. Individuals with heart conditions such as prosthetic valves, history of rheumatic carditis, congenital disease, or Marfans syndrome are at risk. The source of infection may come from IV drug use, dental procedures, GI procedures, urinary and prostatic procedures, skin infections, colon cancer, cardiac surgery, or respiratory infections. The bacteria enters the bloodstream and settles onto the heart. A vegetation or infective mass develops on the valve resulting in a cascade of signs and symptoms such as fever, rash, joint pain, fatigue, cough, weight loss, skin lesions, trouble breathing, etc...

One important preventative task is to keep those teeth clean. Routine brushing, flossing, and dental visits will keep the bacteria from developing and seeding into the body.

Antibiotics during dental procedures may be used to prevent endocarditis in high risk individuals. A single dose of Amoxicillin or Clindamycin is typically given one hour prior to the procedure. Guidelines suggest antibiotic prophylaxis in treatments involving gingival or tooth root manipulation.

The following conditions should receive antibiotics:
1. People with artificial heart valves
2. Certain congenital heart disease conditions
3. Previous history of endocarditis
4. Cardiac transplant

Mitral valve prolapse is not an indication for antibiotics.

Practice good oral hygiene and keep brushing those teeth!
For more information, talk to your health care professional and dentist. Thanks!

Male Breast Cancer

2010-03-02T06:29:00.000-08:00

A pleasant 60 year old obese male presented to my office with complaints of a left breast lump for the past several months. He described it as tender and firm. There was no redness or pus. It was near his nipple area. He has no family history of breast cancer. His medical history was unremarkable. He does have a 30 year history of tobacco use. Upon examination, a 2 cm mass was palpated and minimally tender. He was sent for a diagnostic mammogram and ultrasound. The results came back highly suspicious for tumor and he was promptly referred to surgery for biopsy. His results are pending.

Male breast cancer is rare. About 1% of breast cancers occur in men. About 2000 men were diagnosed with breast cancer in 2008 with approximately 400 deaths. Typically, male breast cancer occurs between the ages of 60 and 70 with the median age being 67.

Risk factors include:
1. Age
2. Obesity
3. Heavy alcohol use
4. Liver disease
5. Hormone usage
6. Klinefelter Syndrome (chromosomal disorder)
7. Strong family history of breast cancer
8. Radiation exposure
9. High estrogen levels (from obesity, alcohol, hormone use, etc...)

Signs and symptoms include:
1. Lump
2. Nipple pain
3. Nipple discharge
4. Enlarged lymph nodes under the armpit
5. Changes to the breast skin such as redness, dimples, scaling...
6. Nipple soreness
7. Nipple inversion

Diagnosis is made by mammogram, ultrasound, and biopsy.
The most common type of male breast cancer is infiltrating ductal carcinoma.

Treatment depends on the staging/severity. It may consist of mastectomy, chemotherapy, radiation, and/or hormone therapy.

Male breast cancer is very similar to female breast cancer. Prognosis and remission rates are virtually identical and is based on the staging and extent of the cancer.

Two ways to prevent this rare disease is to maintain a healthy weight and to drink alcohol in moderation.

Talk to your health care professional for more information.

Thank you and have a nice day.

Fluoride in Children

2010-02-22T17:09:00.000-08:00

Fluoride plays an essential role in dental health. Fluoride helps prevent tooth decay by stopping the acid from bacteria to erode enamel and by strengthening the enamel. It can also assist in reversing early tooth decay by remineralization. Since the addition of fluoride in the water system, tooth decay has been reduced by about 30%. Unfortunately, over 25% of toddlers still present with one or more cavities.

Water fluoridation became national policy in 1951. About 60% of the United States population receives fluoridated water. If you are unsure about your town's water system, contact the local health department. Below is the dosing for fluoride depending on the fluoridation of the town water.

Dosing Schedule for Children for Dental Caries prevention
Ages 3 months to 3 years old
1.Local Water Fluoride <0.3 ppm: Fluoride 0.25 mg daily
2.Local Water Fluoride 0.3-0.7 ppm: No Fluoride Supplement Necessary
3.Local Water Fluoride >0.7 ppm: No Fluoride Supplement Necessary

Ages 3 to 6 years old
1.Local Water Fluoride <0.3 ppm: Fluoride 0.50 mg daily
2.Local Water Fluoride 0.3-0.7 ppm: Fluoride 0.25 mg daily
3.Local Water Fluoride >0.7 ppm: No Fluoride Supplement Necessary

Ages 6 to 16 years old
1.Local Water Fluoride <0.3 ppm: Fluoride 1.00 mg daily
2.Local Water Fluoride 0.3-0.7 ppm: Fluoride 0.50 mg daily
3.Local Water Fluoride >0.7 ppm: No Fluoride Supplement Necessary

Fluoride supplements are typically prescribed. It comes in liquid and chewable tablet forms and may be combined with a multi-vitamin. Supplementation may begin at six months of age. As children get older, fluoride toothpastes are used to prevent tooth decay.

Children two years of age and younger should not use fluoride toothpaste but instead use a training toothpaste like Orajel Toddler. Children over two years of age should use an ADA approved fluoride toothpaste but with assistance from a parent. Kids should be taught not to swallow and use a "pea-size" amount. Also, children under six years of age should not use fluoride mouth rinses.

Excessive fluoride intake can cause a condition called enamel fluorosis (discoloration of the permanent teeth). Talk to your health care professional for more information.

Finally, dental visits should begin within six months of the first tooth or at one year of age.

Hope this was informative!

Folic Acid and Pregnancy

2010-02-15T17:41:00.000-08:00

Throughout residency and in practice, I have seen many pregnant women. One of the most important pieces of advice I provide is the need to take a prenatal vitamin, more importantly, folic acid.

Folic acid is a B9 vitamin, essential in cellular production and division. It is found in green leafy vegetables, orange juice, dry beans, spinach, bananas, peanuts, enriched whole grain foods, and kale. The recommended daily allowance is 400 micrograms/day. Folic acid can help prevent coronary heart disease, anemia, and, in babies, neural tube defects.

Neural tube defect is a condition when the baby sustains a birth defect where there is incomplete development of the brain and spinal cord. Examples include spina bifida, anencephaly, and encephalocele. Typically, these defects occur in the first month of pregnancy, when the mother is unaware of her pregnancy. Folic acid can reduce the incidence of neural tube defects by up to 70%. Unfortunately, about 3000 babies are born each year with a neural tube defect.

The recommended dose for women who are pregnant or are expecting to be pregnant is 400 micrograms per day. Adequate folic acid intake should begin for all women who are of child-bearing age. It is wise to start a prenatal vitamin one month prior to conception to help ensure fetal nerve and brain development. One study indicated that three out of four women did not take their vitamin at least four times a week in the month before they became pregnant.

Folic acid can also reduce the possibility of cleft palates, preeclampsia, premature birth, congenital heart defects, and miscarriage.

There are special circumstances when more folic acid supplementation is required. Examples include previous child with a neural tube defect, family history of neural tube defects, personal history of diabetes, seizure disorder, or rheumatoid arthritis.

Folic acid supplementation does not stop at the birth. During breast feeding, the recommended amount is 500 mcg daily.

Typically prenatal vitamins contain 400mcg of folic acid. Most multivitamins also contain 400mcg. Check the label and verify that it has 100% of the RDA (recommended daily allowance).

Talk to your health care professional for more information. Thank you and have a nice day.

The Importance of Fiber

2010-02-10T11:49:00.000-08:00

Fiber is an essential component in a healthy diet. There are numerous benefits in eating an adequate amount of fiber. Unfortunately, many Americans do not meet the recommended goals.

Fiber is a type of carbohydrate that can not be digested. It passes through the body without being metabolized but it participates in many roles to maintain health.

There are two main types of fiber:
Insoluble-Fiber that does not dissolve in water and thus can help with constipation.
Soluble- Fiber that can dissolve in water and forms a gel like substance. This helps with cholesterol and sugar control.

The recommended amount is based on age, gender, and caloric needs but on average one should consume about 25 grams a day of dietary fiber from food. The average American consumes about 5-15 grams per day.

The benefits of fiber include:
1. Improves bowel health and aids in constipation
2. Lowers risk of heart disease
3. Decreases risk for diabetes and helps stabilizes blood sugar
4. Reduces risk for diverticular disease
5. Helps reduce bad cholesterol levels
6. Helps with weight loss
7. Lowers risk for hemorrhoids
8. Helps with irritable bowel syndrome
9. Reduces chances of gallstones and kidney stones

Sources of fiber include whole grain foods, legumes, nuts, fruits, and vegetables.

Here are some tips about adding fiber to your diet:
1. Add color to your plate (green leafy vegetables, red apples, brown rice, etc).
2. Instead of "white" foods, go with colorful foods...brown rice instead of white, sweet potatoes instead of white potatoes, whole grain pasta instead of white pasta.
3. Add fresh or frozen vegetables to soups, casseroles, pasta dishes.
4. Eat more beans, legumes, peas, lentils...refried bean nachos!!!
5. Drink water to also avoid constipation and to help the beneficial effects of fiber
6. Snack on dried fruit, fresh fruits, veggie sticks, nuts, popcorn, whole grain crackers instead of chips.
7. Substitute white flour with whole grain flour...great for pancakes.
8. Choose whole grain cereals.
9. Read food labels.
10. Add fiber gradually to your diet.
11. Add a spoonful of flaxseed to your food.

Here are some examples of foods with their fiber counts:
2 slices of whole-wheat bread = 4 grams of fiber
1 cup of cooked brown rice = 4 grams
Reduced-Fat Triscuit crackers = 3 grams
¾ cup cooked oatmeal = 3 grams
1 cup of canned minestrone soup = about 5 grams
1/2 cup vegetarian or fat-free refried beans = about 6 grams
1/4 cup kidney beans, added to a green salad = 3 grams
1 large apple = 4 grams of fiber
1 banana = 3 grams
1 cup strawberries = 4 grams
1 cup cooked broccoli = 4.5 grams
1 cup raw carrots = 4 grams
1 sweet potato = 4 grams
1 cup cauliflower, cooked = 3 grams
2 cups raw spinach leaves = 3 grams

Talk to your health care professional about dietary fiber. In some cases, patients may need fiber supplements such as Metamucil or Benefiber

Thank you and drive carefully!

Eye Floaters

2010-02-02T12:07:00.001-08:00

34 year old male presented to my office with complaints of seeing spots and transient blurry vision. He stated it began about a week ago after recovering from a cold. He describes the spots as bright "sperm-like" things. The blurry vision occurred when he was reading a book. He could not read the preceding word when focusing on a specific word but after a few minutes, the vision cleared. He also complained of a mild frontal headache. In the office, he continued to see the bright spots, but otherwise felt well. His blood pressure was excellent and his physical exam was unremarkable. He was sent to the eye doctor with the presumed diagnosis of visual floaters. The diagnosis was confirmed after the retinal examination.

Visual floaters (entopsias) are common, typically after the age of thirty five. They are from pieces of the vitreous gel in the eye that float and drift aimlessly in the eye ball. They can be described as spots, specks, cobwebs, light-flashes, strings, or clouds in the visual field. Floaters are more evident on a white or bright background. They may interfere with vision depending on the location but they are constantly moving and eventually settles to the floor of the eye.

Risk factors include older age, near-sightedness, Diabetes, sarcoidosis, syphilis, history of retinal disease, or previous cataract surgery.

Floaters are typically not a major problem. They tend to be an annoyance. An ophthalmologic examination is recommended to assess the retina. Medical concerns include retinal detachment (emergency), diabetic retinopathy, vitreous detachment (severe), bleeding in the eye, and infection.

If there is a sudden onset of floaters or if there are flashing lights with the floaters, contact the eye physician immediately. Also, if there seems to be a shade coming down the visual field, contact the eye specialist immediately. These are signs of a retinal detachment.

Floaters tend to dissipate with time. The brain also adapts to the presence of floaters and they become less annoying. There is no safe proven method to eliminate floaters. Surgical intervention may be utilized in very severe cases. Talk to you health care professional for more information.

Thank you.

Bad Things Can Happen to Healthy People

2010-01-25T19:15:00.000-08:00

I recently took care of a young patient who was diagnosed with a large neck mass that was compressing his windpipe and carotid and jugular vessels. He was diagnosed with tongue cancer years ago with a recurrence in 2008. He underwent surgery, radiation, and chemotherapy but unfortunately the neck mass developed. He fought hard. His family provided extraordinary support. However, there was nothing medically that could be performed to cure his cancer.

Reviewing his case, I expected to find the cause of the tongue cancer. I expected to see a tobacco history but he never smoked. He had no significant history of alcohol, drug, or tobacco use including chew tobacco. We looked at environmental and work exposures but found no association. He worked in HVAC. Bad things can happen to healthy people.

In medicine, we assess risk factors, find causes, and prevent potential severe medical conditions. We advise people to stop smoking to reduce the chance of heart disease. We encourage exercise and healthy diets to reduce the obesity epidemic. We vaccinate children to prevent Polio, Measles, Mumps, etc...We advise colonoscopies, pap smears, mammograms to prevent cancer. However, as in life, the unexplainable does occur in medicine.

One of the most frustrating aspects in medicine is when bad things happen to healthy people. This young man had no risk factors for tongue cancer yet he was diagnosed at around thirty years of age. The median age for tongue cancer is sixty. Risk factors include tobacco use, alcohol, HPV, and age. The incidence is about three per 100,000 per year (rare). We can only blame a faulty gene. The thought is always what could we have done to prevent this but unfortunately the answer is nothing.

Does this case reduce the importance of preventative medicine and risk factor stratification? No. It makes me appreciate how delicate and precious human life is and to be more cognizant about medical "zebras" and rarities. It makes preventative medicine more important so people can live life to its fullest. Therefore, eat healthy, drink in moderation, avoid drugs, do not smoke, exercise, and laugh. And if something bad does happen, understand that there is always a silver lining somewhere in the clouds, whether it be improving a physician's skill, bringing a family together, or making people appreciate their own lives.

Also, pray for the citizens of Haiti. It is a devastating situation and I wish to all my colleagues who are going to Haiti a safe journey.

Thank you.

Please Stop Smoking!

2010-01-18T15:48:00.000-08:00

The past several months I have had a run on severe tobacco related illnesses. Smoking is very detrimental to the vital organs but yet about 46 million adults smoke in the United States. Here are several patient cases...

50 year old male presented to me with complaints of chest pain and shortness of breath. He smokes 2 packs a day for 30 years. He has a history of high blood pressure but was not taking his medication due to cost (but yet could afford his 2 pack a day habit). He was sent to the ER and was found to have a myocardial infarction (heart attack). He underwent cardiac stenting and is now on multiple medications to prevent another heart attack.

70+ year old female presented to the office with chest pain and back pain. She smoked a pack a day for over forty years. A chest xray was done and a mass was found. After further diagnostics, she was diagnosed with lung cancer and the tumor had wrapped around her heart. Surgery could not be performed. Palliative therapy was done and she passed away.

A young twenty-something adult came to me with complaints of exertional shortness of breath. He was hospitalized for pneumonia several months ago. He continues to wheeze and utilizes two inhalers to stabilize his breathing. The patient began smoking when he was eight and continues despite repeated counselling to quit. He is a laborer but now has difficulty with exertional work. His quality of life is poor and he has difficulty keeping up with his young son.

A 60+ year old male saw me in the office with flu-like symptoms. He had trouble breathing, fever of 104, fatigue, and muscle aches for several days. Supportive care was advised with follow up. Several days later, his relative called and said he was confused. He was admitted to the hospital and diagnosed with pneumonia. Despite aggressive antibiotics, steroids, and oxygen support, he decompensated within 24 hours and was intubated (tube placed into his lungs). Upon further investigation, he had smoked 1 and a half pack a day since childhood and his lungs were in poor shape. Due to his smoking history, he developed COPD (chronic obstructive pulmonary disease) which made him very susceptible for respiratory infections and failure. He is recovering.

A 60+ year old female presented to the office with an oral gum lesion for several weeks. It was a raised mass with ulcerations on her lower gum line. She has poor dentition. She had smoked for many years. The patient was reluctant to go to the specialist but eventually listended to my advice. The biopsy revealed squamous cell carcinoma (cancer) and a total excision was performed. This scare resulted in her quitting tobacco.

This is just a sample of cases I see that are tobacco related problems. Smoking can contribute to many health problems such as COPD, lung cancer, heart disease, oral cancers, asthma, strokes, heart attacks, emphysema, pancreatic cancer, bladder cancer, high blood pressure, cervical cancer, peripheral vascular disease, pneumonia, kidney cancer, impotence, psychological disorders, fetal problems, etc....

Help is out there. Call your health care professional to help quit this deadly habit!

Acute Sinusitis

2010-01-11T18:05:00.001-08:00

In recent months, I have seen many complaints of sinus infections. The typical patient will come to the office and complain of facial pain around the cheeks with a fever and nasal drainage. Acute sinusitis is a very common illness in the primary care setting, accounting for about 16 million office visits per year.

Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage and mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.

The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.

The causes of sinusitis include:

1. Viral (Rhinovirua, Influenza, Adenovirus, Parainfluenza)

2. Bacteria (Streptococcus, Haemophillus, Moraxella)

3. Fungal (Aspergillus, Mucormycosis) in immunocompromised patients (Diabetics, HIV, cancer patients)

Risk factors include:

1. Allergies

2. Nasal passage abnormalities (deviated septum, polyps)

3. Trauma

4. Dental infections

5. Recurrent upper respiratory infections

6. Nasal dryness

7. Inhaled irritants (tobacco smoke)

8. Immune disorder

9. Inflammatory disorder

10. Hormones

Signs and symptoms (up to 4 weeks) include:

1. Pain/pressure in the cheeks, between the eyes, forehead, or nose (worse when leaning forward)

2. Upper teeth pain

3. Headache

4. Fever

5. Bad breath

6. Nasal drainage (yellow/green)

7. Trouble breathing through the nose

8. Reduced ability to taste or smell

9. Cough at night

10. Nausea

11. Fatigue

12. "Double sickening" (Patient begins with a cold, gets better, then gets worse again)

Treatment includes:

1. Saline nasal spray (Ayr or Ocean spray)

2. Short term decongestant (Sudafed)

3. Anti-inflammatory (ibuprofen)

4. Fluids

5. Rest

6. Moist heat on the sinuses (warm compresses)

7. Humidifier

8. Avoid anti-histamines

If the symptoms do not improve after several days, contact your health care professional.

Typically viral sinus infections will improve after 5-7 days. Acute bacterial sinus infections usually require antibiotics.

If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.

Major complications are extremely rare.

Contact your health care professional for more information.

Thank you and have a nice day.

Tobacco Cessation

2010-01-03T14:53:00.000-08:00

The new year always brings resolutions such as weight loss, exercising, improving relationships, etc. Another very common one is tobacco cessation or trying to quit smoking. Here are some strategies to help with this difficult yet attainable resolution.

1. Go cold turkey if possible. It can be done, especially in cases where an individual smokes less than a pack a day.
2. You need to really want it!!! Daily commitment is a requirement when trying to quit.
3. Set a quit date. Make it a meaningful date such as a wedding anniversary, birthday, or holiday.
4. Take advantage of counselling programs to keep motivated. It can range from phone sessions to group meetings.
5. Understand the positives when quitting such as improved breathing, lower risk for heart disease, whiter teeth, better breath, lower risk for lung cancer, more available money, etc...
6. Utilize social support from friends and family members. If other people smoke, make it a group goal and support one another.
7. Remove cigarettes, ash trays, other related items to reduce the urges.
8. Avoid or change habits that trigger tobacco use (i.e. alcoholic drink at a bar).
9. Avoid smoking environments and eat at non-smoking restaurants.
10. Reward yourself in successful weekly or monthly intervals.
11. Do it for the children...second hand smoke increases asthma attacks, allergies, ear infections, sinus infections, etc.
12. Talk to your physician about medications such as Chantix, bupropion, or nortriptyline, especially if smoking more than one pack a day.
13. Utilize nicotine replacement supplements to help with the cravings and withdrawal symptoms such as the gum, patch, nasal spray, lozenge, or inhaler.
14. Do not let smokers smoke in your house or car.
15. Exercise and eat healthy to keep your weight stable.
16. Chew gum, eat carrot sticks or pretzels, suck on lollipops, to keep your mouth busy.
17. Try alternative therapies such as hypnosis, acupuncture, or acupressure.
18. It is OK to "slip." Try again and get back on track.
19. Stop the excuses.
20. It is all about "one day at a time."
21. Try Quit Meters (available online) to keep track of your success
22. Find a healthy passion to replace smoking such as leading a tobacco cessation group.
23. NEVER GIVE UP!!!
24. Talk to your health care professional...use them as a resource.

Check out the QuitNow website or call 1-800-QuitNow (free service)
Thank you and have a Great New Year!!!

Car Seats

2009-12-27T19:34:00.000-08:00

Recently, the news reported on the importance of car seats for toddlers. Here are the some of the child passenger safety recommendations.

Rear Facing in the back seat:

Birth to one year of age and
20 lbs or under

Forward Facing in the back seat:

Toddlers from one year to four years of age and
20 lbs to 40 lbs
It is best to keep the toddler rear facing as long as possible

Booster seat in the back seat:

Children from four years of age to about eight years
4' 8" tall or under
Children should stay in a booster seat until the adult seatbelt fits correctly over the lap and shoulder

Seatbelts in the back seat:

Children at least eight years old
4' 9" and taller

Seatbelts in either the back or front seat:

Teenagers 13 years old and older

Here are some enlightening statistics:

1. Children riding in the front seat are 40% more likely to be injured in a crash than those riding in the back seat.
2. Children in the back seat are about 38 percent less likely to be injured in a crash.
3. Car seats reduce the risk of death by 71% for infants and by 54% for children ages 1-4.
4. Booster seats reduce injury to 4-8 year olds by about 59%.
5. 42% of all unintentional childhood deaths are due to crashes.
6. Motor vehicle crashes claims nearly 1,800 children's lives and results in more than 274,000 injuries each year.
7. Approximately 80 percent of car seats are not installed and/or used correctly.
8. Seat belt use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were also unbelted.

Motor vehicle injuries are the leading cause of death among children in the United States!!!

Please follow the car seat recommendation, confirm proper installation, and always wear seatbelts. Talk to your health care professional for more information.
Excellent resources include the Healthy Children website and the NHTSA site.

Thank you.

Happy Holidays!

2009-12-21T18:05:00.000-08:00

Wishing everyone a safe and joyous Holiday Season!!!

Water and Infants

2009-12-20T15:32:00.000-08:00

During my infant well child exams, I advise mothers not to give water to infants. I usually get a perplexed face from the mother and sometimes a few words from the grandmother. During residency, I rotated through AI DuPont Children's Hospital emergency room. One evening, a young infant boy came to the ER with a seizure. He had no medical problems and no history of seizures. His family history was unremarkable. The family denied any high fevers or any accidental ingestions. Upon further investigation, the baby was recovering from a viral cold and the parents were giving water to prevent dehydration. Labs revealed a critically low sodium (hyponatremia). The baby was treated and released and the parents were counselled on not to give water to infants.

Providing water to infants to prevent dehydration increases the risk of seizure by diluting and then decreasing the sodium count in the blood. The low sodium then causes altered brain activity. The reasons why this occurs are 1) kidneys are not mature to flush out the excess water and 2) the infant diet does not contain enough salt to balance the excess water. Water intoxication can lead to several signs and symptoms including drowsiness, irritability, facial swelling, low body temperature, poor coordination, nausea and vomiting, irregular breathing, and then seizures.

Treatment is giving infants anti-seizure medications and salt containing fluids. Prognosis is excellent. Babies typically recover without any problems.

The best way to prevent water intoxication seizure is to not give water to babies. This includes tap water and commercially bottled water. Also, there have been reported cases of water intoxication from repeated dunking during swimming lessons. If the baby shows signs of dehydration, continue to give formula and/or breast milk. An oral rehydration solution such as Pedialyte can also be utilized.

Contact your primary care physician for more information. Thank you and have a nice day.

Cocaine and the Heart

2009-12-13T18:58:00.000-08:00

A 40 year old male presented to the ER with complaints of severe chest pressure and trouble breathing. The symptoms began earlier in the day and progressively worsened. His medical history was remarkable for tobacco use but no cardiac problems. Diagnostic tests were performed which confirmed his heart attack. He was also found to have a positive drug test. Typically, young males do not have a heart attack unless there is a precipitating factor such as cocaine use.

Cocaine is the most abused illegal stimulant in the United States. About 15% of adults have tried cocaine. About 34 million people age 12 or older have experimented with this highly addictive drug and about 1.5 million are regular users. Recently, the percentage of college students using this substance has increased.

Cocaine is a powerful stimulant of the central nervous system. It comes from the leaves of the Erythroxylum coca bush located in South America. Cocaine can be injected, snorted, swallowed, smoked, or rubbed onto gums. Its effect is immediate and wears off in about thirty to sixty minutes.

The signs and symptoms of cocaine use include:
1. Euphoria
2. Increasing sense of alertness
3. Elevated mood
4. Paranoia
5. Restlessness
6. Anxiety
7. Dilated pupils
8. Excited speech
9. Decreased appetite
10. Sense of power
11. Hallucinations

There are many more symptoms....here are some of the detrimental health effects
1. Increase risk for heart attacks
2. Abnormal and life threatening heart rhythms
3. Stroke
4. Emphysema
5. Stomach ulcers
6. Kidney failure
7. Impair sexual function
8. Psychosis

The risk of heart attack in the first hour after using cocaine is 24 times normal!!!
Nearly one-fourth of heart attacks in people ages 18 to 45 are cocaine related.

The patient underwent cardiac stenting and had a full recovery. I can only hope this was a wake-up call.

There have been thousands of cocaine related deaths but the one I always remember is Maryland basketball star Len Bias.

Talk to your children about drugs. A helpful guide is on the Family Doctor website. Click here.

Contact your primary physician for more information.
Also, useful websites include:
National Institute on Drug Abuse
Substance Abuse Treatment Facility Locator

If you have never tried cocaine, please don't...it only takes one time to potentially ruin your life.

Postpartum Depression

2009-12-06T06:25:00.000-08:00

I recently saw a 22 year old patient with complaints of fatigue, muscle aches, and feeling down for several weeks. She recently had her second child with no obstetrical complications. She feels depressed and is also worried about not bonding with her baby. Her medical history is unremarkable with no history of psychiatric disorders. She has a very supportive family. The patient was diagnosed with postpartum depression and was started on treatment with success.

Postpartum depression is a common type of depression affecting about 15% of women after the birth of their child. PPD usually begins several weeks after delivery but can occur anytime in the first year. PPD can last for several weeks to months.

There is a milder form of depression called the baby blues that begins a couple days after delivery and lasts for about 2 weeks. About 50% of women experience this condition. The signs and symptoms include trouble sleeping, irritability, heightened emotions, but it does not interfere with the mother's ability to care for her child. PPD does affect the woman's ability to function.

Risk factors include history of depression, psychosocial stress, lack of family support, young age, substance abuse, and problems with a previous pregnancy.

It is not clear what causes PPD but hormonal or chemical changes may play a factor.

Signs and symptoms of PPD (lasting more than two weeks) include:
1. Agitation
2. Feeling sad, hopeless, and overwhelmed
3. Crying a lot
4. Fatigue
5. Loss of appetite
6. Insomnia
7. Trouble focusing, remembering, or making decisions
8. Feeling worthless
9. Loss of interest or pleasure in activities
10. Headaches
11. Chest pain
12. Body aches
13. Lack of motivation
14. Withdrawal from friends and family
15. Decreased sex drive
16. Negative thoughts about the baby

Treatment includes
1. Family support
2. Asking for help
3. Rest and taking naps
4. Exercise, take walks
5. Talk to other mothers
6. Breast feeding
7. Eating healthy and continuing a prenatal vitamin (add fish oil to your diet)
8. Counselling with a professional
9. Medications such as antidepressants

Postpartum psychosis is a rare, severe form of postpartum depression that requires immediate medical attention. Mothers may experience hallucinations, display bizarre behavior, thoughts of hurting or killing herself or the infant. Postpartum psychosis requires psychiatric hospitalization and treatment.

Bringing a newborn into the world is a beautiful but life changing experience. If you have any concerns of the "baby blues" or postpartum depression, contact your physician immediately. Early intervention will improve the quality of the baby's life and your life.

Here is a postpartum checklist adapted from the New England Journal of Medicine
Click here

Talk to your healthcare professional for more information. Thank you.

Hand Foot and Mouth Disease

2009-11-29T18:41:00.000-08:00

Recently, a five year old girl saw me with complaints of "my mouth hurts" and "my tummy hurts." Her mother noticed sores in her mouth several days ago. Her medical history was unremarkable, she was a healthy active young girl. Upon examination, she had a temperature of 100.6 and a couple of small sores in her mouth. Interestingly, she also had a rash on her hands. Reassurance was given to both the mother and the girl and she recovered nicely in several days.

Hand Foot and Mouth Disease is a viral illness that affects young children, typically under ten years of age. It is most commonly caused by coxsackieviruses (Enterovirus genus), members of the Picornaviridae family. HFMD is contagious and spread by nasal secretions, saliva, fecal material, and aerosolized droplets. Daycares have a high incidence of HFMD. It is more common during the summer and autumn months. Children are contagious one week prior to the onset of symptoms and potentially several weeks after resolution.

The signs and symptoms include (but not limited to):
1. Fever
2. Fatigue
3. Cough
4. Abdominal pain
5. Sore throat
6. Poor appetite
The rash and sores develop 12 to 36 hours later. The oral sores are painful, red, blister-like lesions located on the tongue, inner cheeks, or gums. The rash on the palms, soles of feet, or buttocks are not itchy, red, and possibly blistery. The rash and sores can last for five to seven days.

HFMD is not usually serious and self-limiting (will resolve with time). Rare complications include viral meningitis, myocarditis, and encephalitis.

Treatment includes:
1. Fluids
2. Supportive care
3. Tylenol or ibuprofen for the pain
4. Popsicles/ice cream for the oral pain
5. Warm salt water rinses without swallowing (1/2 teaspoon of salt with one cup of warm water)
6. Time...HFMD will usually resolve in 7-10 days

Prevention includes:
1. Good hygiene
2. Hand washing (twenty seconds)
3. Do not rupture blisters
4. Avoid close contact with patients diagnosed with HFMD
5. Keeping toys and surfaces clean

Call the doctor immediately if the child develops any of the following symptoms:
1. Fever higher than 100.4° Fahrenheit (38° Celsius) for infants younger than 6 months and higher than 102° Fahrenheit (38.8° Celsius) for older kids
2. Poor appetite or trouble feeding
3. Difficulty breathing
4. Convulsions
5. Unusual sleepiness
6. Severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
7. Neck stiffness

Please note Hand Foot and Mouth Disease is not Foot (Hoof) and Mouth Disease.

Call your primary physician for more information. Hope this was informative!

Osgood Schlatter Disease

2009-11-27T10:27:00.001-08:00

A 13 year old female presented to the office with bilateral (both) knee pain. She stated the pain was worse when running but better on rest. The pain started during field hockey season and has persisted for months. She denied any trauma or injury. Exam was remarkable for tenderness right below both knee caps. Radiograph findings were consistent with Osgood Schlatter Disease.

Osgood Schlatter disease is a benign condition that causes pain, tenderness, and/or swelling below the knee cap, over the shin bone (tibia). It is typically seen in active teenagers eleven to fifteen years of age (during the growth spurt years) with a male to female ratio of 3:1. The pain is caused by stress on the patellar tendon that attaches to the quadriceps at the front of the thigh to the tibial tuberosity. The repeated stress from running, jumping, gymnastics, dancing, etc, causes inflammation and possible avulsion fractures at the site which leads to the pain and a bony lump. The pain is typically worse during activity.

The signs and symptoms include:
1. Pain on the upper shin, below the knee cap...can be intense!
2. Swelling at the site
3. Tender bony lump
4. Tight quadriceps

Osgood-Schlatter disease affects about 20 percent of adolescents who participate in sports. The sports include soccer, football, basketball, ballet, gymnastics, volleyball, field hockey, lacrosse, etc...

Diagnosis is made by history, physical, and x-rays.

Treatment includes:
RICE
R = Rest the knee from the painful activity.
I = Ice the affected area for 20 minutes, 3 times a day.
C = Compress the painful area with an elastic bandage.
E = Elevate the leg.

Anti-inflammatories (Motrin, Advil) also will help with the pain.

Physical therapy is utilized to strengthen the quadriceps and hamstrings. Some examples include straight leg raises, quad contractions, and leg curls.

The pain may last for several weeks to several months. Physical activity may have to be restricted depending on the severity of the pain.

With adequate time, treatment, and rest, Osgood Schlatter disease should resolve. Rarely does OSD occur after the growth spurt years due to the strengthening of the patellar tendon.

For more information, contact your primary physician.