Dr. Brian's Healthy Thoughts

PTSD and Risk Factors

noreply@blogger.com (Dr. Brian McDonough) — Tue, 03 May 2011 02:32:00 +0000

Posttraumatic stress disorder or PTSD is a major complication for soldiers fighting wars. There are obvious reasons for this. Stress, the concern over life or death, and fear of the unknown often contribute. But when soldiers witness death and destruction directly they can have long-term effects. But what soldiers are at greater risk to develop PTSD. Are there certain characteristics? Are there certain ways to find out? According to a new study in the archives of Gen. Psychiatry, military service members who screened positive for signs of PTSD before they were deployed were five times more likely to develop the condition. There were other risk factors. Those who took psychiatric drugs before deployment were to two and a half more times more likely. Experts say that early intervention is necessary for people at risk

A Look at Meaningful Use

noreply@blogger.com (Dr. Brian McDonough) — Fri, 22 Apr 2011 03:52:00 +0000

The term is meaningful use. The vast majority of people words the meaningful use don't really mean all that much, but in medical circles these two words will dramatically affect the way you receive care. Meaningful use is the way the government has chosen to describe a series of rules and regulations that will help determine how computers and technology will affect the care you are given. The good news is that there are all sorts of regulations put in place that will be used to measure the quality of your care and the way records are kept. The bad news is that many of these regulations were written by politicians or people who have very little to do with the practice of medicine. Overall I believe we are definitely heading into a time where care will be improved especially from an organizational standpoint and consistency of decision-making. My fear is that a great deal of the art of medicine may be left behind with the clicks on a keyboard. The best way to achieve success and we can accept nothing but success is to involve healthcare providers and patients in the process

Do You Want To Know The Future This Much????

noreply@blogger.com (Dr. Brian McDonough) — Mon, 18 Apr 2011 02:23:00 +0000

There have been many tremendous breakthroughs in the field of genetic research. As a result of greater understanding of the genetic code we understand the origin of many illnesses and conditions some of which can be life-threatening. But a new report in the Journal Pediatrics takes a look and a very interesting study which is based on the information we have learned from genetic research. Do the majority of parents who have young children want to know what conditions their children may develop when they are older. In other words would you as a parent wants to know if your young child was someday going to suffer from a certain form of cancer or genetic disease. According to the new study a majority of parents would want their children to be tested and know the results. The American Academy of pediatrics advises against this type of testing. This is an interesting study that at one time would have been a hypothetical discussion. But it is becoming more realistic everyday.

The battle over the medical chart!

noreply@blogger.com (Dr. Brian McDonough) — Fri, 15 Apr 2011 02:30:00 +0000

There is a battle going on in medicine these days and as patients it is very important that you know what is happening. I don’t know if you saw the Seinfeld episode where Elaine wants to see what is on her doctor’s chart. It is actually very entertaining to watch the comedy surrounding what Elaine sees as her doctor’s ability to write anything he wants seemingly without her control. Fortunately, patients have access to their charts and have control. But the battle I am talking about has to do with hospital charts. Each day doctors, nurse and anyone involved with an in patient’s care writes notes as a way to communicate information to other healthcare providers –information that is crucial for your healthcare. But, long after discharge the government and other payers for care look at the notes and determine what they will pay for your hospitalization. The battle is that the notes are potentially being used to generate payments. We need to return to a time when the charts were used to help people get better ..not justify fees.

Herpes Lasts Forever

noreply@blogger.com (Dr. Brian McDonough) — Wed, 13 Apr 2011 01:51:00 +0000

There is a concerning new study dealing with the herpes virus. According to a report in the Journal of the American Medical Association people with genital herpes can be contagious even when they don't have symptoms. We have known for many years that herpes is spread through sexual contact when people have source or what is called prodromal period in the days before the soars appear. Worldwide more than 530 million people at the herpes virus and according to this report people who harbor the virus can be shedding it as much as 10% of the time. This means they could infect sexual partners. Although use of condoms can reduce the spread of genital herpes, it does not provide 100% percent protection.

A very interesting Blog

noreply@blogger.com (Dr. Brian McDonough) — Wed, 13 Apr 2011 01:38:00 +0000

Shifting the bell curve

The nurse at my doctor's office was checking my blood pressure last week when the following conversation ensued:

Nurse: (trying not to look worried) Um, have you ever had low blood pressure before?

Me: No. I've always had normal blood pressure.

Nurse: (now not hiding worry) Well, I'm getting 100/70 for you.

Me: Yep. Perfectly normal.

One of the residents today was telling me about a code he attended in the hospital yesterday. The code was called for hypotension (dangerously low blood pressure). The resident rushed into the room to find the patient sitting calmly, eating his breakfast. The nurse informed the resident that the patient's blood pressure was 90/60.

My intention here is not to lambaste nurses. They are merely following their protocols and experience. The larger question, I think, is when did reasonable blood pressures become "low"? Is it just because most of the blood pressures that nurses (and docs, for that matter) see are elevated?

I can't separate the word "normal" from the picture of a bell curve in my head. And I have to wonder if the bell curve for "normal" blood pressures isn't starting to shift toward the right.

I don't like the complacency toward a new norm that these events portend. How can we convince our patients that their blood pressures are too high when the bell curve of normalcy has shifted? I have started using the word "healthy" to describe desirable blood pressures instead of "normal."

Because, sadly, normal doesn't seem to be healthy anymore.

Laurence Bauer, MSW, MEd

Chief Executive Officer

Family Medicine Education Consortium

Laurence.Bauer@fmec.net

EMR and Catching Hospital Errors

noreply@blogger.com (Dr. Brian McDonough) — Thu, 07 Apr 2011 02:49:00 +0000

One of the major things that hospitals can do to ensure your safety as a patient is to keep careful track of possible errors. No one wants to make an error especially in a hospital setting when patient lives are on the line but if these errors can be measured and people can learn from them,similar mistakes can be prevented. But according to a study from the University of Utah in the journal Health Affairs ,current tracking measures including a self reporting system are not catching the majority of errors. The University of Utah uses a technique called the global trigger tool which measures errors. Their system was able to identify 354 errors compared to only 39 with the other systems that are more traditional. This means that 90% of mistakes were missed. A review of the study shows that many of these mistakes were not major errors nor did they necessarily cause patients significant harm but the point is we need better ways to monitor errors across the board. It is hoped that as electronic medical records become more part of patient care many of these errors to be picked up earlier.

Something New and Exciting

noreply@blogger.com (Dr. Brian McDonough) — Sun, 13 Mar 2011 01:31:00 +0000

For several years, you have trusted www.mymedicalreports.com as your site for the latest in breaking medical news and trusted health information. In the coming weeks we will be making a transition to a new and exciting site called http://www.123mymd.com/ which will have all you have been used to and even more!

This does not mean www.mymedicalreports.com is going away. It is being transitioned into a resource for physicians who are being faced with the challenge of meeting Meaningful Use and introducing electronic medical records into their practices and care of hospitalized patients. Certainly, non physicians will always be able to access www.mymedicalreports.com, but the new interviews and information will be aimed at practicing physicians.

Take a look at http://www.123mymd.com/ and let me know what you think. The blogs you have been used to reading on this site will be continued on our new site. You won't miss a beat!

Sudden Death In High School Athletes: Is It Time For Routine EKGs

noreply@blogger.com (Dr. Brian McDonough) — Mon, 07 Mar 2011 02:24:00 +0000

The deaths of teenage basketball Star West Leonard closely followed by 17-year-old rugby player Matthew Hammerdorfer have raised a very reasonable question, "just how often do tragedies like this strike". According to the journal Circulation, the Journal of the American Heart Association, the rate of sudden cardiac deaths in young athletes was similar to that of deaths from lightning. But even though they are rare they are hard-hitting and have tremendous impact. The two primary causes of sudden death from heart conditions in which there were no previous symptoms are hypertrophic cardiomyopathy and a genetic condition called long QT syndrome. Hypertrophic cardiomyopathy is a thickening of the heart muscle and can cause cardiac arrest during exertion. The QT syndrome is a problem with electrical regulation of the heart. It is very difficult to detect these underlying heart conditions but a physical examination. EKGs can help but in the United States they are not recommended because testing is costly and can lead to false positive results which would mean unnecessary additional testing. There are many cardiologists who believe the EKGs should be standard. The European Society of cardiology recommends routine EKGs. One of the best ways to screen is through pointed questions for instance does the child have heart palpitations, a racing heart or passes out. Sadly the first warning in many of these cases is the sudden cardiac event while participating in a sports related activity.

Down Syndrome Blood Test

noreply@blogger.com (Dr. Brian McDonough) — Sun, 06 Mar 2011 21:18:00 +0000

Down syndrome is a chromosomal disorder that results in cognitive delays. It is caused by having an extra copy of chromosome. Down syndrome can be diagnosed with a procedure called an amniocentesis where amniotic fluid is taken from the pregnant mother. This procedure does carry a small risk of miscarriage. Now there is news out of the journal nature medicine that a simple blood test could help detect a baby with down syndrome. The study which was performed in Greece involved 40 cases. The scientists were successful in detecting down syndrome however the authors believe that more cases are necessary and more studies need to be completed before the test can be approved for use. According to the article the scientists believe they can spot down syndrome through fetal DNA that has been shed into the mother's bloodstream. Once again this is not approved for use in United States

Diabetes Can Shorten Your Life

noreply@blogger.com (Dr. Brian McDonough) — Thu, 03 Mar 2011 02:49:00 +0000

Diabetes is the seventh leading cause of death in the United States it affects about 26 million Americans each year. We have known for quite some time that a person with diabetes has an increased risk of heart disease: things like heart attack and stroke. But now according to new report New England Journal of Medicine there are some more disturbing statistics. Overall, people with diabetes die younger than people who do not have diabetes. This particular report looked at 820,000 people by reviewing 97 existing studies. And what they found is that diabetes can shorten average person's life by six years. To put that in perspective a person who smokes cigarettes can shorten their life by seven years. Obviously this raises concern. But it doesn't take one major fact into account. People who control their blood sugar with close measurement and medication do much better than those who do not monitor and treat their blood sugar on a regular basis. So if you're a diabetic don't be discouraged but make sure you follow up closely with your doctor and take care of the condition every day.

Dangers of Smoking

noreply@blogger.com (Dr. Brian McDonough) — Wed, 02 Mar 2011 04:27:00 +0000

It is a well-known fact that cigarette smoking can increase the risk of lung cancer. But according to a report in the British medical Journal it can play a role in the development of breast cancer as well. A study out of West Virginia University looked at over 80,000 women and followed them for 10 years. What they found is that cigarette smokers were at a 16% greater risk for breast cancer compared to non-smokers. Even those who kick the habit were 9% greater risk. When they took a look at the effect of long-term smoking the researchers found the longer a woman smoked the greater her risk for breast cancer. Perhaps the most disturbing part of all the statistics is the fact that the increased risk continued for up to 20 years after a woman stopped smoking. If lung cancer and emphysema and heart disease were not enough reasons to quit perhaps the concern over breast cancer might be a motivation. Put simply smoking cigarettes is one of the worst things you can do for your health.

Parents Overtreating Kids for Fever: A growing Problem

noreply@blogger.com (Dr. Brian McDonough) — Mon, 28 Feb 2011 03:41:00 +0000

Do you have fever phobia? The American Academy of pediatrics says that it is a problem in this country. Fever is one of the most common clinical symptoms in children and certainly if the temperature is elevated it can be a warning sign that there are other problems. The fever is really the bodies way to fight infection and sometimes a low grade fever is not a bad thing. However due to advertising and the ready availability of many medications to control fever there are parents who will turn to medicine when the temperature is 99.5. Many of these medications used to treat fever have side effects themselves. The Academy of pediatrics lists what they consider to be the best recommendations and obviously each case should be considered on an individual basis but over treating a fever is not a good thing. There are two groups were you must take fever is extremely seriously: in children under three months of age and those who have chronic disease. I am not saying to ignore fever but think about how quickly you turn to medications and if you have questions talk with your physician.

Stress and Pregnancy

noreply@blogger.com (Dr. Brian McDonough) — Fri, 25 Feb 2011 03:38:00 +0000

There are many women who are trying to have children and feel the stress of becoming pregnant. But does the stress make getting pregnant more difficult? According to a new report in the British medical Journal stress does not seem to play much of a role in fertility. The study looked at 14 prior studies and measure emotional distress and the success rate following fertility treatments. In the 3500 women tested stress did not seem to affect pregnancy. In addition feelings of tension worry and depression did not appear to play a role as well. It should be mentioned that this study looked at women undergoing fertility treatments. The authors make a point to say that this does not necessarily mean women who are not undergoing fertility treatments are not affected by stress. However it is a fair assumption that it would not play a role

Cell Phones and Brain Cancer-Is There A Link?

noreply@blogger.com (Dr. Brian McDonough) — Wed, 23 Feb 2011 04:07:00 +0000

It is a question that has been asked many times before, Can using a cell phone lead to brain cancer? It is an important question because mobile phone use has increased from 7.6 million in 1991 to 223,000,000 today. As of this point there have not been any significant studies to show a direct connection. But the National Institutes of Health decided to look at something else. They look at the activity of the brain in people who use cell phones. 47 healthy people had their brain activity measured by PET scans. Their brains were measured when the cell phone was on and actively transmitting electromagnetic rays and when the cell phone was off. What they found is that activity in the brain closes to the antenna was almost 7% higher when compared to the rest of the brain. What it shows us is that the brain is sensitive to electromagnetic waves from cell phones. It doesn't tell us anything else. Already some are suggesting the advantages of speakerphones and minimizing the amount of time the cell phone is held to the ear. Once again this is not a measure of cancer but it does show that our brains are in some way affected by electromagnetic waves from cell phones.

The importance of stretching

noreply@blogger.com (Dr. Brian McDonough) — Thu, 17 Feb 2011 03:59:00 +0000

There is some controversy over in age-old exercise adage. According to a new report being presented at the American Academy of orthopedic surgeons meeting all that stretching you do before and after you exercise might not be that necessary. Researchers assigned about 2700 runners who run at least 10 miles or more each week into two groups. One group stretched 3 to 5 min. justified exercise and the rest were told not to stretch before working out. After three months the researchers found there was no difference in injury rates among runners to stretch before a run compared to those who didn't stretch. However in those individuals who were used to stretching and were told to stop 40% developed injuries. Critics of the study say they need more information about how much the athletes ran and the condition they were in. Experts on the subject say that stretching is beneficial particularly for people who do not have an opportunity to exercise often. Personally until I see more studies on this subject I continue to support the theory that stretching reduces the chance of injury

Heart Diseas---Yes, It Happens in Women

noreply@blogger.com (Dr. Brian McDonough) — Tue, 15 Feb 2011 03:01:00 +0000

There was a time when we did not believe women were at great risk for heart disease. The problem was that women were not studied like men. All our information was based on studies of middle-aged men. But over the past two decades we have learned that women are at significant risk especially after menopause . The American Heart Association knows that too. They had come out with their first guidelines since 2007 advising what warning signs for doctors to look for. They say doctors should be concerned about illnesses linked to heart disease in women such as lupus rheumatoid arthritis and women with a history of high blood pressure during pregnancy or high blood sugar during pregnancy. They also want doctors to be aware of the fact that women in different racial and ethnic groups have different rates of heart disease.

Surgery in The Womb: Fighting Spina Bifida

noreply@blogger.com (Dr. Brian McDonough) — Wed, 09 Feb 2011 23:37:00 +0000

Doctors at the Children's Hospital of Philadelphia have just released the findings of a major study looking at performing surgery in the womb to help prevent many of the devastating effects of spina bifida. Spina bifida is the most common birth defect of the central nervous system. One of the major problems is the result of what is called a myelomeningocele. This is a problem that occurs one part of the spinal column does not close around spinal cord. Babies born with this have lifelong disabilities including paralysis, bladder and bowel problems and excessive fluid pressure in the brain. The physicians from the Children's Hospital as well as those from Vanderbilt and the University of California in San Francisco performed fetal surgery. During the procedure surgeons covered the myelomeningocele with multiple layers of the fetus' own tissue. In most cases the surgery was done between 19 and 26 weeks gestation. The surgical team made incisions in the mother and her uterus and repair the spina bifida lesion while the fetus was in the womb. The results of the study are promising after 30 months children had better scores in measurements of motor function. Those with the surgery were twice as likely to walk without crutches of those who did not have the surgery obviously more work needs to be done in the surgery was not without risk fetal surgery raises the risk of premature birth and starring in the mother's uterus

Congratulations to President Obama!!

noreply@blogger.com (Dr. Brian McDonough) — Wed, 09 Feb 2011 02:08:00 +0000

I don't care what your politics are but sometimes you have to say well done. That's the case with our president Barack Obama. Up until recently he was like one in five adults smoking cigarettes. That's 46 million people in the United States who are addicted to nicotine. But now there is news from the First Lady that the president had kicked the habit. This is not the first time he is quit. Mr. Obama says he has tried several times before and returned to cigarettes. However that just makes him more normal. Three out of four smokers who try to kick the habit relapse within six months. But what some may see as a weakness can also be a strength. People often follow the example of public figures. When President Reagan had a colonoscopy the numbers skyrocketed. The hope is that many Americans will try to follow in the president's footsteps and the fact that he has failed before and continues to try maybe the best lesson of all. Back in 1964 the Surgeon General declared tobacco hazardous to your health. Since that time booking rates have dropped but progress has been limited in the past 10 years. Perhaps the president will serve as inspiration for smokers to quit

You are what you eat!

noreply@blogger.com (Dr. Brian McDonough) — Tue, 08 Feb 2011 03:10:00 +0000

There is more information to feed your child a healthy diet. According to a British study from the University of Bristol children who have a diet high in could have a slightly lower IQ in later life. The report is based on information from a study of 14,000 people born between 1991 and 1992. These children's health has been monitored throughout their lives. According to the authors of the study there was a significant difference in children who ate a diet high in salads , vegetables, fruit pasta and rice when compared to those who had a diet high in processed fats and sugar. According to their information the 20% of children in the study who ate processed foods at an average IQ of 101. Those with a healthier diet had an average IQ of 106. Critics of the study say it is virtually impossible to eliminate other factors such as parents of the children an environment in which they live. The authors agree that the study may not be perfect but they add that the healthier diet not only make sense from the stance of an IQ but for overall health as well

When The Internet Was Young

noreply@blogger.com (Dr. Brian McDonough) — Sat, 05 Feb 2011 03:24:00 +0000

I came across this "commercial break" conversation from the 1994 "Today Show" and it puts things into persepective as to how far we have come in the world of technology.
When I consider the hours I am putting into order sets and electronic medical records it makes me smile to think of simple days:

Here is the link: http://www.youtube.com/watch?v=JUs7iG1mNjI

Enjoy. The irony is that I worked for that program two years later and probbaly knew as little as they did!

HPV Vaccine: Is It Tiem To Give It To Boys As Well

noreply@blogger.com (Dr. Brian McDonough) — Thu, 03 Feb 2011 03:09:00 +0000

The human papilloma virus or HPV vaccine was approved in June of 2006 for use in girls and women for the prevention of cervical cancer. For many years we had known that 70% of cervical cancer cases are associated with HPV. But the question has remained for many years why not give the vaccine to boys as well. According to a new study in the New England Journal of Medicine 4000 boys and men between the ages of 16 and 26 were given either the HPV vaccine or a placebo. After three years the researchers found the vaccine reduced HPV infection by as much as 90% in those who were HPV negative at the start of the testing. Those in favor of vaccinating boys for HPV say that this could dramatically reduce the chances of HPV being spread by sexual activity simply because fewer would have the virus. Those against the idea say they are not certain about the long-term protective effects of the vaccine in question whether it's cost-effective to vaccinate so many people. They also point to the fact that the study was funded by Merck which is the company that produces gardasil, the leading HPV vaccine. Needless to say this is going to raise much debate

Cholesterol Control: Not Where We Want It

noreply@blogger.com (Dr. Brian McDonough) — Wed, 02 Feb 2011 02:56:00 +0000

It is a good news and bad news scenario. The good news is nearly 50% of people with high cholesterol are getting treatment compared to about 28% a decade ago. The bad news is only 50% of people with high cholesterol are getting treatment. There are still 48 million adults with high cholesterol levels that are not controlling it. This puts them at greater risk for heart attack and stroke. Of particular concern is the LDL or bad cholesterol the LDL should not be over 160 for healthy people and many are saying it should be below 100 for those with heart disease or diabetes this is a number which is not changing rapidly enough. There are other issues as well. For instance treatment is much more common in people who have health insurance than those who are uninsured. This study looked at more than 79,000 adults in eight countries. In case you're wondering diagnosis of elevated cholesterol levels was highest in the United States and lowest in Thailand.

A Positive Report about Video Games--For Once!!

noreply@blogger.com (Dr. Brian McDonough) — Tue, 01 Feb 2011 03:56:00 +0000

Videogames don't get the greatest press when it comes to health reports. Think about it there usually associated with violence , poor grades or some sort of negative image. But there is actually a positive story about videogames...at least when it comes to girls. According to a new study of 287 video gameplaying teens between the ages of 11 and 16 those who played with their parents actually have a positive outcome. Besides the fact they probably beat their parents and I'm willing to bet on that one the actually had increases in communication. Playing age-appropriate games with parents had a positive effect on girls who reported a high level of parent connectedness they had lower levels of internalization of emotion and lower aggressive behavior. Now there was a downside. If girls played games that they perceived as inappropriate for their age with their parents they experienced a high rate of internalization of emotion and negative feelings. Now you might be wondering about boys. According to the study playing with parents as very little effect

A Warning About Breast Implants

noreply@blogger.com (Dr. Brian McDonough) — Tue, 01 Feb 2011 00:44:00 +0000

Most women who undergo surgery for breast implants have the procedure for cosmetic reasons, but for more than fifty thousand women each year breast implants are for reconstruction purposes--in most cases after a woman has had a mastectomy as part of breast cancer treatment. For many women these implants can help provide a stronger sense of self and body image. but many are facing a new concern. Last week the Food and Drug Administration announced that saline and silicone implants have been linked to a very rare but potentially aggressive form of cancer called anaplastic large cell lymphoma. The key word is rare--this form of cancer is extremely rare, but any type of link with cancer (especially for those who have dealt with it) can be stressful. The most important take home message is that if you have implants this is something you should keep in the back of your mind and, at least, discuss with your physician. It also is important taht this risk--even though it is small, be discussed with every woman who is thinking about getting implants.