You can't touch this

Some modern medical tests use radioactity to trace blood flow during a stress test, thyroid activity, etc. This leaves the patient mildly radioactive for 1-3 days depending on the test or procedure. Under such occasions the doctor will give the patient a card attesting that they have had a medical procedure involving a small amount of radioactive material. Don't lose this card!
You may set off alarms in the airport. Or be stopped at check points to prisons or military bases. Recently a firefighter in Connecticut was pulled over by a policeman after he set off a radioactivity detector in the state police car. The fireman was impressed,  "I had no idea the police even had devices like that." He showed his medical card to the police officer and was allowed to go instead of being held as a suspected terrorist.

Diverticulitis

Diverticulitis, the word looks scary but it's not hard to pronounce di - ver - tic -u -LI - tis. What is it?

Imagine a pimple, a pore on your face which becomes infected and swells. Now imagine that pimple happening alongside your large intestine. As people age, small sacs or pouches, (like pores in the skin) form along the intestine. The sacs are called diverticula and the condition is called diverticulosis. If digested food (feces) becomes trapped in these pouches and becomes inflamed, it's called  diverticulitis.

No one really knows what causes these small sacs to form but it's very common with more than half of Americans over age 60 having diverticulosis that can be seen during a colonoscopy. There are usually no symptoms for diverticulosis (sacs only). Diverticulitis is a different story and can often start suddenly with

• Tenderness or pain, usually in the left lower side of the abdomen
• Bloating or gas
• Fever and chills
• Nausea and vomiting
• Not feeling hungry and not eating

That sounds a bit like GERD or even the flu. I'd guess the first two items, tenderness and bloating are the symptoms to watch for. Pain on one side of the abdomen could be appendicitis, potentially very serious. See your doctor!

Treatment for severe cases may require hospitalization. Or your doctor may suggest:

• Rest in bed and possibly use a heating pad on your belly for the pain
• Take pain medicines
• Drink only fluids for a day or two, and then slowly begin drinking thicker liquids and then eating foods
• Antibiotics.

Fiber is recommended - think of it as the equivalent of washing your face for pimples. But too much fiber may make one gassy so find the right balance.

Once you have the sacs you have them for life. Traditionally diverticulosis patients are recommended to avoid food items that may become trapped in the gut sacs like coarse grains, nuts, coconut, corn and popcorn, dried fruits, skins on vegetables and fruits, and seeds from tomatoes, strawberries, pickles, and cucumbers. However the Mayo Clinic reports that current research has shown that these foods aren't associated with an increased risk of diverticulitis. So the cause remains a mystery.

For more information see...
http://www.mayoclinic.com/health/diverticulitis/DS00070

http://www.webmd.com/digestive-disorders/tc/diverticulitis-topic-overview

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001303/

Drug Shortages

"The global market is starting to show cracks; the world is definitely not a flat billiard table. It's looking more and more like an out-of-balance roulette wheel."
-Edward Tenner, The Atlantic.com

I've seen a lot of buzz lately regarding a Washington Post story about a Shortage of Key Drugs.

A record 211 medications became scarce in 2010 — triple the number in 2006 — and at least 89 new shortages have been recorded through the end of March, putting the nation on track for far more scarcities. The paucities are forcing some medical centers to ration drugs — including one urgently needed by leukemia patients — postpone surgeries and other care, and scramble for substitutes, often resorting to alternatives that may be less effective, have more side effects and boost the risk for overdoses and other sometimes-fatal errors.

The article identifies three factors for the increasing scarcity:

1. Major pharmaceutical companies purchased smaller companies with patents on life-saving drugs. But when the patents expired, the big company abandons production because it will now be less profitable.

2. The pharmaceuticals claim there is tougher regulation of production by the FDA (which the agency denies).

"Shortages of pre-loaded epinephrine syringes and propofol, for example, occurred when suppliers dropped out just as the FDA was demanding additional documentation."

3. Globalization of manufacturing means a storm or natural disaster anywhere in the world can stop production of an item with many components. Globalization also raises concerns about the quality of the ingredients used.

The drug cytarabine has caused the most concern and gotten the most attention because it is highly effective for treating several forms of leukemia and lymphoma. [...] Many hospitals are running low, and some have run out completely. [...] Cytarabine’s scarcity was caused by hitches that two out of the three manufacturers hit in obtaining raw materials, as well as the discovery of crystals in some shipments.

At least 19 patients were sickened and nine died in Alabama this year after being infused with a solution through their feeding tubes that was apparently contaminated with bacteria by a pharmacy using an unfamiliar ingredient because of a shortage

Bottom Line

A common knee-jerk reaction is, "See this is what happens when companies control the heath industry. Government needs to be in control."  But look at Russia, Cuba, England for counter examples of lack of care and resources for the common man when the government runs the show.

The solution is greater competition (not patents). But reform is also needed at the FDA level. When regulation is too strict it becomes a barrier to entry and small companies can not compete. Regulation can also ban foreign companies. But too little regulation is also a problem as we know companies will cheat and defraud the consumer with fake or even dangerous drugs.

So how about this. Every day(?) take one random sample from production. Have a competitor test it for quality control. Perhaps monthly have FDA also test a sample to ensure that competitors are not in collusion and hiding bad test results.

When contamination is found, don't fine the company - that is not really a deterrent; that just pushes the fine to the consumer with higher prices. Instead prosecute the CEO for endangering the health of the public. Having a CEO (and other company officers) go to jail seems more effective than paying a fee from company profits. Prosecute for allowing a dangerous drug to be released. Not for intent or ill will. But negligence for failing to adequately test the quality of inputs and outputs. A company must be responsible for the drug it creates - no excuses.

The Return of Flu Season

“I like pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.”

- Winston Churchill

From the British Telegraph, "The hospitals are gridlocked.” Winter flu is overwhelming hospitals in England. Four weeks of intense pressures from flu have left casualty departments (i.e. emergency rooms) “overwhelmed” with patients.  Desperately sick people have been left for hours waiting on trolleys.

"Dozens of NHS [National Health Service] units have cancelled surgery and clinics for outpatients. At least 10 major centres issued “black alerts” — the highest emergency warning — meaning they were at breaking point, forcing patients to be sent elsewhere.

Scores of hospital wards closed due to norovirus, the winter vomiting bug, which put more than 1,200 beds out of use in one week as nurses attempted to isolate the disease. "

Part of the problem is that people have no place to go after hours and on weekends.

"In many parts of the country out-of-hours services are absolutely inadequate, so what we get is people turning up at A&E [Emergency Rooms] simply because they do not know where else to go"

Bottom Line

Be prepared for a very bad flu season. In England the number of deaths from flu had almost doubled.

Whooping Cough

"We are eager to tunnel under the Atlantic and bring the Old World some weeks nearer to the New; but perchance the first news that will leak through into the broad, flapping American ear will be that the Princess Adelaide has the whooping cough." - Henry David Thoreau

Many years ago my sister lived in Watertown, NY, on the north-western edge of the state near the Canadian border. I'm glad she's not living there now since this region is experiencing an epidemic of Whooping Cough with some 300 cases to date.

Whooping cough, formally called Pertussis, is a highly contagious bacterial disease that causes uncontrollable, violent coughing. It is spread through the air by tiny droplets when a patient coughs or sneezes. The coughing is extreme and can make it hard to breathe; often a deep "whooping" sound is heard when trying to take a breath. It is a serious disease and the infection usually lasts 6 weeks.

Pertussis used to kill 5,000 to 10,000 people (usually children & infants) in the United States each year. Now, a vaccine has reduced the annual number of deaths to less than 30. But today parents are skipping the vaccine and the disease is returning. In 2004 the number of whooping cough cases spiked past 25,000, the highest level it's been since the 1950s.

Whooping cough begins like the common cold about a week after exposure. But 10 to 12 days later the coughing fits begin, they can last for more than a minute, and the patient may turn red or purple from lack of air (the "whoop" is a desperate gasp to breath!) Vomiting may also result from a coughing fit. Fits usually occur in groups, with multiple episodes every hour around the clock.

These extreme symptoms can be fatal with infants who rarely "whoop". Instead they gasp for air with a reddened face and may actually stop breathing for a few seconds during particularly bad spells or they may choke on vomit.

Treatment - antibiotics such as erythromycin are effective if Whooping cough is caught early BEFORE the coughing begins, but when diagnosed too late, the antibiotics will reduce infectiousness but not the symptoms. Infants younger than 18 months need to be monitored to ensure breathing and may need to be hospitalized. Curiously, cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used. Most cough mixtures loosen the mucus in the lungs to encourage coughing - with whooping cough the patient is already coughing too much and too frequently so the last thing you want is more coughing.

During recovery, let your child rest in bed and use a cool-mist vaporizer to help soothe irritated lungs and breathing passages. Be sure to follow directions for keeping it clean and mold-free. In addition, keep your home free of irritants that can trigger coughing spells, such as aerosol sprays, tobacco smoke, and smoke from cooking, fireplaces, and wood-burning stoves.

Kids with whooping cough may vomit or not eat or drink much because of frequent coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, too, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to urinate (or in infants, fewer wet diapers)

Bottom Line

During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case. Remember that the first symptoms do not appear for a week to 10 days and two weeks for the severe coughing. In rare cases it can be 21 days from infection to symptoms. So people may be infected and not know it.

All children should be immunized before the sixth birthday and given a booster shot between ages 11-12.

http://en.wikipedia.org/wiki/Pertussis
http://kidshealth.org/parent/infections/bacterial_viral/whooping_cough.html
https://health.google.com/health/ref/Pertussis

Stroke

“I thought so hard I got a headache.” - J.D. Cobb

Some serious illnesses can be difficult to detect. Appendicitis is often confused with stomach pain. Since the heart has no pain nerves a Heart Attack makes itself felt as left arm pain or nausea. Likewise with stroke, would you recognize the precursor symptoms of a stroke?

At http://www.everydayhealth.com/ patient hcwriter describes the symptoms she experienced before her stroke.

The First Precursor: The Pain in My Legs

“I can't really say exactly what happened when I had my hemorrhagic stroke on April 8, 2009, because I was unconscious for the first eight days. I can tell you about some events before…
It was Thursday, March 26, when ... I had an awful pain in my feet and ankles … I realized if the pain continued until the next day, I couldn't go to work.

I woke Friday morning and the pain was worse. I called my ENT doctor and he put me a round of antibiotics since I had ear surgery two weeks before. Maybe I was getting an ear infection. The doctor didn't know.

[On Saturday] I called a friend of ours, an Orthopedic Surgeon, and these were his words to me: "If a warm bath doesn't help and if the pain increases and moves up your leg on Sunday, go to the Emergency Room."

[On Sunday] All of the above happened and I was scared. I drove myself to the ER on Sunday. I was tested using an Ultrasound and the doctor saw blood clots in both legs. My platelets … had also dropped dangerously low.… I was admitted.

The Second Precursor: My Experience with a Blood Thinner

During the next two days, I was given tests and my blood clots in both legs were reconfirmed. … A hematologist … put me on Lovenox, an injectable blood thinner, … to break up the clots.
On April 1, the hospital finally released me and I drove myself home. … The pain in my legs was still there and it was constant. Over the next two days, I saw an improvement in the pain level. … I thought, I had narrowly escaped something that would throw my life is disarray. Besides, this wasn't a good time to miss work, with events coming up, one after the other. It's never a good time to miss work.

The Third Precursor: A Cosmic Headache

Tuesday evening [April 7] I had the beginnings of a headache. I could count on one hand how many times I've had headaches in the past twenty-five years. [She stayed the night at a friend’s house and the pain increased. After 9pm she took some Tylenol.] Somehow, after a while, I fell asleep. And that was all I knew.

I went into convulsions about 4:30 am. I missed the paramedics who came to my friend's house, [I missed] the hospital … where I spent fifteen hours under observation, and [I missed] the flight to Capital Health in Trenton, known for treating severe neurological problems.

Eight days later, I am told, I woke up. And that's what I heard first upon awakening: You've had a stroke. I was stunned to hear that news, but when I wanted to speak, to ask questions about why the stroke happened, no words were coming out. I …was without speech.

There are two types of strokes. 80% are ischemic stroke when a brain artery has been blocked by a blood clot. A hemorrhagic stroke occurs when an artery ruptures or leaks. If an artery is unable to supply a portion of the brain with oxygen-rich blood, that portion of the brain can become permanently injured within minutes. Stroke often results in permanent serious complications and disability. It is the second leading cause of death worldwide and the third leading cause of death in the U.S.


Bottom Line

“A stroke was the furthest thing from my mind. It was something that happened to other people, which leads me to believe, if I could have a stroke, anybody could have a stroke.”

Many strokes are sudden with no warning. If you experience one of the following “mini-stroke” symptoms, get emergency treatment immediately before the brain is permanently damaged:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion or problems understanding
• Sudden difficulty speaking
• Sudden vision difficulty in one or both eyes
• Sudden dizziness, loss of balance or coordination, or difficulty walking
• Sudden, severe headache with no apparent cause

Dengue Fever

"A danger foreseen is half avoided." - Chinese fortune cookie

It’s sad in our modern age of medicine to see many old diseases returning like whooping cough, measles, TB, etc. Part of the fault is overconfidence, we think the disease is gone and stop taking the shots that protect us. Then one sick person visits from overseas and sets off an epidemic.

Another cause for diseases spreading is a change in habitat or habitat invasion. When a new housing development is built next to a marsh, expect mosquitoes. Global warming is also causing animals and insects to move into new locations. For example, the Florida Keys is experiencing a wave of Dengue fever – huh, what? Isn’t that something out of old jungle stories?

Dengue (pronounced den’ gee) is a viral disease spread by mosquitoes for which there is no immunization and no cure. It affects 100 million people each year – usually in the tropics. An extreme case of Dengue, called Dengue hemorrhagic fever (DHF), can be fatal but with hospitalization the survival rate is 99%.

The principal symptoms of dengue are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.

Dengue hemorrhagic fever (DHF) produces a fever that lasts from 2 to 7 days, with symptoms consistent with dengue fever. When the fever declines new symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (the capillaries) become “leaky” allowing the blood plasma to escape into the body. This can lead to shock and death, if circulatory failure is not corrected.

Treatment

For normal dengue fever the “treatment” is pain relievers with acetaminophen like Tylenol. Do NOT use aspirin – you don’t want to thin the blood any further. Rest, drink plenty of fluids, and consult a physician.

If you feel worse (e.g., develop vomiting, severe abdominal pain, bleeding) in the first 24 hours after the fever declines, go immediately to a hospital for evaluation. You may need a plasma drip to keep you alive during the high risk period of DHF.

Bottom Line

Everything old is new again. Each of us needs to brush up on the symptoms and treatment of “lost” diseases that used to plague our grandparents.

Sleep Apnea

Whenever I want you, all I have to do is dream – song lyrics by the Everly Brothers

A coworker was operated on last week in an attempt to correct his Sleep Apnea, a sleep disorder characterized by pauses in breathing during sleep of ten seconds or more. Each episode of missed breaths is called an apnea. Sometimes Apnea is obvious – a friend tells us her husband will stop breathing for noticeably long periods when asleep; and then restarts with a snort. Sometimes the Apnea is not obvious – who’s going to notice if every few minutes you take 10 seconds between breaths?

Commonly the person with Sleep Apnea has no idea that they are breathing irregularly – the only clue for the sleeper is daytime sleepiness and frequent fatigue caused by poor quality sleep. Apnea reduces the amount of oxygen to the brain and prevents deep sleep that is so refreshing and invigorating. A Wisconsin Sleep Cohort study estimated in 1993 that 1 in 15 Americans have moderate or worse sleep apnea. It also estimated 9% of middle-aged women and 24% of middle-aged men were affected, undiagnosed and untreated.

Snoring is sometimes taken as a sign of Apnea but actually air is moving through your throat while you snore. It’s when you STOP snoring and stop breathing that apnea occurs. What the snoring may tell you is that your throat passageway is narrow and at risk for closure while sleeping.

The test to officially diagnose Sleep Apnea is called a polysomnogram, or "sleep study". The patient is hooked to wires and devices to measure brain waves, breathing, blood oxygen level, eye movement (for REM sleep), leg movements, and chin movement AND then is asked to sleep normally in a hospital bed. Five or more Apnea events per hour is considered clinically significant.

There are two common treatments for Sleep Apnea. I know many people (my father included) who use a CPAP machine (continuous positive air pressure). These machines force air down your throat while sleeping to keep it open and unblocked. The other option is surgery to widen the airway by removing tissue or tightening the muscles alongside it. It’s more expensive but it can cure the problem. By comparison, CPAP cures the symptoms but not the cause and needs to be used the rest of your life.

Bottom Line

If you find yourself tired no matter how much sleep you get, ask your doctor to prescribe a Sleep Study. It’s not cheap, about $7000, but many medical insurers will cover it and the CPAP machine afterwards. The alternative can be death. I know two relatives who fell asleep while driving a car. One caused a major accident with serious injuries; the other woke up after crossing the median but before hitting anything.

http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html

PS

Happy Birthday to my Sister!

Deep-vein thrombosis

"Just as the body cannot exist without blood, so the soul needs the matchless and pure strength of faith"- Mahatma Gandhi

Today we reach the final item on Women’s Health Magazine’s list of Seven Warning Signs not to ignore.

Your calf is extremely tender in one location, noticeably swollen, and red or warm to the touch.

You might have deep-vein thrombosis, or DVT, also known as a blood clot. I know two people who have died of blood clots. One, the father of a friend, died of a clot a week after surgery. The other had a leaky heart condition and a clot traveled to her brain. Nowadays I notice that hospitals put leg pumps on patients to prevent clots while recovering.

Anytime blood starts to pool in your lower body and there is a risk of forming a clot. It could be hours sitting at a computer, on a long flight or in a hospital bed. I try to keep my feet at least slightly elevated when sitting – and it helps to stand up and walk around.

When a clot gets big enough to act as a stopper in the vein or artery, the area around it will start to hurt and swell. Smokers and women who take the Pill have a higher risk of developing clots.

If you suspect a clot, resist the urge to massage the area or to walk it off. If the clot breaks free, it can travel through to your lungs and cut off your oxygen supply or to your brain and cut off blood flow there.

Bottom Line

See your doctor, who will do a CT scan or ultrasound to look for DVT. If you have a clot, you'll need to take blood thinners--sometimes for up to a year--to dissolve it.

Back Pain

"Low back pain is common and affects people of all ages. It is second only to the common cold as the most common affliction of mankind, and it is among the leading complaints bringing patients to physicians’ offices."-Cleveland Clinic Journal of Medicine

The sixth of the seven Warning Signs from Women's Health magazine is back pain with tingling toes. This sign I can personally relate to.

As a computer progamer I sit for hours at my PC with less than perfect posture. Some 15 years ago I began experiencing awful back pain. It got worse and worse but I did nothing about it. Then one day it went away. Hurray, I thought. Not long thereafter a stange, new experience began - a shooting pain down my leg that became worse over time. I had no clue what this meant until a friend of my wife gave it a name, Sciatica. My first visit to the doctor was odd - I was in so much pain that it hurt to sit and was easier for me to lie on the floor. The prescription was an x-ray, take some asprin, and rest. Nothing to worry about - until the x-ray results came back. Then the doctor was seriously worried.

A cartiledge disk in my lower back had ruptured. The original pain was the disk being squeezed, then relief when it popped, and new pain as the protruding disk began pushing on my spinal column. A Neuralogist tapped my knees and toes to see if there was any nerve damage (no thankfully) and I was scheduled for surgury within days. There was great concern that the protrusion would bruise or damange my spinal column causing paralysis from the waist down.

The operation was simple with a scar only a few inches long and I was sent home early morning after an overnight stay on some powerful pain medications. The recover took six weeks before I was allowed to drive or go back to work. Physical therapy lasted many months to rebuild the back muscle and strengthen other muscles.

Bottom Line

If I had gone to a doctor earlier, during the back pain stage, I could have avoided later pain and surgery by early application of steroids and physical therapy. I was lucky that the surgery was successful. Sometimes it is not and the pain remains.

7 Warning Signs

“I will not be as those who spend the day in complaining of headache, and the night in drinking the wine that gives it” - Johann Wolfgang von Goethe (author)

From Women’s Health Magazine comes this list of 7 WARNING SIGNS YOU SHOULD NOT IGNORE.

1. Severe head pain
2. Throbbing tooth
3. Sharp pain in your side
4. Passing chest pain
5. Abdominal discomfort with gas or bloating
6. Back pain with tingling toes
7. Leg pain with swelling

I’ll try to cover these, one each day, with the exception of Ovarian Cancer (can you guess which one that is from the list of symptoms?) With my grandmother, mother and wife I’ve experienced, secondhand, Fallopian Tube Cancer, Ovarian Cancer and Uterine Cancer. But I leave these topics as an exercise to the reader and will focus instead on problems that can affect either sex.

We may all experience mild versions of the symptoms above – headaches, chest pain, sore tooth, etc. But when the intensity is at 10 on the pain dial, you need to find out why.

Head Pain – a super headache could be a migraine. Migraines often have a visual side effect that distorts your vision. But a sudden and severe head pain, the worst in your life, could be something much worse than migraine. A friend of ours was living in Mexico and attending a movie show with her husband when she saddening started screaming at the top of her voice and collapsed. She was rushed to a hospital and was unable to speak and paralyzed on one side of her body. The cause – a ruptured brain aneurysm.

An aneurysm is a blood vessel that swells and widens like a balloon. In a majority (60%) of patients there is no symptom prior to rupture. Afterwards symptoms may be major or minor depending on the size of the vessel to rupture and may include:

• Nausea and vomiting
• Stiff neck or neck pain
• Blurred vision or double vision
• Pain above and behind the eye
• Dilated pupils
• Sensitivity to light
• Loss of sensation or paralysis

A CT scan is needed to detect an aneurysm and the blood vessel needs to be repaired immediately so call 911 if you experience the “worst headache of your life.” Brain damage will begin two ways:

1. Portions of the brain may die that are cut off from the blood flow
2. Blood pooling and pressure inside the brain can injure nearby blood cells

About 40% of the people who suffer bleeding from an aneurysm die within the first month. Approximately another one third have major nervous system damage such as long-term memory problems and may have difficulty with thinking, perception, and performing simple daily activities. When our friend recovered her speech (after much time and therapy) she would intermix English and Spanish words as she spoke – her brain had trouble keeping the two languages separate.

Bottom Line

Autopsy studies reveal that 3-6% of all adult Americans have experienced aneurysms that never ruptured. It’s a ticking time bomb inside many of us so it's important to recognize the symptoms and respond quickly. The risk is higher as we age. One positive risk factor that can be controlled is smoking. Smokers are 10 times more likely to rupture an aneurysm. Binge drinking raises the risk of damage (by thinning the blood?) and there are some hints that high blood pressure is also a factor.

http://www.emedicinehealth.com/aneurysm_brain/article_em.htm
http://www.brainaneurysm.com/aneurysm-symptoms.html
http://www.bafound.org/info/symptoms.php

It's your data

"God heals and the doctor takes the fee" - Benjamin Franklin

CNN has a must-read story "Patients demand: 'Give us our damned data'". It describes how individuals suffer while hospitals dither or refuse to transfer patient data to another hospital.

CNN recommends these tips.

1. Know your rights
   The federal Health Insurance Portability and Accountability Act, gives hospitals and doctors 30 days to respond to a request for medical records, although some state laws provide for a shorter time frame. In urgent situations, such as a transfer to another hospital, it's customary for hospitals to move more quickly.
2. Be prepared to make your request in writing.
3. Confirm that the hospital receives your request.
4. If you have a choice, select a medical provider who uses electronic medical records. These can be emailed to you or accessed via a secure web site.
5. Get the new hospital or doctor to help you by having them make the request.
6. Remember the limits of the law
   Your doctor doesn't have to give you access to to information he or she thinks might cause you or someone else substantial harm. Some states allow even more information to be kept from a patient. For example, the New York Department of Health Web site says doctors may deny you access to "personal notes and observations" they've made in your record.
7. Get angry - be firm, don't accept no.
   You may need to bring in an attorney.
8. File a complaint with the Office of Civil Rights at the U.S. Department of Health and Human Services.

Bottom Line

It's your data. You paid for it.

Healthcare

"We Have Met The Enemy and He Is Us" - Walt Kelly

An interesting article at NewScientist.com makes the claim that Healthcare revamp won't cure America. It’s true that we have a problem. “Politicians are trying to revamp a system that spends around twice as much per person on healthcare as most European countries, while getting worse results overall, lagging on measures such as life expectancy at birth and infant mortality.”

But two new studies claim the problem is not the US Healthcare system, but rather with the poor habits of Americans. "One of the main reasons that US healthcare is so expensive is that we are sicker than other people."

One study concludes “that the blame lies largely with high rates of chronic disease caused by poor diet, lack of exercise and the lingering effects of tobacco use from a time when smoking was more prevalent in the US than in Europe.” The other study agrees and also found that “in some respects – screening and treatment of cancer and cardiovascular disease, for example – the US healthcare system is actually performing well.”

Bottom Line

Politicians are claiming that US Healthcare can save big bucks with more “pre-screening” of cancer, diabetes and cardiovascular disease. But Shannon Brownlee of the New America Foundation in Washington DC says, "[pre-screening is] not going to fix the underlying problems of poverty, poor diet, lack of exercise and smoking, which are the biggest determinants of health."

In the US we drive short distances instead of walking. Just yesterday a colleague from Poland suggested we walk a mile to lunch. That’s crazy, I replied, so we drove instead.

Also in America the great Industrial Food complex makes it cheaper to eat junk food than healthy food. I can get ramen or chips quite cheap. I have to spend real money to buy organic at Whole Foods.

The healthcare system does not insure good health habits. My wife was making real progress meeting with a nutritionist to lose weight until the Insurance Company changed its mind and decided to stop covering the cost.

Constipation

“How long a minute is depends on what side of the bathroom door you're on” – unknown

According to MedicineNet.com, normal constipation is defined as fewer than three bowel movements per week. Severe constipation is less than one bowel movement per week. There is no medical reason to have a bowel movement every day. In fact going without a bowel movement for two or three days usually results in more mental distress than physical discomfort.

A frequently overlooked cause of constipation is medications. Narcotic pain meds (like Tylenol #3), antidepressants, anticonvulsants, iron supplements, Calcium channel blockers and antacids with aluminum can slow the bowels. Another cause is too little hydrating liquids in your diet. Alcohol and caffeine pull water out of your body so think of coffee, tea, and soda as negative fluids. Calcium can harden stools so drink milk in moderation and avoid huge quantities of cheese, ice cream, etc.

Lack of exercise and prolonged bed rest can slow the passage of food through the bowels and cause constipation. The day after my wife had surgery, the nurses made her walk up and down the hallway to get the intestines restarted. She was not allowed to leave the hospital until a bowel movement was made.

Ironically the best way to avoid constipation is MORE fiber in the diet. Many types of fiber bind to water and help retain water within the intestine. Fiber adds bulk (volume) to the stool and the water softens the stool. Natural fibers can be found in fruit, vegetables and whole grains. At least five servings of fruits and vegetables are recommended. If this is not enough, there are fiber supplements (like Metamucil) you can buy at grocery stores and pharmacies.

One side effect of fiber is gas. Since each person is unique in how their digestive system will react to different types of fiber, you should experiment to see what works for you. Try different sources of fiber one at a time; starting with a low dose and increasing the dose every week until your bowels return to normal or troublesome flatulence interferes. (Fiber does not work overnight.) If gas or bloating occurs, either reduce the dose of fiber or switch to a different fiber.

If fiber is not working for you, check out MedicineNet’s description of laxatives, enemas, drugs, etc – their use and side effects. Prunes are a safe and natural laxative but cause gas or cramps with some people. Long term, continuous use of some laxatives can harm the colon and actually cause constipation.

Bottom Line

It is important to distinguish recent onset constipation from recurring, long duration constipation. If you’re suddenly constipated with no prior history, then see a doctor to rule out serious medical illnesses like tumors or cancer of the colon. If you experience constipation with rectal bleeding, abdominal pain and cramps, nausea and vomiting, or involuntary loss of weight then see a doctor.

Appendicitis

“I recently went to a new doctor and noticed he was located in something called the Professional Building. I felt better right away.” - George Carlin

According to the Health & Science section on Time.com, “Appendicitis afflicts roughly one in 10 people during their lifetime and accounts for more emergency abdominal surgeries than any other ailment.” Yet despite its commonality, it is very difficult to diagnose. Doctors use physical exams and CT scans but are frequently wrong. Since a burst appendix can be fatal, in case of doubt, doctors will operate. In 3% to 30% of all surgeries for appendicitis, the actual cause of abdominal pain is found to be constipation, gastroenteritis or ovarian cysts, for example. Also shockingly, while waiting for test results, as many as 45% of surgeries happen too late, after the appendix has already ruptured. The Time article then goes on to describe a new urine test to detect appendicitis but it’s in clinical trials and may be three years away from general practice.

According to eMedicineHealth.com,

Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms. … Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent.

Another possible sign is abdominal pain that gets worse if you move, walk, or cough.

Since appendicitis advances so rapidly it is vital to see a doctor or emergency room if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting that lasts for more than four hours.

If you suspect appendicitis, do not eat or drink, this may complicate surgery. If thirsty rinse your mouth with water but don’t swallow. Do not take laxatives, antibiotics or pain medications as these may mask the symptoms and delay a proper diagnosis resulting in rupture. I once had back surgery postponed because I was NOT in pain during the pre-surgery doctor visit. I had visited a massage specialist the day before and all sciatic pain was gone for about 24 hours. So no pain, no operation.

After an uncomplicated appendectomy, the patient may gradually resume a normal diet with a restriction in physical activity for at least two to four weeks. The doctor will check the incision the following week to look for possible wound infection. [eMedicineHealth]

Bottom Line

Many people who have had appendicitis say the pain is hard to describe. It may not feel like any pain you have had before. It may not even be a very bad pain, but you may feel like something is wrong. If you have moderate belly pain that does not go away after 4 hours, call your doctor. If you have severe belly pain, call your doctor right away. [WebMD]

Medic Alert Tatoos

The world is divided into two kinds of people: those who have tattoos, and those who are afraid of people with tattoos. - Unknown

Here’s a new idea reported on by USA Today. “Increasing numbers of people who have serious medical conditions, such as diabetes, are turning to tattooing to identify themselves on the chance a health emergency leaves them unable to communicate.” This is an alternative to wearing a medic alert bracelet that can break and fall off.

My mother wears a bracelet to warn medics that she has a dangerous allergy to penicillin. Other reasons for an alert tag include heart disease, dementia, organ transplant recipient, and hearing or speech impairment.

Bottom Line

Alert bracelets (and now tattoos) save lives. The web site, http://www.medicalert.org/ offers a wide choice of alert “jewelry”. Don’t like bracelets? Then how about an alert necklace or an alert watch in a wide choice of metals? The company http://www.laurenshope.com/ makes “stylish” medical bracelets for the fashion conscious.

Triage

“Getting out of the hospital is a lot like resigning from a book club. You're not out of it until the computer says you're out of it.”
- Erma Bombeck

Since hospitals are private companies in the business of making money, it makes little sense for them to have empty beds or unused capacity. That’s just wasteful and unprofitable as a business. And yet that “efficiency” means hospitals can quickly become overwhelmed with the smallest of disasters.

Normally, one should not consider a rock concert a “disaster scene”. (Unless you really, really hate rock music :-) But last year, in Kansas City, Rockfest2008, exceeded the capacity of St. Luke’s Hospital, a major institution and winner of frequent quality awards. A concert of 50,000 fans created 22 ambulance calls over a couple of hours with cases ranging from heat exhaustion to a broken spine. This is an incident rate of just 0.044% but “The surge was so great the hospital had to place some patients on mattresses on the floor and tell ambulances that it had reached its limit for all but trauma patients.” Just imagine what would happen if the incident rate were higher like a biological agent or dirty bomb exploded in a sport stadium or other crowded event.

With mass care events, triage is activated (with a twist). Normally, with hospital emergency room triage, the most serious cases go first. Mr. Gunshot wound goes to the head of the line; Little Runny Nose Kid gets to wait (and wait). But with mass care, with overwhelming number of patients, the most serious patients are allowed to die. The goal is to save the highest total number of lives. A first responder or medical practitioner could spend 30 minutes trying to revive one person with CPR or save 6 seriously wounded from bleeding to death in the same time period. When forced to choose, would you save the one or the six?

When I was a “victim” in a Sarin gas attack drill, it took hours for medical rescuers to arrive. The fireman who arrived first became victims. Then guys in “space suits” showed up to take air samples. Then a bio-unit set up decontamination tents and finally bio-suited teams brought in stretchers or escorted the wounded to the tents for processing. All “victims” had a card stating the severity of our “wounds”. We noticed the rescuers were NOT saving those with “black” tags, the most seriously wounded. When we asked, they explained, these people were already dead after so long a wait or soon would be. They had to remain focused on the lives that could still be saved.

Bottom Line

Most of the time the American health system is a marvel with speedy service. But come flu season, a rock concert or a real disaster, there will be too few doctors and too few beds. This is one of the real fears behind a viral pandemic – hospitals will not be able to cope with the patient load. For this reason it is vital to know First Aid and be able to care for the health of yourself and your family as much as you can.

P.S. New Scientist magazine notes that Health workers may flee in pandemic panic. A survey in the UK revealed that only 15% of hospital workers would go to work during a pandemic. Even the Nurses and Doctors would stay home.

Germ Theory & Dr. Lister

“Expect the best, plan for the worst, and prepare to be surprised.”-Denis Waitley

Did you know that Listerine, the antiseptic mouthwash, was named after Dr. Joseph Lister who discovered the idea of antiseptic surgery by killing bacteria in 1867? Prior to Dr. Lister, a surgeon would put on their gore splatter overcoat, take the dirty saw off the wall, sharpen their knife on the sole of their boot, and then hack away as quickly as possible (2-3 minutes max) to avoid contamination from the “air”.

While great advances were made in anatomy and surgerical technique in the early 1800s, the vast majority of patients would die days later from infection. Going to the hospital was always a LAST resort; only used when at death’s door. Even today, at least 100,000 Americans each year are "left vulnerable to surgical infections", see Hospital infection survey: Too many patients still at risk.

Antiseptic means anti-sepsis (pus). Lister learned about the germ theory of disease and rot from the research of Louis Pasteur. Lister confirmed that bacteria was also cause of surgical pus and infection but he had a problem. He could not “Pasteurize” patients by heating them up. Fortunately he had heard that Carbolic acid was useful in deodorizing sewage so he decided to try it as a germ killer. It worked and deaths from amputations declined greatly. This discovery was praised and studied by the leaders of Medical Science (the French and Germans) but largely ignored by the British and Americans until overwhelming evidence proved that Lister was correct.

One reason for opposition to antiseptics was the damage it did to living tissue. Sure it kills germs but it can damage flesh too. Surgeons lived by the skill of their hands which Carbolic acid would turn to red puffy hamburger. The America Chief of Surgery at Johns Hopkins, William Stewart Halsted, invented the rubber glove to protect the pretty hands of his favorite nurse (and future wife) from acid damage.

The Germans improved upon Lister’s idea for clean surgery. Instead of killing germs (antiseptic) by spraying everything in acid, why not prevent germs (aseptic) by use of hand washing, clean gowns, surgical masks, and sterile instruments? This worked too and didn’t harm the doctors and nurses.

Bottom Line

When the British Medical Journal surveyed 11,000 physicians for the most significant medical breakthrough in the past 150 years, the winning answer was Sanitation. Today we take it for granted that we can drink water straight from the faucet and not catch cholera. We go to hospitals today with the assumption that we will survive.

During emergencies the first casualty is usually sanitation. Floodwaters and power outages allow sewage to mix with drinking water. Food spoils without refrigeration. Toilets overflow and human waste is improperly disposed of. People are crowded together, with stress induced weakened immune systems, and germs spread.

So keep Dr. Lister in mind and remember that germs can kill. After an emergency, boil your water and cook food completely; toss out anything spoiled. Clean ALL wounds no matter how minor. You can use Listerine for this! It was used in surgery (in stronger concentration) for decades before it became a mouthwash.

When to see a Doctor?

"An apple a day keeps the doctor away” – proverb

The media has had a field day with Swine Flu and the number of health related stories is up - way up! Swedish researcher, Hans Rosling (of Gapminder.org), published a video last month comparing Google news of Swine Flu versus Tuberculosis. For each Swine Flu death there were 8176 stories published between April 24 and May 6. For each Tuberculosis death there was one tenth (0.1) of a story. So while the flu is being overhyped there is a silver lining – this is a great time to find articles on health care.

When fighting a pandemic, the best weapon is quarantine; i.e. keep away from sick people. And where are you most likely to find sick people? The Hospital! You might visit the hospital for an injury and pick up the flu in the waiting room or emergency room. I read a story today by an EMT worker who was told if they carried a person with signs of the flu, the vehicle had to be completely scrubbed and disinfected and allowed to air dry for three hours before they could pick up another patient. During a pandemic the EMS fleet would be largely grounded (at most 8 passengers a day per vehicle) if this disinfection rule were maintained. In cases of large-scale emergencies like an earthquake or hurricane, 50% of the regional hospitals may be knocked out of service when needed most.

So what happens if you need medical care during a pandemic or disaster? Many sites promote being your own doctor and stocking up now for a first rate medical supply. But do not carry this to extremes. Certainly you can do more first aid and even advanced first aid at home. Many emergency rooms visits are for minor injuries or illnesses that don’t require a doctor or for which a doctor can do nothing (You paid good money to hear, “take two aspirin and get some rest”?).

My newest commuting CD is about the history of Medicine and disc one is about Hippocrates who started modern western medicine. The instructor points out that it was not easy convincing people that natural causes, not the gods, were responsible for illness. “Faith healers”, priests of Apollo, sacrifices, etc had an excellent reputation because 90% of the time a patient will recover regardless of what is done. The human body is very resilient.

Sadly our schools don’t teach the public how to distinguish the 9 times you’ll recover on your own from the 1 time profession help is required. “Doctors cannot give set guidelines for when to see a doctor and when it is unnecessary because symptoms with the same cause vary too much and symptoms with different causes overlap too much.” [Merck] Many people play it safe and see the doctor every time or for every sniffle. When SARs hit the world in 2002-2003, there were just 208 officially reported cases in the US but the number of calls to 911 and the number of EMS runs increased by 10%. In Maryland this meant an additional 60,000 EMS calls by those who thought they might have SARS. [Based on 2002 call volume of 600,000]

Here are some sites about when to see a doctor:

About.com: Cold & Flu
Merck.com
WebMD
MyDr.com.au

Bottom Line

We can all do more to be our own doctor at home. Yet don’t over do it. Don’t bleed to death from a serious injury or attempt surgery at home because you might catch the flu in an ambulance or at the hospital. During a pandemic or disaster you will most likely need to drive yourself the hospital (ambulances and EMS being overwhelmed). And once there, the hospital staff will be overwhelmed so bring your own facemasks, water, food, and be prepared for a long wait.

Here are some sites for stocking your medicine cabinet and learning advanced first aid:

How to Maintain a Good First Aid Kit
Stocking Up on Prescription Medicines (amazing details of what to buy)
Advanced Trauma Care First Aid Kit

Wilderness First Responder
Wilderness Medicine-Beyond First Aid
Where There Is No Doctor - (html)

Hospital Germs

“When a lot of remedies are suggested for a disease, that means it can't be cured.” - Anton Chekhov (Russian playwright)

What is it about doctors and a casual attitude towards germs? I wrote earlier, Did you forget to wash your hands?, about the history of hand washing and how doctors resisted the idea that dirty hands could kill. Now a new study shows that unwashed scrubs can also kill, Hospital Scrubs Are a Germy, Deadly Mess.

Some medical personnel wear the same unlaundered uniforms to work day after day. ... At the University of Maryland, 65% of medical personnel confess they change their lab coat less than once a week, though they know it's contaminated. Fifteen percent admit they change it less than once a month. Superbugs such as staph can live on these polyester coats for up to 56 days.

Bottom Line

Dirty scrubs spread bacteria to patients and, when worn in public, allow superbugs to escape to places like restaurants. Scrub germs can cause extreme diarrhea, dehydration, inflammation of the colon, and even death. They are difficult germs to kill. "Only scrubbing with bleach removed [them]".

In recognition of this problem some hospitals are returning to laundering scrubs and/or prohibiting wearing the scrubs outside the hospital.