https://doctorgigi.com/blogs/news.atomDr Gigi - News2012-08-19T00:50:00-04:00Dr Gigihttps://doctorgigi.com/blogs/news/foot-ankle-health-do-vs-md-interview-your-new-doctor2012-08-19T00:50:00-04:002020-08-04T01:23:03-04:00Foot & Ankle Health; DO vs. MD; Interview Your New Doctor?Dawn Hackney
Ok... so I am a bit behind, but I am trying to get caught up! The following is from theJune 22, 2012 episode of Let's Talk Medical with Doctor Gigi.
Foot & Ankle Health:
Podiatrists are specialists in foot & ankle care. They treat with medications, orthotics, bracing, &surgery. Orthopedists care for bones & joints, so they also treat foot & ankle problems, but I have found very few who "specialize" in the area of the foot & ankle. For this reason, I prefer to see a Podiatrist for my foot & ankle care as this is the Podiatrist's only focus, whereas most Orthopedists also treat knees, hips, shoulders, all types of fractures, & perhaps even backs. If you have an Orthopedist who likes to treat foot & ankle issues, I am certain he will give you great care. Just keep in mind that the Podiatrist makes 100% of his living on caring only for the foot & ankle, so they likely have more expertise in regards to these issues.
A common foot problem is plantar fasciitis, which is inflamation of the tissue which connects from the bottom of the heel to the toes. The tissue closest to the heel can get inflamed due to your going barefoot, or perhaps due to positions such as squatting, or even due to problems with your shoes. When you get plantar fasciitis, you are usually keenly aware of it by the classic description: "sharppain in my heel when I take my first few steps after sleeping or sitting a while." It is interesting to note that the pain does usually subside after you take a few steps, but it generally reoccurs every time you take your first steps after being off your feet for a little while. This painful condition can be treated by your Primary Care doctor or a Podiatrist or an Orthopedist. Usual care involves anti-inflamatory drugs such as Ibuprofen, Aleve, or Celebrex, along with some behavioral changes, which include: never going barefoot, using a good arch support & a soft-soled shoe, & stretching thetissue at the bottom of your foot. Sometimes steroid injections, physical therapy, & even orthotics are needed.
Another common foot & ankle problem is osteoarthritis, which is astiffness or pain in 1 or morejoints of the foot or ankle. This process is usually associated with a history of trauma in the past, such as sprains, strains, or even fractures. X-rays are generally needed to confirm the typical joint changes of arthritis, & it should be noted thatPodiatrists often do their x-rays in astandingposition whereas most Orthopedists & typical radiology departments often do them in a seated position. X-rays done while the patient is standing allow for evaluation of the joint in the position itassumes while standing & walking. Usual treatment for arthritis is anti-inflamatories, though sometimesPT, orthotics, or even surgery are needed.
Stress fractures of the feet occur when the bones of the foot get weak, generally from osteoporosis, & simply walking or standing breaks one of those bones. These are commonly seen in older women, as these are the same people who get the most osteoporosis. Generally they involve the bones of the forefoot, so often the lady will present to the doctor with pain & swelling in the foot between the ankle & toes (on the top, not on the bottom of the foot). There is usually no significant history of trauma, as simply the stress of standing & walking can cause this fracture. Remember those standing x-rays done by the Podiatrist? Those allow the weight of the body to stress & thus spreadout the bones & tissues of the feet, which often can make it easier to diagnose these types offractures. Thankfully stress fractures usually heal well with a soft walking cast or similar brace, but it ismost important to remember what this type of fracture tells us... you have osteoporosis!!! So, if you develop a stress fracture, you must not only treat it, but you must see yourdoctor to treat your osteoporosis!
The feet & ankles take a beating, & when your feet hurt, every step can be misery! If yours are painful, don't hesitate to see your Primary Care doctor, a Podiatrist, or an Orthopedist, as there are many diseases which affect these body parts, but these doctors have solutions which can make your life much less painful!
DO vs. MD, & Should I Interview My New Doctor?:
If you refer back to an earlier blog, you will find more information regarding the differences betweenDO physicians & MD physicians. Basically, both go to medical school & both go to residency training after medical school to get their specialty training. Thebiggest difference is that DO's learn chiropractic theory & training, whereas MD's do not. Once medical school is completed however, many DO's never do manipulation, so they often tend to be very similar to MD's, practicing mainstream medicine with pills, advice, compassion, & surgery. Often,these twophysicians train in the same residency programs, so they are not necessarily that different from one another. For instance, I trained at Bayfront Medical Center in a Family Practice residency program run by MD's. Most of the residents were MD's, but at least one was a DO. She graduated from our program & I am certain that she practices medicine very similar to the way I practice medicine. So although we went to medical schools with different philosophies, our post-medical school training was the same, so ultimately the way we practice is the same.
So how do you know if you like & trust your new doctor? Should you "interview" him or her? Well, I for one do not like the idea of being interviewed, as I think that if you really want to know what kind of a physician I am, you need to let me tackle your medical concerns. I can explain to you that I went to LSU Medical Center, then toBayfront Medical Center's Family Practice residency program, & then started my solo family practice office. I can inform you that I amBoard Certified inFamily Practice, & that I have never been sued (THANK GOD!). But what I really can'ttellyou is thewayI think, the fact thatI love to educate, the manner in whichI workwith youto come to anagreeable plan foryourmedical concerns & future health, nor the way thatI practice cost-effective medicine. To really "interview" me (or any other physician), I believeyou must presentwith a medical problem or concern, &watch us in actionas we evaluate & treat you. If after that you do not like your doctor, find another one. But if you do like your new doctor after this first encounter, letthatbe the deciding factor, notthe less important issue of whatcredentialsarehanging on the wall.
In closing, don't forget to listen to thelive version of Let's Talk Medical with Doctor Gigi as we broadcast during The Skip Show onFridays at 1-2PM Eastern time onWTAN 1340-AM in the Tampa/St. Pete area. If you are not local, please catch us with live streaming via www.SkipShow.com, where you can also find podcasts of all our previous shows so you canlistenat your convenience! As always,I welcome your medical questions or comments, & thus invite you to contact me during the live show via (727)-441-3000 or toll-free (866)-TAN-1340, or you cane-mail me at any time via DoctorGigi@SkipShow.com.
Until next time, here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/rating-physicians-generic-plavix-vicodin-reformulated-stop-smoking-headaches-blood-clots-travel2012-07-22T00:52:00-04:002020-08-04T01:23:02-04:00Rating Physicians; Generic Plavix; Vicodin Reformulated; Stop Smoking; Headaches; Blood Clots & Travel.Dawn Hackney
Welcome back to my blog, which puts into writing the topics discussed during theJune 15, 2012 episode of Let's Talk Medical with Doctor Gigi.
Rating Physicians:
Many websites are available to rate physicians, & you can use them torate your doctor or even to learn about a doctor before you establish a relationship with him. Keep in mind however that like all statistics, theserating scales do not always tell the truth. Often times, the most dissatisfied patient is the one most likely to cast an opinion. Also, anybody is allowed to vote, so I could encourage friends & even relatives to give glowing reports. I generally get good scores, but I lose a few points when judged on timeliness. At first you might think that I don't respect my patient's time, or perhaps I overload my schedule, or perhaps I have too many distractions, but in fact I run late because I spend so much time with patients... they get the time they need, not just the time for which they were scheduled. So, the fact that I do not get a perfect score, does not truly reflect a defect or problem with my medical care. Keep in mind that a perfect doctor for you might not be the perfect doctor for someone else. If your doctor has good basic medical knowledge & judgement,if he listens to you, educates you, sincerely tries to understand & know you, & in general treats you as a friend orfamily member, you have a fabulous doctor... for yourself... & you should not worry about the rating he might get from other patients.
Generic Plavix:
Plavix (= Clopidogrel) is a medicine used to thin blood, thus it is used to decrease the risk of strokes & heart attacks. It is pretty expensive, so many people have been awaiting the release of the generic version. Happily, the generic Plavix hit the market in May 2012. If you have insurance coverage for your medications, you likely have seen the price drop. However, if you pay for your own medications, you might not see the price drop until after the first year that the generic is available. Thus you will get a cheaper Plavix around May 2013. Again, this illustrates the fact that although a generic medication is approved, theprice often does not drop significantly for cash-pay patients until 1 whole year after the initial approval. This is due to the fact that usuallyonly1 company gets the right to produce the generic version the first year. Many companies can begin to produce their generic versions once that first year has passed, & this results in a significant cost savings for all patients (insured & non-insured).
Vicodin Reformulated:
With the use of narcotics on the rise... an epidemic you might say... there has been much concern about the fact thatmost narcotics are combined with Tylenol. Many doctors & most patients forget this, & frequently patients end up taking an overdose of Tylenol which can be lethal. In fact, we used to recommend a maximum daily dose of 4,000 mg of Tylenol, but now we have lowered that maximum dose to 3,000 mg of Tylenol per day.
Vicodin is a commonly used narcotic pain medication which combines Hydrocodone (the narcotic) with Tylenol. It used to be available with5, 7.5, or 10 mg of Hydrocodone, combined with 325-500mg of Tylenol. Physicians used to frequently prescribe the Vicodin 5/500 at a dose of "1 to 2 pills every 4 to 6 hours as needed for pain." Therefore a patient was allowed a maximum dose of 2 pills every 4 hours (6 times per day), resulting in a total daily dose of: 5 mg of Hydrocodone per pill X 2 pills = 10 mg of Hydrocodone per dose 10 mg Hydrocodone per dose X 6 doses per day =60 mg Hydrocodone per day. Unfortunately, if you figure out the dose of Tylenol, you will find that this dosing provides an OVERDOSE of Tylenol: 500 mg of Tylenol per pill X 2 pills = 1,000 mg of Tylenol per dose 1,000 mg of Tylenol per dose X 6 doses per day = 6,000 mg Tylenol per day!
Thank God forPharmacists who have worked diligently toeducate physicians about the dangers ofthese combination drugs, & have often suggested other doses which will not overdose our patients on Tylenol. This wasnot lost on the Pharmaceutical industry, who is now reformulatingnarcotic-Tylenol combination products.
Vicodin will soon be released in itsnewly reformulated version... which will use300 mg of Tylenolregardless of the amount of Hydrocodone in the pill. Thus if a patient takes 2 pills 6 times per day, they will only get a max of: 2 pills X 300 mg Tylenol X 6 doses = 3,600 mg of Tylenol per day. Though this is higher than the new overdose level of 3,000 mg of Tylenol per day, it is at least below the 4,000 mg dose which is the known toxic dose. Expect to see this change occur during September or October 2012, & expect other narcotic medications to follow with similar reformulations.
By the way, Tylenol overdose is a nasty way to die. TheTylenol injures your liver, but ittakes upto 5 days for your liver to show the full extent of that damage. Thus, a person who intentionally overdoses on Tylenol will often wake up in the hospital after having had his stomach pumped. Most times he is happy to be alive & thankful that the suicide attempt was not successful. Unfortunately, about 5 days later his liver will begin to die, & without a liver transplant, so might he. Physicians can check a Tylenol level when the person first shows up in the Emergency Room, & they can use this level topredict whether the liver will actually die or not. Of course, slow daily unintentional overdose is different as the damage to the liver occurs slowly over time, but the outcome is the same.
Stop Smoking:
If you or someone you love is trying to stop smoking, here are some helpful hints.
If you live in Florida, you should check out "Tobacco Free Florida" as I think they can provide you withfree nicotine patches. If you have never tried these patches, you should, as they often work well for people truly committed to stopping smoking. Be sure to follow the directions, as the strenghth you will need varies depending upon the amount of cigarettes you smoke. The 21 mg patch is the correct strength for someone who smokes about 1 pack per day, whereas a 1/2 pack perday smoker should use the14 mg patch. Of course you start with a high dose, then wean down over time.
Though the nicotine patches help many people stop smoking,I prefer the Nicotrol Inhaler device. It is a small plastic device that looks like the plastic tip on a cigar. It unscrews, & inside it holds a small sponge that is impregnated with nicotine. As you "smoke" the device, air comes in through the sponge & picks up the nicotine, thus carrying it into your lungs. Thus you get the nicotine... which is truly what you are addicted to... but you do not get the tar & smoke! Your hands & mouth feel as though you are smoking, so they are happy too! Over time you are supposed to use less & less of these inhalers, but even if you never stop using them, you will at least be doing less damage to your body than if you continue to smoke cigarettes. Also, because you only get nicotine when you "smoke" the Nicotrol inhaler,you can choose to smoke a real cigarette interspersed with the inhaler, thus you do not have to worry if you have an occassional "slip" with the tobacco cigarette.
Though Nicotrol inhalers are expensive, I recently saw where you can get a month's supply for a maximum of $50. To cash in on that deal, you should go to the website www.Nicotrol.com where you can get acoupon which will limit your cost to $50. You will still need a prescription, but I don't think there is a physician among us who would not be happy to provide you with that!
Headaches:
If a 50 year old ladystarts to develop headaches which are associated with nausea, is this likely to be migraines? It is certainly true that migraine heasdaches can develop when ladies go through hormonal changes such as menopause, butat 50 years old you must also giveconsideration toneurologic abnormalities such as masses, tumors, strokes, or pre-strokes (called TIA's, which stands for transient ischemic attacks). Thus it is likely that this lady should have aneurologicexamination & perhaps an MRI of her brain, just to be certain there is not a more ominous cause for her headaches.
Also, tension headaches, which are caused by muscle tension or spasm, can be associated with nausea as well. And don't forget,stress can causeboth migraine & tension headaches.
Though you can certainly awaken with a tension headache or a migraine headache, you should also give consideration to the fact that morning headaches can be a sign of sleep apnea. So if youawaken with headahces, snore loudly, have daytime exhaustion, & awaken feeling as tired as you were when you went to bed, you just might have sleep apnea. Talk to your physician & he can order a sleep study to evaluate this further. As a cost-effective measure, ask if you can get a "home" sleep study, as these can now be conducted at your own home, which is less expensive than going to a sleep lab.
Blood Clots & Travel:
If blood sits still too long it tends to clot. Thus it should come as no surprise that travel increases the risk of gettingblood clots in your legs which are called "deep vein thromboses" orDVT's. These unfortunately can break free & go to the lungs where we call them "pulmonary emboli" (= PE). Pulmonary emboli cankill you as they block up the blood vessels of the lungs, thus liquid blood cannot pass through the lungs to pick up oxygen,resulting in a deadly lack of oxygen to all thebody's organs. So if youtravel 2 hours or more, you shouldpump your feet up & down to push the blood through your leg veins. You should alsostand up or at least try to stretch out straight so you remove the bend at your hips, thus re-establishing a straight course for the blood to flow from your feet to your heart. If you develop red, hot, swollen legs or shortness of breath aftertravel, do not delay in contacting your doctor & be sure to give him this history so he will evaluate you urgently. The best study to evaluate for DVT's is a Doppler ultrasound of the legs, & the usualtest for a PE is either aventillation-perfusion scan or aspiral CT of the chest. Again, these clots can be life-threatening, so if you think you have one, get your studies done urgently, even if that means going to theEmergency Room!
Thanks for visiting my blog, & I hope you learned something useful. Remember you can hear me live on WTAN 1340-AM on Fridays from 1-2PM Eastern time. Or if you prefer, check it out on www.SkipShow.com where you can listen live or to the podcasts. I would love to hear from you... comments of questions. You can reach me live during the show via (727)-441-3000 or on our toll-free number: (866)-TAN-1340. If you prefer, you can reach me any time via: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
PS I would love to impact more people, so please consider sharing this blog with your friends & family on Facebook or on your other chosen social media.
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https://doctorgigi.com/blogs/news/bleeding-after-menopause-nipple-confusion-psa-vs-bph-coumadin-vitamin-k-iron-for-anemia2012-07-08T00:54:00-04:002020-08-04T01:23:02-04:00Bleeding After Menopause; Nipple Confusion?; PSA vs. BPH; Coumadin & Vitamin K; Iron for Anemia.Dawn Hackney
I recently attended the 25th Reunion of my medical school class. If you are quick with math, you know now that I graduated from medical school in 1987! The reunion of the LSUMC Class of 1987 was in New Orleans, & I guess we have gotten old enough that we "earned" the opportunity to celebrate at Arnaud's Restaurant. This grande restaurant served great food, & provided a balcony over-looking Bourbon Street... so we really felt the New Orleans experience! The highlight of the night was a tour of the restaurant, where we learned that it occupies the entire city block & is a conglomeration of 14houses which were individually purchased & joined together over many years. I guess that explains the variable decor & the steps up & down from one room to another! And of course, the true highlight of the entire weekend was the opportunity to spend quality time with many friends, most of whom we see all too seldom! I have found that the bond we established during our 4 years ofmedical school seems to be an ever-lasting one, & I am already looking forward to our 30th reunion. Even better than that is the fact that due to social media, we will likely be better at keeping up withone another from here forward!
Despite my "play time," I did broadcast "Let's Talk Medical with Doctor Gigi" from my parents' home in Port Allen, LA. Following are the highlights of thatJune 8, 2012 episode.
Bleeding After Menopause:
We have discussed that menopause is the absence of ovarian function, either due to the "death" of the ovaries or due to their surgical removal. With the lack of ovarian function there is also a lack of a menstrual cycle as it is the ovaries which normally produce the hormones which cause this cyclic bleeding monthly. Once you lose ovarian function, you stop having periods, & though the bleeding usually does not just stop, the cycles usually get further & further apart. Once there is no period for one year, you are fully menopausal... also known as "post-menopausal."
It is very important to know that once you have stopped having periods for 1 year, you shouldneverhave a period or vaginal bleeding again... & this includes "spotting!" In fact, doctors call any of these "post-menopausal bleeding," & we generally assume that this is endometrial cancer (= cancer of the uterine lining) until proven otherwise. Of course, if you have had a hysterectomy then you have had youruterus removed, so you no longer have an endometrium (as this is the inner lining of the uterus). Thus a person with post-menopausal bleeding would notneed to be as concerned if she does not have a uterus. But if she has a uterus, she MUST see her GYN or Primary Care physician for a physical exam, probably a pelvic ultrasound, & likely abiopsy of her endometrium... & she should NOT wait!
Fortunatelymost post-menopausal bleeding is found to be due to benign causes, but the work-up for cancer must prove this as it cannot be assumed! Often times the cause is infection, but I believe the most common etiology is vaginal dryness (=atrophic vaginitis) which is common is women who have lost their estrogen hormone. Fortunately a small amount of estrogen cream applied to the vagina & external tissues can make these dry tissues healthy again, resulting in resolution of the abnormal bleeding, as well as a return to more supple, pliable, moist genital tissues which makes sex more fun!
Also, note that if you takehormone replacement for menopause, you might have bleeding depending upon how you take those hormones, & how long you have been on them. If you take them in acyclicfashion... 25 days of progesterone, with the last 10 days combined with estrogen,followed by 5-6 days of no hormones... you should bleed monthly (during the 5-6 days of no hormones). If you take both the estrogen & progesteroneevery day, you might bleed irregularly for thefirst 6 months, butafter that, you should not bleed... so call your doctor if you do!
As a last note, a Pap smear only tests for cervical cancer. That means that it looks for cancer on the bottom of the uterus. It does not tell you anything about endometrial cancer, so even if your Pap was recently normal, youmust call your doctor if you develop unexpected post-menopausal bleeding!
Nipple Confusion?:
Don't get me wrong, I strongly believe in breast feeding! It provides the most natural source of nutrition to our babies, & the first 3 days of breast feeding is particularly important as the breast milk is very special at that time. It is called "colostrum," & it isloaded with antibodies (from the mother) which provide the baby with a great immune system until he can produce his own!
But will it confuse the baby if you inter-mix the breast feeding with a bottle? People have proposed that if you feed the baby a bottle, he will get "nipple confusion" & not feed properly. I really don't subscribe to this idea, as I know that babies are born with what doctors call "primitive" reflexes, which are hard-wired from birth to help the baby survive. This includes a "rooting" reflex which causes the baby to turn his head toward anything that tickles or presses against hischeek, & a "suck" reflex which causes him to suck anything put in his mouth. So a baby really doesn't care about nipples or bottles, he just has reflexes which drive him to find nutrition! So I believe that most babies can be fed both & not get confused. Of course, over time they might develop a preference for one or the other, but you can deal with that when or if it happens. If he happens to prefer the breast, great! If he prefers the bottle, you can alwayspump your breasts & place that breast milk in the bottle he likes.
I propose that having a baby who will take both the breast & the bottle is beneficial. If somehow your breast milk does not come in properly, you could be starving &/or dehydrating your baby if you do not offer him a supplement! Also, what will you do if you get ill &have to take medication which is not safe for your baby (Mom's body will share many medications with her baby by secreting them into the breast milk as it is produced)? What will you do if you want to goout & have an adult beverage? And don't forget, breast feeding is a fabulous bonding opportunity for Mom & baby, but what about dear old Dad? Allowing him to feed the baby (with abottle of breast milk OR formula) willhelp insure that he & the baby bond as well!
PSA versus BPH:
Does a normalPSA mean that the prostate is fine? No, it means that the "prostatic specific antibody" is normal, thus indicating that it is unlikely that you have prostate cancer or prostateinfection/inflamation.
What about symptoms like: urinary frequency (= the need to urinate often), urinary hesitancy (= a delay in starting urination when you try), nocturia (= having to get up at night to urinate), or poorurinary stream (= a weak stream, so basically you don't make bubbles in the toilet, & perhaps you don't make noise)? These are symptoms of an enlarged prostate... what we call "Benign ProstaticHypertrophy" or BPH. If you have these symptoms you should discuss them with your doctor, who will likely do a digital rectal exam (= DRE) to check thesize of the prostate, & also to feel for masses which could be cancerous. If there are no masses & the PSA is normal, it is not likely that you have prostate cancer, sotreatment for the enlarged prostate can begin. Certain blood pressuremedications can shrink the prostate, so often Hytrin (= Terazosin) or Cardura (=Doxazosin) are used if the man has high blood pressure AND BPH. If he does not have high blood pressure, oftenFlomax (= Tamsulosin) is used. If these medications do not help, surgery is generally indicated. The old surgery is the Transurethral Resection of the Prostate (= TURP) which is more bloody & requires a longer time in the hospital with a foley catheter in the bladder. The newer pocedure is the GreenLight Laser treatment, which uses a laser to remove the excess prostate tissue. Due to the laser cauterizing the tissue, there is almost no bleeding & faster healing, so it is usually done as an out-patient procedure... though you usually go home with a catheter which is removed in the Urologist's office thenext day.
Coumadin & Vitamin K:
Coumadin is a blood thinner used to decrease the risk of blood clots (and thus strokes) in people who have an irregular heart beat, such as atrial fibrillation. It is also used when a person has a deep vein thrombosis (= DVT) or even apulmonary embolism (= PE), as these blood clots must be thinned, dissolved, & then prevented. Coumadin interacts with many foods & medicines, thus it will vary in effectiveness depending on what you eat & the meds you take. In particular,VitaminK reverses the effect of Coumadin. For this reason, doctors recommend that anyone who takes Coumadin should also follow a low Vitamin K diet. This is difficult for many people as Vitamin K is found in large amounts in leafy green vegetables. So, must a person who takes Coumadin change his diet radically & avoid leafy greens? Well, it is best to simply avoid Vitamin K food products, but this is impractical for some people. I recommend therefore that if you really enjoy leafy greensor other high Vitamin K foods, eat them... but do so consistently. Find the amount of Vitamin K contained in these foods &try to eat the same amount of Vitamin K every day. In doing so, your Vitamin K level will be stable so the doctor will be able to find the dose of Coumadin that willwork with that dose of Vitamin K. So if you ever end up on Coumadin, but love spinach, don't worry. You can eat it, but you will have to eat it daily or find something with a similar amount of Vitamin K to eat daily.
Many of you may know that there is a new blood thinner on the market. It is called Pradaxa, & it is very special in that it is not affected by food & meds. In fact, doctors need not monitor labs to insure proper effectiveness. Unfortunately it is new so we are still getting familiar with it, & of course it is expensive. Perhaps it's biggest downfall however is that it's effect is not reversible, so if you are injured & bleeding, the doctor cannot give you medicine to reverse it's blood thinning effect, meaning that you will bleed freely until it's effect wears off. Conversely, Coumadin can easily be reversed by giving the patient a large dose of Vitamin K... so perhaps in the long run, it is the safer blood thinner.
By the way, Coumadin is the name-brand version of Warfarin. You have likely used Warfarin around your house or camp, as it is commonly known as rat poison!
Iron for Anemia:
Anyone who has ever taken an iron supplement knows that iron often causes constipation & stomach upset. I learned many years ago about a supplementwhich is great for treating anemia, and which does not tend to cause stoamch upset. It is called "hematinic" which I tend to think translates to "blood tonic." Since learning of its existence I have not written a prescription for iron, as my patients have responded very well to the hematinic & have essentially no side-effects. You should be able to find a hematinic in a good health food store. Like any other medication, you need to follow your body's response to the supplement, so be sure to get lab work after 1-2 months to be sure your blood counts are improving.
Keep in mind that I am happy to answer your medical questions. Just call during the live show or e-mail me any time. "Let's Talk Medical with Doctor Gigi" airs live during "The Skip Show" on Fridays at 1:00 PM Eastern time. We're on WTAN 1340-AM in the St. Pete/Clearwater area, or you can catch us live via www.SkipShow.com where you will also have access to our recorded podcasts. Our contact info is as follows: (727)-441-3000 or toll-free (866)-TAN-1340 or DoctorGigi@SkipShow.com.
Hope to hear from you soon, & until then, here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/he-who-pays-chooses-how-to-play-metastatic-cancer-hurricane-preparedness2012-06-17T00:55:00-04:002020-08-04T01:23:01-04:00He Who Pays Chooses How to Play; Metastatic Cancer; Hurricane Preparedness.Dawn Hackney
This blog contains information presented in the live broadcast ofLet's Talk Medical with Doctor Gigi on June 1, 2012. Please check out the podcast on www.SkipShow.com if you prefer the audio version.
He Who Pays Chooses How to Play:
The New York mayor has proposed that his city should essentially outlaw large sodas. So what do you think about government taking away your Big Gulp? As a physician, I see the beauty of encouraging people to eat & drink sensible serving sizes, especially as we battle our epidemic of obesity, but I really hate the idea that my dietary habits might be dictated by government! The problem is that as long as government is responsible for our healthcare, they have a vested interestin our health. Thus, they just might be justified in passing laws that seemingly help to keep us healthy. Again, I like the idea of healthy habits, but I despise the idea of government-mandated anything! We asAmericans like our freedoms, so how can we think this is a good idea?
Well, the unfortunate truth is that "he who pays chooses how to play." So if government pays foryour healthcare, they will dictate how you live your life... perhaps affecting your diet, your exercise habits, your sleep habits, your sexual habits, etc. If that sounds frightening, start paying attention to healthcare policy, & start thinking about the control Big Brother already has... & be leery of giving them more control! This is an aspect of government-provided healthcare which many of us have not considered.
When government or insurance pays the doctor, realize that the doctor actually works for them. Whenyoupay the doctor,he works foryou. Which program do you think provides for an appropriate doctor-patient relationship? There are many political policies which might seriously affect your health, as well as your freedoms, so if you care, get involved & realize that"free"healthcare is NOT FREE!
Metastatic Cancer:
A "primarycancer" is the initial cancer that develops, & it is named according to the area in which it first begins. When that primary cancer spreads to a different area, then it is called "metastatic" or "secondary" cancer. So if cancer begins in the breast, it is called a primary breast cancer. If that cancer spreads or metastasizes to the brain, it is still called breast cancer (notbrain cancer), but it is metastatic breast cancer which has gone to the brain.
Metastaticcancer is obviously not likely to be as treatable asprimarycancer, but it isnot by definition terminal! The curability depends on the type of primary cancer as well as the extent of metastatic spread... which is determined by thenumber of metastases& the organs involved with metastases. It also depends upon the overall health of the patient, & also to a large degree upon the patient's attitude. So never decide that there is no hope just based upon the knowledge that a cancer has metastasized... ask for treatment options & perhaps get several opinions.
During the show someone asked questions regarding a cancer which has just been diagnosed & has already metastasized to the bone. Obviously I cannot say whether this is curable, but certainly the patient should not assume there is no hope! Oncologists are the specialists who treat cancer patients, & they know treatment protocols, expected outcomes, cancer behavior, etc. So obviously this person must see an Oncologist soon! Many cancers like to metastasize to bone, so this could be a primary breast cancer, or perhaps a primary prostate cancer, or even some other cancer. Depending upon the type of primary cancer, the treatment will vary, so the Oncologist will need to diagnosis the primary cancer. The work-up is chosen by the Oncologist based upon the patient's history & a physical exam, & might include x-ray studies like CT scans or PET scans, biopsy of the bone tumor, mammograms, prostate checks, blood tests, & more. Treatment will depend on the type of primary cancer, but generally the bone lesions are treated with radiation, which shrinks the tumors & helps decrease the pain... & yes, bone cancer is VERY painful! Bone cancer also weakens the bone, thus patients with bone cancer are at risk of breaking those affected bones. This type of fracture is called a "pathologic fracture" indicating that the bone has broken due to a pathologic process (the cancer),not because of trauma or osteoporosis. Radiation also helps to decrease the risk of these pathologic fractures.
As a side-thought, there are primary bone cancers, so not all bone cancer is metastatic. There are many primary bone cancers, including Multiple Myeloma (which actually is cancer of the bone marrow), Osteosarcoma (which is most common in young people aged 10-25, & saddly is very malignant), Chondrosarcoma (which is cancer of cartilage), & several others. Each cancer has it'sown personality & behavior, so I guess it is easy to see why we need Oncologists!!!
If you want to check out a great website with patient-friendly yet thorough cancer information, check out www.AboutCancer.com. It is the website of my friendDr. Robert Miller who is a RadiationOncologist in St. Petersburg, FL. Once in the website, go to "Dr. Miller's Web Site," then click on "Cancer Information."
Hurricane Preparedness:
So June 1 has arrived, & with it comes another hurricane season. Those of us who live in coastal states must prepare our homes, our property, & ourselves just in case the next 6 months bring threatening storms.
First it is important to know your evacuation zone, so you will know when it is imperative for you to leave. Have a plan as to where you will go, but pack a road map in case you have to take an alternative route. If you cannot evacuate independently, register with your city so they can get you the help you need. It is best to not depend on a shelter, but if you must, be sure you know where those are. If you require a special-needs shelter to assist with medical issues, be sure to register for that as well.
I am from Louisiana & live in Florida, so I've been through the drill more than a few times. I also recall a hurricane which hit Louisiana when I was 5 years old. Though we were 70 miles from thecoast, I still remember the frightening wind & sideways rain. Myhome was also hit by a tornado which camefrom Hurricane Andrew as it headed north in the Gulf after having devastated Homestead, FL. To say the least,I have great respect for hurricanes, & as such,I evacuate. I can onlyhope you will do the same!
As a physician I would strongly encourage you to pack the following:
1) a 2 week supply of your medicines - ask your doctor for samples or a separate prescription which you can purchase on your own if your insurance will not allow an extra or early refill.
2) a list of your medications including the dose of each pill & how you take them.
3) a paper with your medical problems, past surgeries, allergies (to meds & to foods), physicians, & immunizations. After a bad storm you could be incapacitated & unable to tell rescue personnel this information, & without electricity there might be no access to your medical record if it is electronic. Also, your physician might not be available or reachable. If you have a medical app (likeMyMedical) on your iPhone, iPod, etc., be sure to update it now.
4) perhaps a copy of your last 1 or 2 office visits from your doctor, as well as your most recent labtests, including blood tests, x-rays, colonoscopy, mammogram, DEXA, etc.
5) equipment you'll need such as your CPAP machine, oxygen, bandages, crutches,braces, glasses, contac solution, etc.
6) water - plan to need 1 gallon per person per day & prepare for 3-7 days... but don't forget the animals! If you can, keep the water in plastic jugs, but if you are caught without an adequate storage unit, fill the bathtub with water (after scrubbing it of course). Also, as water is so heavy, you might not be able to take enough with you if you evacuate. In this event, you should pack panty hose to act as a strainer, &bleach to purify water. Bleach should bepure Sodium Hypochlorite 5-6%, & you should mix it as follows: 2 drops of bleach to 1 quart of water, or 8 drops to 1 gallon. If the water is cloudy you should double the amount of bleach: 4 drops to 1 quart of cloudy water, or 16 drops to 1 gallon of cloudy water. Mix the bleach with the water & allow it to sit for 30 minutes before you drink it. Of course, if you have propane or another source of heat, you can boil the water to purify it. Remember however that flood water not only contains bacterial contamination, but also often contains contaminants such as chemicals (from cars, boats, pipelines, etc.). Unfortunately neither bleach nor boiling will help with this issue.
7) NOAA radio which will sound an alarm when a weather emergency happens in your area (such as a change in the hurricane's route or speed, or such as a tornado).
8) food - remember that you can go days without eating, but you won't last long without water! Consider buying MRE's or similar packaged food from an Army store or camping store. If you pack canned goods, don't forget a hand-held can-opener.
9) a full tank of gas in a well-tuned car.
10) pets, leashes, pet food & medications, crates & beds, shot records, & perhaps towels to dry them off. If your pet is fearful of bad weather, ask your Veterinarian for "storm pills" & be sure to pack them with your other supplies!
It is a good idea to pack things in advance, & those that cannot be packed early can be written on a list so you can quickly grab & go! I like to keep evacuation supplies in the attic, so if I am caught off guard I can just climb up & honker down. Don't forget, you'll need a ladder to get up there, & you should store an ax or chain-saw in the attic in case you have to cut your way out!
As some last thoughts:
Be sure that you only use a generator in a well-ventillated area; otherwise you might survive the disaster only to die from carbon monoxide poisoning.
Don't walk through storm water. It possibly has contaminants such as sewage & other chemicals, & it might be deeper than you expect. Also, you could be electrocuted if there is a downed powerline hidden beneath the water.
And so we conclude another blog. I hope you find the information helpful... & if you do, please consider sharing the blog with your friends & family. You can do that by hitting the "F" or "T"button at the bottom of the blog to share with your Facebook or Twitter connections.
Also, consider listening to the radio program. You can do this by tuning to WTAN 1340-AM in Tampa/St. Pete, FL area, or if you are not local, find us on the web via www.SkipShow.com where you can listen live or check out the recorded podcast. Feel free to call or e-mail questions or concerns: (727)-441-3000 local, or(866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Stay safe, & here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/asthma-awareness-month-claudication-vascular-problems2012-06-05T00:56:00-04:002020-08-04T01:23:00-04:00Asthma Awareness Month; Claudication & Vascular Problems.Dawn Hackney
The following reviews topics discussed on Let's Talk Medical with Dr. Gigi as it aired live on WTAN 1340-AM on May 25, 2012.
Asthma Awareness Month:
May is Asthma Awareness Month, so let's discuss some highlights of this disease. It is basically inflamation of the airways, which results in sputum, spasm, & swelling. The inflamation can be due to infections (viral, bacterial, or fungal), allergens (pets, dust mites, cockroaches), orirritants (like smoke, perfumes, chemicals, or even acid from GE reflux). People with asthma react more vigorously to these triggers than the average person as they have a gene which causes an over-production of inflamatory substances in their airways.
Despite the advancement of medicine over the past decades, the prevalence of asthma has been steadily increasing since the 1970's. We are not sure why this disease continues to affect more & more people, but perhaps it is related to poor air quality or perhaps the gene is being passed on to more of our relatives! At present, approximately 20 million people have asthma, & of these 6 million are children. In general,children have worse outcomes than adults, so they must be monitored more closely & treated more aggressively.
There are many medications for treating asthma, but there are basically 2 types of meds: anti-inflamatory meds & anti-spasm meds. The anti-inflamatory meds decrease the inflamation in the airways, so they essentially treat the disease itself, & are thus consideredMAINTENANCEmeds as they are used daily to maintain control of asthma. Anti-inflamatory products are either steroids (like Asmanex, Azmacort, Q-Var, Pulmicort, Flovent, & Aerobid) or leukotriene inhibitors (like Singulaire, Accolate, & Zyflo).
On the other hand, the anti-spasm meds are also called beta-agonists, & they come in 2 types: short-acting & long-acting. Short-acting beta-agonists are meds like Albuterol & Xopenex, which start to work within several minutes but only work for about 4-6 hours. Long-acting beta-agonists are meds like Foradil & Serevent which take a little while to start to work (15-30 minutes) but then last for about 12 hours. The short-acting meds like Albuterol are used as EMERGENCY (or RESCUE) inhalers as they work so quickly,but if you have good control of your asthma you shouldnotneed them very often. In fact, if you use your rescue inhaler more than 2 times per week, you should call your doctor as you might need additional evaluation or treatment. The long-acting beta-agonists can be used as maintenance meds, & are often found combined with steroids in products such as Advair (which is a steroid plus Serevent) or Symbicort (which is a steroid plus Foradil), but as they take a while to work, they are never used as rescue inhalers!
If you take your maintenanceinhaler daily but suddenly realize that you are having more shortness of breath or more wheezing (this is actually the noise made by the air passing through an airway whichis in spasm), you should start to use yourrescueinhaler. Remember however that if you use it more than 2 times per week, you should call your physician. You should consider it anemergency each time you reach for your rescue inhaler. So would you really allow yourself to have more than 2 emergencies in 1 week without calling your doctor for help? The doctor will likely look for factors that cause worsening of asthma such as infection or exposures to allergens or irritants. Depending upon the cause for your worsening asthma (called an "exacerbation" of asthma), the doctor might order a chest x-ray, blood tests, or sputum culture, & might treat you with antibiotics, reflux meds, or oral steroids. Severeasthmatic attacks often require hospitalizationfor IV fluids, nebulizer treatments, & IV antibiotics.
Many people used to use an over-the-counterrescueinhaler called Primatene Mist as treatment for asthma. This was Epinephrine in an inhaled form. Since January 2012 it is no longer available due to the fact that it was very potent, had many side-effects, & was over-used by people who could bebetter managed by seeing a physician & getting amaintenanceinhaler.
There is a gadget called a peak-flow meter which can be used to assess your lung function. It is an inexpensive plastic device which your doctor can prescribe, & which you can get from the pharmacy. It measures the peak force exerted when you exhale forcefully. There are standards for age & height, but more importantly, if you check your peak flow intermittently, you will be able to determine yourown baseline, so you will know when you are deteriorating.
Though asthma is a treatable disease, it is still a deadly disease. In fact during my 20+ years of practice, I have had2 patients die from asthma. They were only 29 & 45 years old! So if you have asthma, become knowledgable about your disease, take your meds as instructed, & if you have worsening, do not over-use your rescue inhaler! Instead,call your doctor for further evaluation &treatment! After all, if you can't breath, you can't live!!!
Claudication & Vascular Problems:
People sometimes complain of pain in their legs. When the pain occurs with walking or similarexertion, it is generally due to a blood flow problem though sometimes it is caused by a neurologicproblem. People with back problems, in particular spinal stenosis, often have pinched nerves in the back which cause a heaviness or pain in the legs which resolves with rest AND sitting. In fact, sometimes this "neurogenic claudication" resolves or abates with simplybending forward at the waist... which unloads pressure on the spine. This is why many people like to lean on a shopping cart while walking, as it relieves stress on the spine.
On the other hand, people with vascular (or blood flow) problems get pain & cramps in their legs, but these resolve with rest alone... sitting isnotrequired. This "vascular claudication" is basically like a heart attackof the leg muscles. The muscles are busy working, but due to blockage of an artery, the blood (& oxygen) cannot get to the muscle, so the muscle cramps up & can no longer function. When you rest, the oxygen demands of the muscle decrease & the blood flow is adequate, so the pain resolves & you can walk a little further before the pain returns. If you do not intervene & re-establish good blood flow, you can end up with limited mobility, but over time you can actually get pain even at rest. This is an indication that the blood flow in that leg is so limited that the muscle does not get enough oxygen even at rest. Usually by this time people & their doctors figure out that there is a real problem & they do a bypass surgery or an angioplastyto improve the blood flow.
Early on, vascular claudication is treated with medications like Pletal which make the red bloodcells (which carry the oxygen) more pliable. Red cells look like frisbees, but they are fairly rigid, so the Pletal allows them to be more flexible so they can fold in half, thus squeezing through theblocked arteries more easily. It is interesting to note that although walking triggers pain, a walking program is actually prescribed as treatment for vascular claudication as the body oftenresponds to this oxygen-deprived situation by growing its own bypasses called "collateral" blood vessels!
Though neurogenic claudicationis evidence of anerveproblem, vascular claudicationis evidence ofacirculation problem. It is a reflection of blocked arteries, so if you have it, you should have a work-up to look for other blocked arteries. This should include acarotid ultrasound to look for blockage that could lead to a stroke, & astress test or heart catheterization to look for blockage that could result in a heart attack. Remember, the vascular system is one system... if you haveblockages in one place you are prone to have blockages elsewhere! Note however, that although you should push through the pain of vascular claudication to stress the body & encourage it to create collateral circulation, never push through chest pain, as the body does not generally create its ownheart bypasses!
So we'll end on that note! Hope you learned something, & I hope you'll listen to the live radio broadcast of Let's Talk Medical with Doctor Gigi on Fridays at 1PM Eastern time on WTAN 1340-AM in the St. Pete/Tampa area. Of course you can always catch me on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. I appreciate any input, & please don't hesitate to call or to e-mail your questions: (727)-441-3000 local, (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/better-hearing-month-pre-menopause-symptoms-when-do-meds-expire-celiac-sprue2012-06-03T00:57:00-04:002020-08-04T01:23:00-04:00Better Hearing Month; Pre-Menopause Symptoms; When Do Meds Expire; Celiac Sprue.Dawn Hackney
Happy (late) Memorial Day! I hope you found time to enjoy yourself, but more importantly I hope you found time to thank those Americans who have fought to provide us with the freedoms we so enjoy. And while you were contemplating these heroes, I hope you thought gratefully of the families of these soldiers, as they too have given so much to our country & thus deserve our heartfelt thanks as well!
The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical withDoctor Gigi.
Better Hearing Month:
As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing &balance problems. They usually possess a Master's degree or a Doctorate. Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services. My friend Susan Terry is an Audiologist in St. Petersburg, FL. She owns BroadwaterHearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues. May is Better Hearing Month, so she recently sent educational sheets which I found enlightening; thus, I chose to share her information with the audience.
Hearing impairment affects 10% of the population & is the 3rd most common chronic healthcondition in the US. Hearing loss increases with age, thus it affects 30-35% of people65 or older, whereas 40-50% of people 75 or older will be affected.
The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family. This is the reason so many people adamantly deny having a problem until they get tested & treated.
Hearing loss can lead to frustration, which in turn can lead to social isolation. This is turn can lead to depression, so we must always consider hearing loss as a possible cause fordepression, especially in the elderly.
For each 10 decibels of hearing lost, the risk of dementia increases about 20%. Thus we must also consider hearing loss as a possiblecause fordementia.
Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.
Every person over the age of 40should have a baseline hearing test. Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years. Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!
Pre-Menopausal Symptoms:
Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause). The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes. Most women go through natural menopause between the ages of 48- 52. By definition, a person is menopausal when she has gone 1 year without a menstrual period.
For several years before full menopause, a woman will havepre-menopause. This is aroller-coasterride hormonally as the ovaries are "sputtering" before they die. Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount. As you can imagine, this is a hard time for many women as they don't know day to dayhow they are going to feel... physically or emotionally! Unfortunately this period of pre-menopause can last 5 years!
Pre-menopausal symptoms include: irregular periods, hot flushes, poor sleep, fatigue, moodiness, & vaginal dryness. Initially the periods get closer together... every 2-3 weeks. Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause.
Hot flushes are common, so many people think they are synonymous with menopause, but they are not! Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine. Some anti-depressants cause hot flushes as well. It is interesting to note that the heat associated with a hot flush can actually be felt by other people! If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!
Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically! It is not always an early symptom of menopause, but once it starts, it generally worsens. In fact, without estrogen replacement, vaginal dryness often gets worse year afteryear, even after the other pre-menopausal symptoms have abated.
As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody! So ladies, we owe no one an apology!
When Do Meds Expire?: Most medications are labeled with an expiration date that is2 yearsafter the date that the prescription bottle was filled. But does that really mean that they are unsafe or in need of disposal once that date has passed? First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency. So the real question is whether or not you can accept a bitless potency & still be safe.
If the medication is an antibiotic, I would recommend that you NOT take an expired version. If the antibiotic does not work well you could end up with an untreated infection which could kill you.
On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough. Certainly if that occurs, you would dispose of the expired med & purchase a new batch. Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply. Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.
If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med. For the record though, I would seldom take one which is more than 2 yearspost expiration. Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!
Celiac Sprue:
Celiac sprue is a disease caused by anintolerance to gluten... which is a protein found in wheat, rye, & barley. It is a hereditary disorder & runs in families. Though it often becomes symptomatic during childhood, it can begin later in life. The symptoms of sprue are many: weakness, anorexia,diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis,reduced fertility, & rashes. There is also an association between diabetes, autoimmune thyroiddisease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.
Recently this disease has gotten a lot of attention, & many people believe that they have it. They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps. Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.
So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up. In this manner you will know for certain whether or not you MUST follow this diet. The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminaseimmuneglobulin A. You must know however that this test is measuring your body's immuneresponse to gluten, so if you have been on a gluten-free diet, it will be negative! Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn. Also, since the test measures IgA, people who haveIgA Deficiency will test negative.
To have proper evaluation you should eat a lot of gluten for several weeks, then have the tTG IgAtest drawn. If it is high, you havesprue. If it is normal or low, you need another blood test... a Total IgA level. If it is normal, you do not have sprue. If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue. You thus need further testing to evaluate for sprue, so you would need an upper endoscopy (= EGD) to get into your small bowel and obtain abiopsy. If the biopsy is normal, you do nothavesprue. If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have sprue & are stuck with the gluten-free diet!
I hope this has been educational for you! Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live oron podcasts via www.SkipShow.com. Please call or e-mail me with questions or comments: (727)-441-3000, or toll-free (866)-TAN-1340, orDoctorGigi@SkipShow.com.
Until the next time, here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/diabetes-low-blood-sugar-nurses-week-adult-immunizations-proper-med-lists2012-05-20T00:59:00-04:002020-08-04T01:22:59-04:00Diabetes & Low Blood Sugar; Nurses' Week; Adult Immunizations; Proper Med Lists.Dawn Hackney
Welcome back! This blog will re-iterate & expand upon the topics discussed in the May 11, 2012 broadcast of Let's Talk Medical with Doctor Gigi. Feel free to listen to the corresponding broadcast via www.SkipShow.com where you can find the podcast version.
Diabetes & Low Blood Sugar:
Most of us know that diabetesis a disease in which a person has a disregulation of glucose(= sugar)metabolism, resulting in the person having a highglucose. Diabetes can lead to many bad things, including heart disease, strokes, neuropathy, poor healing, frequent infections, kidney failure, & even blindness, so anyone with the disease obviously wants to have good diabetic control. This means that you would like to have your glucose be between 80-150. If your sugar is often higher than this, you have a higher risk of getting these ill effects, but what happens if you get your sugars too low?
A glucose below 60 is too low, and doctors reallyworryif it gets below 40. This is due to the fact that the brain needs sugar, so if your glucose gets too low, the brain actually dies. Symptoms of hypoglycemia (= low blood sugar) include feeling anxious, confused, cold, sweaty, shaky, & agitated. If you experience these episodes of low sugar, you can quickly correct the problem by eating sugar, so you should carry glucose pills (which you can purchase at a pharmacy) or packets ofsugar (like you get in a coffee shop). In the absence of these, you can try juice or soda... as long as they are NOTsugar-free versions.
Though we aim to control glucose to decrease the harmful effects of diabetes, we must realize that too low of a glucose can actually be more harmful than a high glucose. When your glucose gets below 40 (or perhaps even 60), you can suffer brain damage & even death within several HOURS. On the other hand, a high sugar (more than 150) will take YEARS to cause enough damage to result in brain damage or death. So work with your physician to get good control of your diabetes, but don't try to have such tight control that you bottom-out & have low glucose as that will likely cause you more harm than good!
Nurses' Week:
We recently celebrated Nurses' Week. This celebration begins on May 6th & ends on May 12th... which is the birthdayof Florence Nightengale, who is the founder of modern nursing. Though being a nurse often involves doing tasks which are less than glamorous, it is in my opinion the closest thing to being a mother. Nurses care for us when we can't care for ourselves, & they do so without judgement or malice. Though they often make us do things we don't want to do, they do it for our benefit. They are the quiet support that hold our hands & care for our dignity & emotions, as much as they care for our physical health. They do more for us than we know, & during this week, we celebrate those nurses, past, present, & future who give so unselfishly of themselvesto carefor us! And though they might not love us like our mothers do, the service they give us is done so with love in their hearts!
Adult Immunizations:
Though we are aware that children need immunizations, we often forget that adults also need certain immunizations. Perhaps because schools mandate proof of immunizations, most children get their shots. On the other hand, no one insures adults get their shots, so consider the following & discuss with your doctor to be sure you keep up-to-date.
There are generally 4 adult immunizations: Td or TdaP (tetanus & diphtheria without or with whooping cough), Pneumovax, Flu, & Zostavax (shingles).
Td stands for tetanus & diphtheria, & everyone should get one every 10 years, unless they have had a problem with previous Td shots. This shot protects us from getting tetanus, which is also called lock-jaw. Though we mostly think we are prone to tetanus when we get a rusty nail injury, anyopen wound can be a source of tetanus. Thus, even a clean wound predisposes us to tetanus, so it behooves us to keep current with this shot! Unfortunately, if you have Medicare benefits, Medicarewill only pay for the Td shot if you have an open wound.
TdaP is the tetanus & diphtheria shot with whooping cough as well. Whooping cough does notusually harm adults, but it can kill or permanently injure children. Most kids get DPT shots which include whooping cough, but not every child will make proper immunity, so we still want to immunize adults to decrease the risk of an adult getting the disease & spreading it to a susceptiblechild. So adults have the choice of Td or TdaP... & those who have frequent exposure to children should opt for the TdaP.
Pneumovax is a vaccine to protect you from getting Strep. pneumonia... which is abacteria that often causes sinusitis, ear infections, pharyngitis, bronchitis, & pneumonia. It is recommended that anyone who isprone to these respiratory illnesses (such as those with asthma, emphysema, or even chronic allergies) should get a Pneumovax shot every 5 years. Everyone older than 65 should get this shot. Medicare will pay for only one shot after the age of 65, unless you have high risks for respiratory infections as noted above, though I recommend all of my patients over 65 continue to get this vaccine every 5 years, even if they have to pay cash for it.
Flu shots are given every fall in an effort to protect the population from influenza. As the shotchanges every year, it is given to virtually everybody every year. Again, those who are highest risk of respiratory disease should get this shot annually, but it likely is a good idea for everyone to get one.
Zostavax is the vaccination which helps decrease the risk of getting shingles, which is also known as Herpes Zoster. When a person gets Chicken Pox, the virus causes infection & then goes dormant in the body. If it re-awakens many years later, it causes shingles... which is heralded by a classic painful, blistery, red rash which involves only one side of the body. Anybody older than 50 can get a Zostavax, but unfortunately it is expensive, costing $250-$300 or more. Because of this expense, many wait to get this vaccine when they have Medicare coverage, as Medicare Part D will usually pay for it. Oddly enough though, it is covered as a pharmacy benefit, so most physicians cannot bill for it so they do not give it. Instead, it is recommended that you go to a pharmacy with anin-house walk-in clinic... such as CVS or Walgreens... where the doctor or nurse can get the vaccine from the pharmacy, administer it, & then bill your pharmacy insurance. If you wonder why you can't just pick up a vial of this stuff from the pharmacy then bring it to your doctor to be administered, it is because it must be given to the patient within 30 minutesafter being removedfrom the freezer.
Proper Medication List:
Just a note to make you aware that as a physician I would love for my patients to keep alist of theirmedications. I have noticed however that they do not record the meds as I would like, so here's a few helpful hints.
The list should include the name of the medication, preferably the generic & name-brand if you know... as different doctors will use different names. Also, include the strenghth of each pill AND how many you take & when you take them. This seems straightforward enough, but patients sometimes try to help me by writing thetotal dose they take in a day... yet I need to know the way the prescriptions are written. For example, if a patient takes Pravachol 40 mg 2 pills with supper, this is how I want it recorded. If the patient writes Pravachol 80 mg per day (their total daily dose), I will likelywrite the prescription for an 80 mg pill which is more expensive than 2 of the 40 mg pills. Also, if the patient calls to ask a question about the "2 pills" he takes at night, there will be a disconnect in our communication if my records indicate he is taking one pill at night for his cholesterol problem. Be accurate & be honest when you write your list, as it will help protect you from medication errors in the long-run.
An example of how this can make management difficult, I recall a recent situation at a local hospital. One of my patients was being treated for an infection but also had some chronic pain. Unfortunately he also had a swallowing problem, so swallowing pills was difficult for him. I ordered MS Contin 30mg one pill 2 times per day, so I was confused & agitated when the patient complained repeatedly about having to take 6 pills every morning & 6 pills every night. I checked the computer & could not find where he had 6 pills of any type ordered, so I spoke with the nursewho checked her records. Her records showed that the pharmacy did not have the 30 mg pills, so they had switchedto six of the 5 mg pills for each of the 2 doses. Though there would usually be no problem with this substitution, it certainly was a problem for my patient with swallowing problems! And worse yet, it was a problem for all of us because therecords did not show me an accurate med list, so this impaired my ability to properly care for my patient!
Until next time, you can catch us on the radio... WTAN 1340-AM on Fridays 1:00-1:45 PM in the Tampa/St. Petersburg, FL area, or on the web... www.SkipShow.com where you can listen liveor to the podcasts. We are always happy to answer your questions, so keep them coming... (727)-441-3000 or tollfree (866)-TAN-1340 or DoctorGigi@SkipShow.com. And if you find this blog educational & worthwhile, please become a "follower" & please consider sharing the link with your Facebook & Twitter friends! By the way, I will soon have a central website for the podcasts & this blog, so stay tuned for the opening of www.DoctorGigi.com.
Here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/when-should-we-die-quality-of-life-living-wills-euthanasia-zostavax-shot-protein-in-diet-birth-control-blood-pressure2012-05-14T01:01:00-04:002020-08-04T01:22:59-04:00When Should We Die?; Quality of Life & Living Wills; Euthanasia; Zostavax shot; Protein in Diet; Birth Control & Blood Pressure.Dawn Hackney
This blog corresponds to the May 4, 2012 broadcast of Let's Talk Medical with Doctor Gigi. Feel free to refer to the podcast of that show via www.SkipShow.com if you want to hear us speak about these issues, & as always, please feel free to leave comments here or call us during the live show on Fridays at 1PM Eastern time...(866)-TAN-1340 tollfree.
When Should We Die?:
All machines break down at some point, so when should the human body break down? Are we really doing good to make discoveries that increase one's life expectancy?
I believe that the human body can certainly live well into the 90's or even longer, but at some point it does become frail & ill, & there is little if anything we can do to reverse or cure that. Also, if you want to be the lucky person who lives a healthy life to that age, you must make good choices in your life! You must eat right, sleep well, exercise routinely, find joy in life, & love & be loved! You also pray that you received great genes from your parents, as some issues that effect your life expectancy are not within your control. Even environmental issues such as where you live will have tremendous impact on your health, as we unfortunately learned from the Love Canal incident in New York.
Obviously we spend a lot of money trying to find medications which impact our health. The best option however is to stay healthy... so we should all aspire to do that! Realize that you have but onebody, & affirm to take great care of it, as we can not always reverse the damage a poor or risky lifestyle causes.
So we all want to live to be old & die of old age, but "old" seems to get older as we age. I guess that "old" might even bemore defined by one's quality of life than by a distinct number of years which they have lived. Thus a sick 50 year old person might be "older" than a healthy 70 year old.
But when should we as humans die? Obviously no one wants to die if they have good quality of life. But, without older generations dying, how can Earth support the overpopulation? So life &death become not only a health issue but a socio-economic one as well. If we want to live longer lives, we need to use birth control appropriately & thus decrease over-population. Thankfully, we seem to be doing a better job at that as the birth rate has recently declined. We must also realize that if we live longer, we will need more money for those elder years, thus retirement age will have to goup. This means the work-force will not have as rapid a turn-over, so jobs for younger people will be hard to find. Again, a population issue!
So one of our listeners posed a question: Do I support the one-child policy? I really don't like laws which restrict choices, but I would like it if people would adopt this belief. People should makechoices to not over-populate the world, & at the very least, we should be responsible enough to not have more children than we can comfortably feed, educate, & love. So judge your owncircumstances & make your own choices, but keep these issues in mind!
Quality of Life & Living Wills:
A study several years ago discovered that themajority of the Medicare money is spent in the last 90days of a person's life. While we do not want to give up hope when a person gets ill, we do need to recognize when treatment becomes futile. At the present time, our government & healthinsurance plans are looking at ways to cut costs. They are toying with the idea of withholding certaintreatments based on age. I would rather that we withhold care based on the likelihood of a good versus bad outcome, as this would take into account more important issues than simply a person's age, & certainly seems more scientific to me. Thus a 35 year old with a brain injury who must live in a nursing facility, & who cannot talk or travelmight not qualify for aggressive chemotherapy for cancer, whereas ahealthy 75 year old who lives independently, cares for himself, & continues todrivemight qualify for the treatment. I propose that before we get arbitrary guidelines, we need to start using common sense & make our own good choices!
We also need to make Living Wills which express our wishes to not be kept alive if there is nochance for meaningful recovery, & we must discuss this with our families so they are prepared to honor our wishes when or if the time comes. When a physician approaches a family member to ask if he can abide by the Living Will & thus withhold treatment, he is not reallyaskingyouto decideabout heroics for your family member. In fact, your family member has already made that decision, & you can only decideto allow the doctor to follow your family's written wishes or not. So you are not letting your family member die, you are simply following their wishesasexpressed in the written instructions we call a Living Will.
Euthanasia:
Though I believe in euthanasia, I am not certain that I could actually perform it. I have had my pets euthanized, & though I know it alleviates suffering, I don't know that I could do it. I am thankful however to have Hospice available, as they too ease a patient's suffering, & their pain medications likely expedite death a little... as they suppress respiratory drive. If you or a loved one has a terminal illness, you likely qualify for Hospice. You could instead have "the dwindles" which is not truly a disease, but rather a "failure to thrive." In this instance, we simply know that you areslowly dying, for whatever reason. There is a thought that you must have only 6 months of life left to qualify for Hospice, but that does not mean that you have to die in 6 months. Hospice can provide longer term care if needed, so ask your doctor if you think you need their services, or if you prefer, call Hospice directly to speak with them yourself.
Zostavax Vaccine:
If you have had chicken pox, you are prone to getting shingles, as shingles is a reactivation of thechicken pox virus which continues to live in your spinal cord area after your initial infection. Shingles is a painful, red, blistery rash which wraps around your body in a nerve distribution. This means it will cover a stripe of skin on the right or left side of your body, & it never crosses themidline or middle of your body. It can causepainbefore the rash even appears, & usually the pain is pretty severe. Theolder you are the more likely you will get it, but thankfully most peopleonly get it once. Younger people usually get better, but older people can end up with chronic pain, called post-herpetic neuralgia, which can be so severe that it is debilitating.
Zostavax is the vaccine which helps decrease the chance that a person will get shingles (also called herpes zoster). Thus, it is indicated for people 50 years old or older, as they are prone to the disease, & if they get it, it is possible that the pain might never resolve. Generally we believe you only need one Zostavax injection in your lifetime. The vaccination costs about $250-$300, & most insurances do not pay for it, but Medicare Part D (which pays for the Medicare recipient's medications) will pay. Thus many people wait to get the shot when they are 65 years old as that is generally when they get Medicare benefits. If you really want to get a Zostavax shot, call your insurance to see if they will pay, but if they won't, you have the option to pay for it yourself. Though $250 or $300 is a lot of money, it is probably money well spent to avoid chronic pain.
Protein in Diet:
Linda asked about the amount of protein a woman should have in her diet. First, realize that very few doctors understand nutrition very well as we do not get a lot of nutritional training in medical school. Dieticians are the specialists who know this stuff, so if you have tremendous concerns, see a Dietician for input. I think that a person's diet is supposed to be composed of 40% protein, 30%carbohydrate, & 30% fat. As everyone has different caloric needs due to their age, sex, weight, genetics, activity, medications, etc., you must first determine how many calories you truly need each day. You might discuss this with a Dietician or perhaps you can get a guesstimate by using on-line calculators. Once you have the total calories you need in a day, you multiply by 0.4 to get the 40% of calories which should come from protein. Lastly, you must know that 1 gram of protein = 4calories, so you mustdivide the protein calories by 4 to get the number of grams of protein youshould have per day. You should also know that 1 gram of carbohydrate = 4 calories, but 1 gramof fat = 9 calories!
For example: Let's assume I need 2,000 calories per day to maintain my weight. 2,000 calories X 0.4 = 800 calories which should come from protein. 800 calories of protein divided by 4 calories/gram of protein = 200 grams of protein needed/day. Based on the above, you would need 2,000 X 0.3 = 600 calories from carbs, & 600 from fat. But due to the different calories in these, you would need 600 divided by 4 = 150 grams of carb, but 600 divided by 9 = 66 grams of fat.
Lastly, if you have certain diseases, the above might not apply to you. In particular, people with liverdisease must limit their protein intake as otherwise they produce excess ammonia which acts a bit like alcohol to make them not think clearly. Thus a person with significant liver disease should see a dietician to learn how to eat properly as their needs are somewhat unique.
Birth Control & Blood Pressure:
A patient was recently told that her blood pressure was high, & that due to this she needed to stopher birth control pill. Birth control pills are usually a combination of estrogen & progesterone, & estrogen can increase blood pressure.
First, as she had never had high blood pressure, she must stop the birth control pill, but she must alsolook for other things that might have caused the high blood pressure. She should stop any productsfor weight loss as these can elevate the blood pressure. Similarly she should limit decongestants (such as Sudafed, Pseudoephedrine, & Phenylephrine) & caffeine, as well as alcohol. She should try to exercise & perhapslose weight (if she is over-weight). She might need to consider a sleep study to look for sleep apnea, especially if she is obese & snores a lot.
If the blood pressure normalizes, she could then re-try the birth control pill, but if the blood pressure again increases, she probably should not take the pills any longer. There is a progestin-only pill which she might try, as this should not effect the blood pressure, or perhaps she could simply use condoms & a spermicide. If she is older & in a stable relationship, an IUDmight be a good option or perhaps even a diaphragm or a cervical cap would be acceptable. There is a new procedure called Essure which is a permanent, non-surgical, non-hormonal procedure that will cause blockageof the Fallopian tubes thus preventing pregnancy as the sperm cannot get to the egg. It is basically a non-surgical tubal ligation which is performed in several minutes in the office, but it is NOTreversible, so it is considered a form of sterilization.
Obviously there are many good options in this situation, & the final choice will vary based upon the patient's age, relationship status, & desire for pregnancy in the future. As always, a discussion with her GYN or Family Practitioner should help her make the most appropriate choice for her.
I hope you learned something useful in this blog, & please consider listening to Let's Talk Medicalwith Doctor Gigi on Fridays at 1:00PM Eastern time. We are broadcast locally on WTAN 1340-AM in the St. Petersburg/Tampa area, but you can also find us on the web via www.SkipShow.com where you can listen live or to the podcast at your convenience. Keep in touch & don't hesitate to contact me with questions or comments: (727)-441-3000 or (866)-TAN-1340 which is toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/weight-loss-programs-medical-credentials-beano-weight-gain-anti-depressants-depression-over-used-tests2012-05-06T01:02:00-04:002020-08-04T01:22:57-04:00Weight Loss Programs; Medical Credentials?; Beano; Weight Gain & Anti-Depressants; Depression; Over-used Tests.Dawn Hackney
Welcome back to the Let's Talk Medical with Doctor Gigi follow-up. This blog refers to the show which was broadcast on Friday April 27, 2012.
Weight Loss Programs:
I am certainly no expert on weight loss programs, though I did attend a weight loss program myself when I was a teen, & I even underwent a suction lipectomy when I was 24. I also used to work in a Phen-Fen clinic years ago, so I do understand the desire to discover a magic bullet for obesity! Unfortunately there still is no such thing. Though many programs exist, no one program works for everybody, so I really can't suggest one over the other. I would however like to make you aware that if the program involves an herbal supplement, that supplement is on the market as a food product only. In other words, unless it is a prescription medication, it has not been evaluated as a medication by the FDA; thus, it is treated as food. No one evaluates food for safety or efficacy, so again the claims of weight loss have not been verified... unless it is listed on the product label (which cannotmake false claims). So be cautious of supplements, & realize that the gold standard weight loss programs involve a decrease of calories eaten, AND an increase in calories spent. I like healthy meal replacements like Jenny Craig as they give you complete nutrition but help limit your caloricintake. Be sure to increase your activity, even if you just take a brisk 30 minute walk every day or two, as this helps to increase your metabolism thus burning off the calories more effectively.
Also, just because aphysician has a weight loss program in his office does not mean that it is a great program or more medically sound than others. It also does not mean the doctor is going to oversee the program, as sadly most doctors have had very little training in obesity & nutrition. There is a specialty in Bariatrics which we can obtain if we wish to learn more about this, but few docs truly pursue that training. The draw for physicians to have weight loss programs in their offices is usually a financial incentive, as usually it is a cash pay program. Unfortunately, doctors no longer make ancillary income through ownership in labs, home healthcare agencies, radiology suites, or medical supply companies. This, along with the increased costs of running a medical clinic, as well as fairly stagnant fees (which are controlled by insurance companies &/or the government) has resulted in many physicians looking to do things which bring incashmoney... as these cash pay services arenot controlled by insurance or government.
Medical Credentials?:
All physicians have an MD or DO degree, indicating that he has a doctorate degree in medicine. After that however, that are many different residencies which train us to be specialists. Many of the procedures done by one specialty are also done by other specialists. Thus an ENT doctor might do a face lift, as Plastic Surgeons are not the only group trained to do this. After the doctor becomes a specialist, he can also choose to study in other programs to achieve the knowledge needed to do certain procedures, such as liposuction or face peels.
The point is that many doctors are qualified to do procedures, & they get that training in avarietyof ways. You as the consumer have a right however toknow what the doctor's training is, so don'thesitate to ask... especially if you arepaying cash for a procedure as you are a person who has achoice...
Beano:
Beano is one of my favorite products! It is basically a digestive enzyme which humans do not have. It digests certain carbohydrates which are found in gassy foods such as beans & cabbage. Unfortunately the bacteria which live in your bowel do have this enzyme. So when you eat these foods which you cannot digest, the food gets to your bowel where your bacteria do digest the carbohydrate... and the byproduct of that digestion is methane gas. So, if you take Beano with these foods which you cannot digest, the Beano will digest the carb so by the time the food gets to your bowel the bacteria have nothing to do, thus you getno gas production! Yeah Beano... natural & effective!
Weight Gain & Anti-Depressants:
Many anti-depressants do cause weight gain. The most notorious for this is Paxil, & I can remember this as we used to say: "Paxil packs on pounds." In all fairness, this is probably an issue with all SSRI's, including Paxil, Prozac, Zoloft,Celexa, & Lexapro. Though Paxil is thought to be the worst offender, it has been modified to decrease it's side-effects including this one. Paxil was changed slightly to create Celexa, which was in turn modified to create Lexapro. So perhaps Lexapro (which just went generic) has less weight-gain issue than other SSRI anti-depressants. There is a new anti-depressant named Viibryd (Vilazodone), which is a special sort of an SSRI. It has studies which actually show it does not cause weight gain. If reality proves to be true, it would perhaps be the preferred SSRI anti-depressant as it is also reportedly well tolerated, has little to no sexual dysfunction side-effects, & has less likelihood of a "poop-out syndrome"... call or e-mail if you want to know more about what that is!
We don't really know why weight gain occurs with anti-depressant use, but some propose that they cause the patient to crave carbs, which might result in increased calorie intake. So I try to remind my patients to be cognizant of this carb craving & to try to make an effort to limit carb intake... & instead to increase protein intake as this tends to be more filling.
So what can you do if you have depression, but are concerned about your weight? First, watch your carbohydrate intake. Secondly, ask your doctor if Wellbutrin (= Buproprion) is an option. Remember however that although Wellbutrin is a good anti-depressant which is associated with very little in the way of weight gain & sexual dysfunction, it is not good if that depressed person also has anxiety. By the way, the SSRI's (see above) are the best for treating depression ANDanxiety. Another option is to try an SNRI such as Effexor (= Venlafaxine),Cymbalta (= Duloxetine),Pristiq(= Desvenlafaxine),or Savella (= Milnacipran), but they often cause weight gain also. Lastly, perhaps you should simplytake the best anti-depressant for you, & when youfeel better physically & emotionally, make better choices regarding your diet & exercise, as often depressed people don't exercise or eat properly.
As a final thought, hypothyroidism is a condition in which a person's thyroid functions too slowly. The thyroid is essentially your metabolic gland, so when it is slow, your metabolism is slow & you tend to gain weight. Also, when you have a slow thyroid, you tend to be depressed. So everydepressed patient needs a TSH blood test to rule-out hypothyroidism as part of the problem.
Depression:
How do you know when to take medication for depression? First we need to understand that depression can be due to outside influences, such as unemployment or relationship issues. But depression can also be due to a chemical imbalance in the brain. It is this chemical imbalance which is corrected by the medications we call anti-depressants. Though some anti-depressants replace the serotonin in one's brain, others replace norepinephrine, & still others replace dopamine.
Depression is like any other disease... it has a stepwise method of treatment depending upon a patient's disease severity & personal choices. I suggest that it is similar to diabetes. If you are diabetic, it is first your responsibility to eat right & exercise. If that does not control your diabetes, then you might need pills, & ultimately you might need insulin. So a depressed person should first try to deal with life issues within his control, & perhaps trycounseling, but if that is not successful, perhaps medications are necessary... to correct that chemical imbalance.
Realize that anti-depressants often do not work well untilyou have been on them for 6 weeks, so it is important not to wait too long to try them. There is no shame in trying an anti-depressant, & you can certainly stop at any time, but they work best if you take them for about one year. They also can cause a withdrawal if you stop them too quickly, so always speak with your doctor before you abruptly stop or skip doses. The withdrawal is not an indication that the anti-depressant is addicting however. The anti-depressant replaces certain chemicals in the brain (as noted above), so when you abruptly stop your pills it takes a while for your brain to try to produce those chemicals, resulting in odd feelings such as shock-type feelings in your body & brain. After a few days this will resolve, but slowly weaning your dose should prevent withdrawal from occurring.
Over-used Tests:
Recently each of 9 specialty organizations in medicine, including mine... the American Associationof Family Physicians... chose 5 tests which they feel are over-used in practices today. This establishes 45 procedures for which our specialty organizations have given us guidance to helpdecrease over-use... likely in an effort to rein in healthcare spending. Most make sense & should not result in withholding of care. Instead, this sets guidelines which allows doctors to decrease inappropriate use of tests by applying scientific principles to when & why tests should be conducted. Also, by having these guidelines, doctors have created a means of protecting ourselvesfrom lawsuits which might claim that we did wrong to a patient by delaying such tests.
Remember however that these are onlyguidelines. A patient & his physician can always opt to do more agressive testing if the situation calls for it, so be sure to speak with your doctor if you have concerns, as exeptions can always be made. I think the point of all this is that because we live in an educated society, we have gotten to the point where much of medical care is done at the demand ofsociety or to protect the doctor from lawsuits. These guidelines will help get doctors back in control of the practice of medicine which should help with the tremendous costs of healthcare.
And so this concludes another segment of the blog. Hopefully you found something useful in it, & don't forget to share with your friends & family as perhaps they can learn something useful as well. And don't forget to tune in on Fridays at 1:00 PM Eastern time when we broadcast Let's TalkMedical with Doctor Gigi live on WTAN 1340-AM in the Tampa/St. Pete area. If you are not local, you can catch us on the computer viawww.SkipShow.com where you can listen live or to the recorded podcasts. As always, I happily accept questions & comments, & you can reach me during the broadcast via: (727)-441-3000 or toll-free(866)-TAN-1340, or you can e-mail me any time via: DoctorGigi@SkipShow.com.
So until the next time, here's to our health!
Doctor Gigi
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https://doctorgigi.com/blogs/news/earth-day-otc-med-more-expensive-than-prescription-med-pharmacists-belly-upset-arthritis-meds-hospitalization-list-of-home-meds2012-04-22T01:02:00-04:002020-08-04T01:22:57-04:00Earth Day; OTC Med More Expensive Than Prescription Med?; Pharmacists; Belly Upset & Arthritis Meds; Hospitalization & List of Home Meds.Dawn Hackney
So I have gotten back to the blog after celebrating Earth Day on April 22nd & Arbor Day on April 27th. The following reflects the topics discussed onLet's Talk Medical with Doctor Gigi on Friday April 20, 2012. Sorry for the delay, but one must celebrate holidays!
Earth Day:
Sunday April 22, 2012 we celebrated Earth Day. This is a day upon which we seek to do something good for Mother Earth. It began as a celebration on April 22, 1970, & it was this event which lead to the creation of the Environmental Protection Agency (EPA). In other words, until 1970 there was no agency to oversee the health of our environment. In the 42 years that we have celebrated Earth Day, we have actually celebrated the healthier environment which it has provided, & we have sought ways to improve it even more. Things you can do to celebrate Earth Day include: bike to work, buylocal products, use less plastics, use less petroleum products,recycle, plant a tree or garden, invest inrenewable energy, or clean litter or trash from a park or roadside. I hope that you found time to celebrate this year, but if you did not, put the date on your calendar for 2013... or better yet, celebrate in your own way by making small changes to your routinedaily! After all, without a healthy Earth, is it really possible for you & I to be healthy?
OTC Med More Expensive Than Prescription Med?:
Prilosec is an H2-blocker. It causes your stomach to produce less acid, thus it is used to treat stomach ulcers & gastroesophageal reflux (GERD). Many people take it, but many do not know that it is cheaper if you get a prescription from your doctor. There is a generic for Prilosec... called Omeprazole... which can be gotten from the pharmacy with a prescription. The generic prescription version costs about $15 for a 90-day supply at WalMart & K-Mart, whereas the name-brand Prilosec OTC costs about $44 for the same 90-day supply.
The point is that just because a medicine can be purchased over-the-counterdoes not mean that it cannot be purchased with a prescription, & often times for significantly less! Be sure to ask your doctor &/or pharmacist for advice if you take an OTC med frequently, as you might save money ifyou get a prescription for it. And don't worry about the insurance saying that they will not pay for it because you can get it over-the-counter. Simply tell the Pharmacist that you want to be "self-pay" for this medicine, & simply pay for it yourself... you'll still save money in the long-run!
Several medications should work this way, so be sure to inquire about them: 1) Prilosec (= Omeprazole) - for treatment of ulcers & GERD, 2) Zantac (= Ranitidine) - a weaker medicine to treat ulcers & GERD, 3) Claritin (= Loratidine) - a non-drowsy anti-histamine to treat allergies, 4) Motrin (= Ibuprofen) - an anti-inflammatory medicine to treat pain... works best if you ask for the 600 or 800 mg strength, 5) Miralax (= Glycolax) - a laxative for chronic constipation.
Pharmacists:
YourPharmacist is an invaluable part of your health...& finances! He helps me to take care of you by helping to coordinate your care, as I am not always privie to the medication changes ordered by your other physicians. He also watches for drug interactions & let's me know if he has concerns. I find however that the Pharmacist is not always forthcoming with advise in regards to the cost of medications. However, if you ASK about cost-effective options, he will often have someadvise... so be bold & ask!
I recently thought that I would save my patient money by prescribing the old version of Detrol instead of the newer Detrol LA. The original Detrol is given as a 2 mg pill which is taken2 times per day, whereas the newer version, Detrol LA, is "long-acting" so it is given as a4 mg pill ONCE per day. I thought that the twice a day Detrol had a generic version, thus I thought it should be cheaper & wrote that prescription for my patient. Obviously I was mistaken, & thankfully the Pharmacist alerted me that my good intentions were not going to help with the patient's cost. With that knowledge, I changed the script to the once-a-day Detrol LA, as there is no need to inconvenience the patient with complicated dosing unless there is significant cost savings.
So get to know your Pharmacist, & don't be afraid to breach financial questions. Realize that the best prices are likely found at large retail stores like WalMart & K-Mart, but the independent smallpharmacy likely has a Pharmacist who owns the pharmacy & as such is begging to earn yourbusiness. Though he may not have the lowest prices (because he cannot buy in bulk quantities like the large retailers), he is likely to take more time to advise you as to your choices, which in the long-run might save you more money than if you had dealt with the large retailer!
Also, it usually feels as though the insurance company dictates our healthcare, but remember theyonly control us if we let them. We can use the doctors, pharmacists, physical therapists, etc. of our choosing. It might cost a bit more, but if you can afford it, you just might find that your health isworth that investment!
Belly Upset & Arthritis Meds:
Most medications to treat arthritis are non-steroidal anti-inflammatory drugs... or what doctors call NSAID's. They work by decreasing inflamation, which helps with the arthritis pain, but unfortunately they frequently cause stomach upset. So what do you do if you have arthritis but cannot tolerate an NSAID?
The first thing to do is to be sure you take the NSAID with food! NSAID's cause local stomach irritation, so putting food in the belly with the medicine will likely decrease this irritation. It does not always solve the problem though as NSAID's also cause a decrease in the protective lining of thestomach, resulting in more susceptibility to the irritating effects of the stomach's own hydrochloric acid (which it produces). Also, thoughAdvil (= Motrinor Ibuprofen) is a great NSAID, it must be taken 3 times per day. On the other hand,DayPro (= Oxaprozin) is a once-a-day NSAID. By taking the DayPro less often, it is often better tolerated, so consider giving it a try.
If that does not work, perhaps you should change to Tylenol, as it is not an NSAID, & does not have GI (gastrointestinal) side-effects. However, it is also not an anti-inflamatory, so it might not help the pain. Some people are lucky though & do get significant pain relief, so why not try it?
If Tylenol does not help, there are other options. Adding a proton pump inhibitor (= PPI), such as Prilosec to your daily routine will cause the stomach to produce less stomach acid, thus you will more likely tolerate the NSAID. In other words, the stomach can tolerate some irritation... it's ownacid or the NSAID. So if you must take the NSAID, get rid of the acid by taking a PPI as well.
If you still find problems with the NSAID, you might need to change it to a COX-2 inhibitor such as Celebrex. This medicine does not cause a decrease in the protective lining of the stomach, but does decrease inflamation. Thus Celebrex is a great arthritic medicine, but it is much more expensive than most NSAID's. If you have a Sulfa allergy, you also cannot take Celebrex.
So if Celebrex is not an option for you, perhaps you should change your NSAID to Mobic, which is somewhere between an NSAID & a COX-2 inhibitor. In other words, it is likely safer than the usualNSAID, but not as safe as Celebrex, but it has a generic version (= Meloxicam) which is certainly cheaper than Celebrex.
Some people get relief with a topical NSAID such as Voltaren gel. Since it does not get into the stomach, it should be better tolerated, but it still can cause trouble, especially if you take the maximum doses which will still potentially decrease that protective lining of the stomach. It works best for joints that are close to the skin, such asfingers, elbows, ankles, & knees. The shoulder & hip joints are further from the skin, so the topical treatment does not penetrate them as well. Voltaren gel is also pretty expensive, but it will soon lose it's patent... so watch for the generic soon.
As a last thought, there is an odd drug called Cytotec which can be added to your NSAID. Cytotec coats the stomach & thus protects it. Though this sounds like a great idea, it comes with wierd side-effects, such asdiarrhea & malabsorption of your other meds. It basically binds to your stomach as well as to anything in there, so you must take all other pills several hours before or after you take Cytotec. Cytotec is combined with the NSAID Voltaren & called Arthrotec, which is a great product to treat arthritis yet protect the belly. Arthrotec is very expensive however, so you might ask your doctor to give you the Cytotec generic (= Misoprostol) separate from the NSAID as that is almost certainly a lot cheaper than the one combo product... as is usually the case!
Okay, one more option of which I have just become aware! Apparently Cymbalta (= Duloxetine) which is an anti-depressant in the SNRI class has received approval as treatment for arthritis pain. As it is an anti-depressant, it does not have the typical GI (gastrointestinal) side-effects caused by the NSAID's. It is also used to treat fibromyalgia pain & even neuropathic (= nerve) pain, so it tackles many types of pain. Because of this, Cymbalta might help people who have multiple types of pain as well as those who have concommitant depression. After all, chronic pain often causes depression, & often depression causes pain to hurt more... so one medication which treats both isfabulous!
Hospitalization & List of Home Meds:
When you get admitted to the hospital, the nurses insist upon getting a very detailed list of all of your home medications, including herbs & supplements as well. They must know the dose of the products, as well as how often you take them. Why do they care so much?
Well, there has been much talk about the medication errors that occur in the hospital, so in response to this, thegovernment has charged the hospital (& thus the nurse) with getting the patient's home medication list so the physician can then simply decide which of those meds is to be continued during the hospital stay. First, I would like to say that this has lead to more medicationerrors than you can imagine! Thenurses are not allowed to admit the patient or render careuntilthe list is created, yet they often do not contact me to assist with its creation! So, this is compiled from the patient's best recall or most recent list, which is often not correct. I thus advise that you carry a very up-to-date list, & if you are not sure, insist that the nurse contact your doctoror family member...don't guess!
Also, once this list is created, it is presented to the physician for him to approve the meds that he wants you to take during your hospitalization, & to discontinue those that he feels areunnecessary. This process also lends itself to problems. Often doctors simply continue everymedicine or supplement unless there is a specific reason to stop it. In the old days, we did the opposite... we only ordered the medicines you absolutely needed! So you now get many meds during your hospital stay, whereas in the past you only got the few you desperately needed. Many of your home meds are not stocked by the hospital pharmacy & are thussubstituted automatically with a similar but not identical product. This can cause side-effects which can complicate your care & are difficult to identify. Think about what you do instinctively when you are ill... you usually take only the medications that you think are absolutely necessary. Though you sometimes don't make the proper choices, you at least try!
So when you go to the hospital, bring your medicines in thebottles, so the nurse can check them, & also note any changes that are not listed on the bottles! Also, when your physician sees you in the hospital, be sure to ask him to give you only the most necessary of these meds, so your body & belly will not be taxed trying to deal with unneeded meds or herbs!
That concludes this blog, but please don't forget to check out the radio show... on Fridays at 1:00-1:45 PM Eastern time. Listen locally to WTAN 1340-AM, or try the computerwhere you can listenlive or to the podcast... www.SkipShow.com. As always, feel free to ask questions or make comments via phone: (727)-441-3000 or toll-free (866)-TAN-1340, or via e-mail: DoctorGigi@SkipShow.com. Here's to our health!
Doctor Gigi
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https://doctorgigi.com/blogs/news/medical-research-fda-approves-amyvid-to-help-diagnose-alzheimers-disease2012-04-13T01:03:00-04:002020-08-04T01:22:56-04:00Medical Research; FDA Approves "Amyvid" to Help Diagnose Alzheimer's Disease.Dawn Hackney
This blog reviews the data discussed on the April 13, 2012 Let's Talk Medical with Doctor Gigi. You can check out the podcast via www.SkipShow.com if you prefer the spoken word.
Medical Research:
Skip noted that he had heard advertisements for healthy subjects to do cancer-related research, & wondered how in depth the research could be if they simply wanted "healthy" subjects. In all fairness, some research is done simply to look for trends or even for genetic markers, so they do need large groups of people to participate, & generally all they need is a blood sample &/or a questionnaire completed. Others trials involve medications or equipment, thus they are more stringent. All participation in trials is considered voluntary, as no one can make you participate in medical research!
Regardless of the study, all clinical trials are over-seen by the FDA, which is of course a part of our government. They don't care what is done to a patient or person during a trial, but they do care that the patient's rights & welfare are protected. To that end, they care mostly about the "InformedConsent." This is the paper which tells you who sponsors the study, who the doctors are & how to contact them in case of an emergency, what the drug(s) is that is under study, what the known side-effects of that drug are, what is required in the way of appointments & data collection, as well as blood collections & procedures that are to be done. After reading this informed consent, the FDA considers you to be educated or informed, & after you sign it, they consider that you have given consent to proceed in the trial. Thus the paper is called an "informed consent." As stated before, the FDA doesn't care so much about the specifics of a study (or what we do to you), but they do want to be sure you knew what we planned to do to you & that with knowledge you agree to continue. Of course, you can always leave a study at any time by "withdrawing consent," which means you no longer wish to be in the study. The doctor tries hard to select people who will complete the trial, as usually data is not useful unless the patient completes the study. Those who do not complete are a financial loss to the pharmaceutical company, but of course everybody has the right to leave a study at any time... and of course, as aphysician, my job is to take care of the patient first, & the studysecond. This means that my primary responsibility is to the patient's health, not to the pharmaceutical company!
To get into any trial, the patient must have all the inclusion criteria & none of the exclusion criteria. These are a variety of factors which vary from study to study & which help identifyappropriate people for the trial. All information given to the study staff is evaluated to see if you can be included or need to be excluded. These criteria are written in stone, & the study staff & doctor cannot make exceptions. In fact we get in big trouble if we mess up on inclusion & exclusion criteria, so please be honest with all of your answers to our questions, especially as these criteria help protectyou by keeping you out of studies which might be bad for your health!
Lastly, remember that if you decide to participate in a clinical trial, do your best to do everything exactly as they ask you to. TheFDA expects perfection, both from the patient & from the study staff. To do less than that is to potentially get a bad drug to the market, or perhaps keep a good drug off the market!
FDA Approves "Amyvid" to Help DiagnoseAlzheimer's Disease:
Speaking of clinical trials, as many of you know, I do clinical trials part-time. I am proud to see that one of our clinical trials seems to have helped get a new PET scan dye to the market! The FDA just approved Amyvid which is a product we studied at Meridien Research in St. Petersburg.
First, to understand the excitement surrounding this product you must first understand that Alzheimer's disease is not only very common, but it is a "diagnosis of exclusion." This means that we cannot verify the diagnosis with a test, so instead we seek to exclude other diseases, & if none of them are present we presume that the patient has Alzheimer's. Truly, the only way to confirm the diagnosis of Alzheimer's is to do anautopsy... not a very good option to say the least as it is then too late to treat the patient! At autopsy they should find beta-amyloid which produces hard plaques which degrade the nerve cells (=neurons) of the brain. This beta-amyloid is not found exclusively in Alzheimer's patient's brains, but it is considered a hallmark finding of the disease.
Amyvid is a dye which lights up beta-amyloid when given in conjunction with a PET scan. Thus a PET scan with Amyvid can potentially differentiate Alzheimer's disease from other forms of dementia by identifying the hallmark abnormality noted in that disease. Thusif the test shows beta-amyloid, the diagnosis of Alzheimer's is likely, whereas an absence of beta-amyloid would requirefurther evaluation forotherdiseases.
As a side note, remember that if a person cannot hear or see properly this can make him appear demented or confused. So be sure to check your loved ones' hearing & vision if you feel he is getting confused or forgetful!
Thanks again for your interest in what I have to say, & if you find it helpful, please share with your friends & family. Also, consider being a "follower" so you will get further blogs when completed! And don't forget the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the St. Petersburg/Tampa area. If you can't catch the station, find us on the web via www.SkipShow.com where you can listen live, or check out the podcasts at any time! We also need your questions & input, so get in touch with me: DoctorGigi@SkipShow.com. If you feel the desire to talk to me live, call during the show: (727)-441-3000 or toll-free at (866)-TAN-1340.
Have a great week, & here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/doctors-unappreciated-world-health-day-dangerous-meds-bone-marrow-donation-pink-eye-tick-borne-illnesses-amberen-weight-loss2012-04-12T01:04:00-04:002020-08-04T01:22:56-04:00Doctors Unappreciated; World Health Day; Dangerous Meds; Bone Marrow Donation; Pink Eye; Tick-borne Illnesses; Amberen & Weight LossDawn Hackney
Finally have the computer stuff corrected, so here is the summary of the April 6, 2012 show:
Doctors Unappreciated:
We previously discussed that March 30th is Doctors Day... a day on which we celebrate physicians. Yet, in a recent survey 71% of doctors polled indicated they feel unappreciated. 14% feel appreciated, & 14% are not sure. I think this reflects the frustration that doctors AND patients feel in the present medical system. Doctors have lost control of their profession, & thus have lost their autonomy. We are taught to be independent yet cooperative, but most of us were not taught to be employees. We are used to being "the boss," yet many of us have sold our practices & are employees of hospitals or other large businesses. Our decisions are constantly questioned by non-medical people who read protocols & expect us to care for patients as though they are all the same! We no longer control our schedules, & many physicians have such heavy schedules that they must feel like they are on a production line. Doctors hate this system as much as patients do, but we seem somewhat helpless to change it. So, at least be a good patient by preparing for your visit so you can make the most of your short face-to-face time with your doctor. Prepare a list of your concerns, bring your meds or a list (be sure to include the name, dose, & how you take it), know your pharmacy phone number, & try to be concise. These efforts will help both you & your physician be more satisfied with your interaction. And don't forget to thank your doctor, as he likely does more for you behind the scenes than you realize!
World Health Day:
The World Health Organization was founded on April 7, 1948, & they celebrate their anniversary with World Health Day every April 7th. Each year there is a theme, & the theme for 2012 is "Ageing & Health." Their focus this year is on how humans can stay well as we age. As the world population ages, health issues become more important, so the WHO wants to help us stay well as we age so we can have a better quality of life & consume healthcare in a cost-effective manner.
Surprisingly Dangerous Medicines:
I recently read an article about the dangers associated with some very common medications. The list included: 1) Mineral oil - which when taken in liquid form can run down the back of your throat into your lungs, resulting in "oil pneumonitis" - so if you take any liquid oil product orally, be sure to mix it well with solid food which will absorb it so it can be fully swallowed & not remain in the throat (like grease on a dirty glass) where it can run by gravity into the lungs. 2) Rolaids/Tums - which are used for heartburn, but which contain calcium which can cause you to develop kidney stones. 3) Diuretics - which cause the body to eliminate fluid, but in so doing can dehydrate you &/or cause high potassium (Aldactone does this) or low potassium (Lasix does this). 4) Metformin - which is used very often to treat diabetes, but which can cause liver problems, & 5) Selective serotonin reuptake inhibitor (SSRI) anti-depressants - which cause an increase in serotonin which generally helps with depression. However they should not be taken with other products that increase serotonin, as this excess serotonin can be toxic, causing "serotonin syndrome" which is manifested as muscle twitches, sweating, poor coordination, agitation, diarrhea, & occassionally death. So if you take an SSRI such as Prozac, Zoloft, Paxil, Celexa, orLexapro, you should avoid St. John's wort (an herbal product) & Dextromethorphan (an OTC cough suppressant).
I feel that the biggest point this makes is that everything has potential side-effects. So the decision to use a medication must be based upon the risk vs. benefit ratio. In other words, do the benefits outweigh the risks? The answer will vary person to person & situation to situation, so be sure to discuss your situation with your physician. Also, realize that when your doctor asks for follow-up visits or bloodwork, he is likely monitoring for these potential side-effects.
Bone Marrow & Stem Cell Donation:
So I had to do some research for this as I have never given my bone marrow nor have any of my patients... to my knowledge. I do know the importance of donors however, as without an appropriatedonor, a person in need will die. Unfortunately this was the case for the niece of my long-term employee many years ago. She was in desperate need of a bone marrow donor, but a good match could not be found. As her illness worsened, the physicians decided to try the transplant with the best match they could find... though they realized it would not likely have a good outcome. Sadly, this beautiful 12 year old little girl died shortly after her body rejected the transplant.
So many years later, I am still trying to learn more about bone marrow donation, & the question we had regarding the same has prodded me to do the research for both you & myself. First, I would recommend that you go to the website www.GiftOfLife.org as they have most everything you need in the way of education. They indicated that you need to give a swab of your cheek to begin the process, & this can be done by requesting a kit from them or by going to a community drive. I always thought that you could do it through the local Blood Bank, but I did not see that in the website, so perhaps you can call the blood bank to ask. There is a fee of $54 to process your sample & place you in the registry (which is a worldwide registry), but if you are chosen to donate, all further costs are picked up by them & you subsequently have no other fees to pay. You must be between the ages of 18-60, & should be in general good health. Once your sample is in the registry, they will constantly check for matches, so you might match in a few days, or a few years, or perhaps never. They will call you if you look like a good match, & at that point you will need to give a bloodsample. If the tests on that blood are good, you will then have an exam, & if that goes well, they will set you up for the true donation. Apparently most people donate stem cells, though a few give bonemarrow. The difference is that the bone marrow donor just has a needle stuck into a bone & the bone marrow is aspirated (=sucked out). Of course this is a simple procedure which is done with local anesthesia. To donate stem cells is a bit more complicated. It appears that you are givenmedicine which causes stem cells to leave the bone marrow & enter your blood circulation, where those stem cells are harvested in a process similar to donating plasma. Though it is more complicated, it does not require anesthesia.
Though you are not obligated to donate when you are contacted, of course it would be hard to sayno... especially as you will only get the call when you have already been identified as a potential tosave someone's life! Remember also that although you might offer to be the donor today, someday you or someone you love might be the recipient, so register today!
Pink Eye = Conjunctivitis:
Pink eye is the common term for conjunctivitis, which is an inflamation of the conjunctiva of the eye. It is generally manifested by redness of the eye associated with discomfort or itching, & crusting ordischarge from the eye, & sensitivity to light. The common causes are: allergy, infection, & irritation.
Generally if it is an allergy, it should be bilateral (both eyes), & likely associated with runny or itchyeyes & nose. It also is likely going to occur at the same time each year, as likely pollen might be the cause. There are allergy eye drops available, such as Optivar & Alocril, though they do require a prescription.
Infection can beviral or bacterial. Viral infections are more common & often occur when you have an upper respiratory infection or "cold." These infections are very virulent & spread easily, thus we ask that you do not rub your affected eye as you can easily spread it to your other eye. Also, you often are not allowed to work or attend school until the redness resolves, as otherwise many people might get this infection from you. Fortunately viral conjunctivitis resolves spontaneously, but often the doctor cannot be certain that it is not a bacterial infection unless he does a culture of the eye, as viruses don't grow on a routine culture, but bacteria do. So in theory, a culture is helpful, but it is often not done with the first episode of conjunctivitis.
Many physicians will even treat with an antibiotic (for a bacterial infection) without a culture, as it seems harmless enough to do so... & cost-effective. But, remember that conjunctivitis can be caused by irritants. Occassionally eye medicines, including antibiotics, are irritating to the eyes... thus they worsen the inflamation & thus worsen the conjunctivitis! Also, smoke & chlorine act as irritants & can cause symptoms of conjunctivitis. Treatment for irritant pink eye is to eliminate the irritant, rather than using medicine, although sometimes steroid drops or anti-inflamatory drops are used to speed improvement.
So if you have pink eye, it is likely going to get better without treatment, but you can certainly see your doctor for an evaluation which can help determine the cause, which will then dictate the treatment. Also, if you are an adult with a painful red eye, you MUST see an Ophthalmologist to be certain you do not have glaucoma(which can lead to blindness if untreated). Also, any change inyour visionMUST be evaluated by an Ophthalmologist as well!
Tick-borne Illness:
Tick-borneillnesses are those illnesses carried by ticks. They include many diseases such as: Lymedisease, Rocky-Mountain Spotted Fever, Tularemia, & Colorado Tick Fever. Specific ticks carry certain diseases, & they tend to live in certain regions. Therefore, Lyme disease which is carried by the deer tick, is more prevalent in the Northeastern United States as that is where the deer tick thrives. By the same token, Rocky-Mountain Spotted Fever & Colorado Tick Fever are carried by ticks that thrive in the Colorado mountains. It is important to know that though this is generally the truth, occassionally ticks get transported to new areas, & we do sometimes see outbreaks in abnormal areas. There have been rare cases of Lyme disease in Florida, but it is certainly not common. The deer tick is very tiny... about the size of the dot on an "i"... so the tick is usually not seen. Instead, the bite results in a classic rash which looks like a bull's eye, with circles of red, then white, then red, then white. If you have this classic rash, you should get a blood test to confirm the Lyme infection, & if this is positive, you will be treated with an antibiotic. Local physicians usually know the illnesses which are likely to occur in their hometowns, so a local physician should be consulted if you have a tick bite or odd rash.
But remember that the best thing you can do to prevent tick-borne illnesses is to prevent getting bitten by the ticks! This means that you should wearlong sleeves & long pants, & you should tuck your shirt in your pants, & your pants in your socks. Then spray yourself well with a repellantcontaining DEET.
As one last helpful hint, if you find a tick embedded in your skin, don't pull if off, as often the head will stay embedded & can lead to infection. Instead, grasp the tick with a pair of tweezers & gently unscrew it by twisting the whole tick counter-clockwise. Since the tick has embedded his head by literally screwing it into your skin, this method will unscrew it, thus removing the head cleanly!
Amberen & Weight Loss:
There was a listener who reportedly heard a commercial for Amberen, an herbal supplementgenerally used for menopausal symptoms, in which they claimed that Amberen will balance yourhormones & thus lead to impressive weight loss. First, I will say that menopause does cause a hormonal imbalance, but this does not necessarily cause weight gain, so correcting the imbalance does not necessarily lead to weight loss... so the premise is incorrect from the start. Also, just because they say this in a commercial does not mean it is true.
We addressed a similar issue in October of 2011, when we spoke about the DSHEA Act of 1994. This is the Dietary Supplement Health & Education Act which dictates oversight of dietarysupplements. It was passed after much debate, but it basically classifies dietary supplements asFOODproducts, thus though they are regulated by the Food & Drug Administration (FDA), they are treated as FOOD rather than as drugs. This allows them to be manufactured with lax regulation & thus contamination is frequent, & bio-availability is variable. I recommend that you onlypurchase supplements which have the USP (United States Pharmacopeia) seal on the label, as this shows that the supplement has been voluntarily tested for integrity,purity,dissolution, & safemanufacturing.
The DSHEA Act does dictate that the product cannot make false claimson the label, though apparently the companies get around this by putting their claims in audible commercials. So although you might hear wild claims about these products & how they might cure this or that, you will not likely find the false claims in writing, especially on the label. If indeed a supplement was to labelitself as a "treatment" for a disease, the FDA would consider this a DRUG, & they would then have to do clinical trials to prove safety & efficacy.
So read THE LABEL of your supplements carefully, & if the label does not reflect what the commercial claimed, then don't believe the commercial! Also, be skeptical & read between the lines. I'm not certain, but a brief look at Amberen's website showed it's claims that it helps balance hormones & thus helps improve menopausal symptoms. There was information about how hormone imbalance (& thus menopause) can cause weight gain, then there was information about how Amberen fixes that imbalance, but they leave it to YOU to make the supposition that Amberen therefore causes weight loss. In other words,I never found a sentence that specifically says thatAmberen CAUSES weight loss... it just says hormone imbalance causes weight gain, & that Amberen helps with the imbalance. They let you conclude that Amberen therefore causes weight loss. Very clever, but misleading advertisement, so be careful!!!
In closing, don't forget the radio show... Let's Talk Medical with Doctor Gigi, as that is the foundation for this blog. We are live on Fridays at 1:00-1:45 PM Eastern time, & can be heard on WTAN 1340-AM or on www.SkipShow.com. The podcasts are listed on the website, & go back as far as Sept. 2011... just look for a Friday podcast. If you or your friends have medical concerns, please feel free to call or e-mail me: (727)-441-3000 or (866)-TAN-1340 which is toll-free or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/national-doctors-day-3-30-match-day-3-15-replacing-body-parts-the-importance-of-skin-testosterone-production-in-women-shot-for-treatment-of-cholesterol-plastic-surgery-grandma2012-04-01T01:04:00-04:002020-08-04T01:22:55-04:00National Doctors' Day 3/30; Match Day 3/15; Replacing Body Parts; The Importance of Skin; Testosterone Production in Women; Shot for Treatment of Cholesterol; Plastic Surgery & Grandma.Dawn Hackney
The following reflects subjects discussed live on Let's Talk Medical with Doctor Gigi on Friday March 30, 2012. Please feel free to listen to the podcast version via www.SkipShow.com.
National Doctors' Day - March 30:
March 30 isNational Doctors' Day. It is the day that we as a nation thank physicians for the work they do. It began as a celebration in Georgia in 1933, & Congress recognized it as a national event in 1991. The reason it is celebrated on March 30 is because ether was first used as anesthesia on March 30, 1842. If you think about it, many of the wonderful things we do in modern medicine would be all but impossible without anesthesia. Just imagine having any surgical procedure without anesthesia! I guess we should honor this event, & certainly we need to remember thatphysicians are on the front line of public health. In the "old days" they provided care to people with TB & other infectious diseases, not always knowing if their health was at risk, as they often did not know the mode of transmission of these diseases. So was the case in the 1980's when we provided care on the front lines for people with HIV... before we fully understood this virus & how it is transmitted. I was a resident during this frightening time, & I do remember the hype, but I never remember withholding care due to fear for my own health! We are professionalswho respond to the needs of our patients 24 hours a day, 7 days a week... often ignoring our own needs & those of our families. So on March 30, we as a nation thank the men & women who provide our medical care... & don't forget to thank the families who support them so they can care for you!
Match Day - March 15:
Students who graduate from medical school are called "Doctor"... but that is usually not the end of their studies. Most physicians go from medical school to aresidency program where they study for 3-5 years more, after which they are considered a "Specialist" in whatever residency program they completed. I am a specialist in Family Practice (or Family Medicine), & I trained for 3 years post medical school to achieve this credential. So most of us know that there are residency programs for all specialties in the field of medicine, such as: Family Medicine, Internal Medicine, Pediatrics, Ob-Gyn, Surgery, Ophthalmology, Dermatology, Hematology-Oncology, & Orthopedics. What you might not know is that your doctor might not have become the specialist he really wanted to become. That is because there are a limited number of spots in each specialty each year, & each new doctor has to "match" his wishes with the choices of the residency programs. This is done through a program called "the Match," which is formally done every year on March 15th. Senior students in medical school take elective studies & interview at programs where they hope to obtain residency training. They then make a list of the programs they hope to attend, starting with their number 1 choice. The residency directors create a similar list, indicating the students they would like to train, starting with their number 1 choice. A computer program takes these two lists & creates a"match" between them. My list was short: 1) Family Practice at Bayfront Hospital in St. Petersburg, FL, 2) Family Practice at Earl K. Long Hospital in Baton Rouge, LA, 3) Medicine-Pediatrics at Earl K. Long Hospital in Baton Rouge, LA. I don't know where I ranked on the list for Bayfront Family Practice, but I "matched" to that program... & thus I studied there for 3 years & became a Family Practitioner. If a medical student does not "match," he then gets to participate in the "Scramble," which involves getting on the phone to call residency programs with openings to see if you can quickly lock in a position. Those who participate in the Scramble often get an acceptable residency program, but some have to settle for a program or even a specialty that was not truly on their priority list. Thus a person can go to medical school & graduate after 4 years, but still not havethe opportunity to become the specific type of doctor he wants to become! The most difficult program to get into when I was a student was Ophthalmology. Dermatology was also very competitive. So only the students in the top 10-15% of the class could become Ophthalmologists or Dermatologists. These programs are highly sought due to high income & great work hours, as there are not too many Eye or Skin emergencies!
I did find it interesting to note that in 2012 there are only 2,764 positions for Family Practiceresidents to train, & yet these spots were not filled by the Match as only 2,611 students "matched" in Family Medicine. It should also be noted that many of these spots were filled with "foreign medicalgraduates" which means that these students did not train at a medical school in the US. They may in fact be American, but the school they attended was out of the country... perhaps because they did not get acceptedby an American medical school. So if the future of medicine is in the hands of primary care specialties... which include Family Medicine, Pediatrics, & Internal Medicine... isn't it frightening to see the small number of FP's trained yearly, & perhaps equally frightening that many have spent 1/2 of their medical training years out of the country? So do you want to know what happens to most US medical school graduates? Well of course, they choose to go into higherpaying specialties with better life-styles! So the next time you hear the primary care doctors speaking out about how they areunder-paid & under-valued, you will better understand why youshould care!
Also, if you wonder why physicians seem to be somewhat absent from the political agenda which is trying to re-direct medical care, consider this. First, we really do spend an enormous amount of timetaking care of patients. Secondly, there are only about 800,000 practicing physicians in the United States, yet there is a population of about 311,800,000 people in the US (according to the 2011 statistics). Thus there are311 million more people than there are doctors, making us a verysmall minority, & truly one with a small voice! Intelligent people all have their own opinions, & it is almost impossible for physicians to agree on any one issue such as health care reform, but even if we did, I am not sure our voice would be heard. Oh, & remember, the AMA does not truly representmost physicians, as only about 17% of physicians belong to the AMA! They have their own agenda, & it should be noted that each Specialty in medicine has it's own agenda as well, especially to insure that their evaluations & treatments receive the highest compensation! So, I guess Physicians will not be in the forefront of political action... unfortunately... as I must ask, whoseprofession is it anyway??
Replacement of Body Parts:
With all the wonders in medicine, are there body parts that are not replaceable? Certainly the brain & spinal cord are on the top of the list, but I don't think we replace the stomach, thebowel, or the bladder, nor do we replace entire bones... at least to my knowledge. Sometimes we don't replace an organ, but instead we just replace the hormone or chemical it would produce, such as insulin to replace the pancreas, or thyroid hormone (like Synthroid) to replace the thyroid. I think the future of organ replacement lies in the creation of new organs from your own body. In other words, science will some day be able to use your own tissue to grow you new organs. I read that this has been done recently for a man who had bladder cancer. The doctors removed some healthy bladder cells & grew a new bladder which was transplanted into his body when his sick bladder was later removed!
And as a last thought, the skin is the largest organ of the human body, & I believe it is the one most taken for granted! But, you really do not want to have significant burns which necessitate skin grafts, as that is painful, & often the grafted skin is not as pliable or as cosmetic as you would like. So, take good care of your skin, & be sure to protect it from sun damage by using lots of sunscreen or protective clothing such as hats & shirts!
Testosterone Production by Women:
Men have testicles to produce testosterone, but obviously women do not. So Cindy asked where istestosterone produced in the female body. Well, I answered that the ovaries produce testosterone as well as estrogen & progesterone, but I must correct myself a bit. Though it is true that the ovaries produce all 3 of these hormones, I failed to remember that the adrenal glands also producetestosterone. So at menopause, when the ovaries either die or are surgically removed, the woman's testosterone level will decrease significantly, but there will still be some testosterone produced by the adrenal glands. These are little glands that sit on top of your kidneys, & though they are small they are mighty, as they produce several important hormones such as Cortisol & Epinephrine which help us cope with stress.
Shot for Treatment of high Cholesterol:
There was interest in a recent announcement regarding anew "shot" for high cholesterol treatment. This is a new medicine being studied in clinical trials, & it was given by injection every 2-4 weeks with promising results. It works by causing a decrease in a protein that inhibits degradation of LDL (= Lousy or bad cholesterol), thus the LDL is more vigorously broken down. This is a novelapproach to treating hypercholesterolemia, so it is an exciting medicine. It is however just going into phase 2 trials, so it will be a while before we know if it really works & if it is safe. If it makes it to market, it will likely be an option for those who cannot tolerate statin medicines (which are the typical meds used to treat high cholesterol), or for those who have high cholesterol in spite of takinghigh dose statins. So, we wait...
Plastic Surgery & Grandma:
Should a 73 year old lady have plastic surgery? What if she wants a "nose job" &breastaugmentation? Well, several factors need to be considered. First, it is truly her decision, as the choice to pursue cosmetic surgery is always personal. Secondly though, she must discuss this with her primary care physician & get medical "clearance"for the procedure. If she is healthy, she can then proceed, but I would recommend she have the procedure done in an out-patient surgery center & not in the Plastic Surgeon's office. The surgery center has multiple personnel to provide her with care, such as Anesthesiologists & nurses, & they insure that their staff (including the Plastic Surgeon) is appropriately credentialled. I believe that doctors who operate in these facilities practice more main-stream medicine, & are more likely to have the respect of their colleagues. Those who practice solely out of their offices do so without oversight from the outside world, & many of their colleagues can't truly attest to their skillfulness as they never witness them caring for patients. Also, if grandma has a complication, it would be beneficial to have the surgery center have anaffiliation with a hospital where she could be admitted & stabilized... & it would be optimal if the Plastic Surgeon was on staff at that facility so he could be involved with her hospital care should that be necessary. I might also suggest that she pursue only one procedure at a time, thus limiting the time she is under anesthesia, as this will likely lead to a better outcome. In this case, I would do the "nose job" first, as this is the body part most seen by the public. If grandma does well with this, she can later pursue the breast augmentation (=enhancement or enlargement), but if she does not opt to pursue a second surgery, she can perhaps just get a better bra!
Have a wonderful week, & I hope you participated inEarth Hour on Saturday March 31st. I did participate, thus I turned out all of the lights in my home from 8:30-9:30PM. This provided me an opportunity to eat supper by candlelight & to spend an hour of quality time with my family! Perhaps we should have Earth Hour every night... or at least once per week!
Here's to our health!
Doctor Gigi
PS Remember you can tune into the radio show live onFridays at 1:00PM Eastern time via WTAN1340-AM in the St. Pete/Clearwater/Tampa area, or you can listen on the computer via www.SkipShow.com where you can listen live or to recorded podcasts. Also, keep those questions coming: (727)-441-3000 local, or toll-free at (866)-TAN-1340, or DoctorGigi@SkipShow.com.]]>
https://doctorgigi.com/blogs/news/lessons-learned-from-whitney-houston-effects-of-meds-on-liver-allergy-blood-pressure-commercial-disclaimers2012-03-27T01:04:00-04:002020-08-04T01:22:55-04:00Lessons Learned from Whitney Houston; Effects of Meds on Liver; Allergy & Blood Pressure; Commercial DisclaimersDawn Hackney
This is written in reference toLet's Talk Medical with Doctor Gigi as it was broadcasted live on Friday March 23, 2012.
Lessons Learned from Whitney Houston:
First let me say that I absolutely loved Whitney Houston! She was a beautiful person with an unrivaled talent, & I am very saddened by her struggles in life & her untimely death!
Recently the autopsy results were released which showed what many of us expected: Whitney 's death was at least partially due to drugs. Though she had water in her lungs which showed that she "drowned," she also tested positive for a cocktail of drugs, both prescribed & illicit. The report showed she had Xanax, Flexeril, Benadryl, Marijuana, & Cocaine in her system. Xanax is an anti-anxiety medication which calms a person's "nerves," whereas Flexeril is a muscle-relaxant & Benadryl is a sedating anti-histamine. The first 2 are prescription meds, whereas Benadryl is over-the-counter (OTC). All are sedating products which means that they make you sleepy & relaxed... great idea if you're going to bed, but terrible idea if you're going to try to accomplish activities of daily living such as taking a bath or attending a party! Marijuana also has sedating properties, so you can easily see that Whitney was likely sleepy beyond belief, & in fact possibly nearly comatose which would have allowed her to slip quietly below the bathtub water without awakening, resulting in her breathing in water which resulted in her drowning. That is of course one possibility, though I propose a more ominous cause for Whitney's death. The cocaine which was found in her system, was the most deadly drug... not because it is illegal, but because of it's cardiac effects. You see, cocaine is like speed - it causes the blood pressure to go up & the heart to beat very fast. If the heart beats very fast, it never relaxes to fill with blood, & as a consequence, though the heart is beating, it is not pumping blood. After a brief time, the brain gets low on oxygen (we call this hypoxia) & this causes the person to pass out. Though your brain might not be functioning, the automatic functions such as breathing would continue. So I propose that Whitney took cocaine which caused a very fast heart beat causing the heart to pump ineffectively... causing her to pass out, at which point she went limp & slipped beneath the water, but she continued to take a few breaths... thus the autopsy showed that she drowned. For those who wonder why she could not arouse enough to get her head out of the water, I think this is a plausible explanation. Sadly, I will add that many addicts who "slip" often over-dose because they resume their drug use at the last dose they used... yet after a dose of sobriety they have lost their tolerance & cannot handle that high of a dose. So in Whitney's defense, perhaps this was a fresh "slip" with cocaine... unfortunately we will never know!
This whole issue brings up the fact that of course we should not be using drugs of abuse, but it also brings to light perhaps a much more rampant problem in our society... a lack of respect formedications as a whole! Many people every day do just what Whitney Houston did in regards to combining prescription & over-the-counter drugs without regard to the toxic effects of these combinations. Heath Ledger over-dosed on a combination of sleeping pills & other prescription drugs, but I am certain that he never intended to die. Michael Jackson was so desperate for sleep that he began to use medication that is only used as anesthesia for surgery... strange, but I also doubt he wanted to or expected to die! How many people, in a search for sleep or relief from pain, take multiple medications at doses higher than prescribed by their doctors? And how many of us take over-the-counter meds on top of prescription drugs without getting advice from our physicians? And this is not even addressing the sharing of drugs with our friends & family, much less the parties where teens each bring a pill from home & then take them just for fun! So, before we pass judgement on Whitney, perhaps we need to look at ourselves... & certainly we need to realize that medication is wonderful when used appropriately, but deadly when used inappropriatly! Always speak with your physician before you change doses of meds, add OTC meds, or "share" your meds! Be respectful, as it is not just illegal drugs that kill!
Effects of Medications on the Liver:
Dawn had a question regarding the effect of multiple medications on the liver. First, not every medication is metabolized by the liver, as many are degraded by the kidneys, & some by other metabolic processes. The problem occurs when a person takes multiple medicines that use the same pathway for metabolism, thus the liver might have a problem if you take several of the following: cholesterol medications (such as statins), diabetic medications (such as Metformin), rheumatologicmeds (such as Methotrexate), anti-seizure meds (such as Tegretol or Depakote), or even Tylenol, as they are all "digested" by the liver. As you can see, these are very common meds, & often people take several of these at once. You should not worry about combining them, but you should speak with your doctor to insure that you get proper monitoring, which generally involves blood tests such as an AST or ALT (previously known as an SGOTor SGPT respectively). If these are elevated, your liver is showing signs of being irritated, & your doctor will probably first do further labwork to rule out viral hepatitis as a cause... & he might even do an ultrasound of your liver & gallbladder if you have abdominal pain or other symptoms. If there is no other explanation for the increased liver tests, he will likely try to decrease or stop one of the medications that requires the liver to metabolize it. Generally the damage is not permanent, & getting rid of the offending agent or agents usually results in the liver healing quickly. Of course, if you have a sick liver due to Hepatitis or cirrhosis, you have to be even more careful with medications. As a last thought, remember that Tylenol &alcohol are both metabolized by the liver, so be sure to limit these products if you take prescription drugs that go through the liver. Similarly, anti-inflamatory meds (such as Aspirin, Ibuprofen=Advil,Naproxen=Aleve, & Meloxicam=Mobic) are degraded by the kidneys, so they should be used with caution if you have renal impairment or lots of meds that use the kidneys fordegradation.
Allergy Season:
Of course we have all heard about the early Spring & it's high pollen levels, & many of us have been aware of this for several weeks as we have been suffering with allergy symptoms. These include itchy eyes & nose, watery eyes & nose, stuffy nose, & generally the feeling that you have a "cold"which comes & goes for weeks. There are many choices for treating these symptoms, but many people don't understand those options. In general, if you have a runny or itchy nose or eyes, try an anti-histamine as this type of medicine will dry things up & decrease the itchiness. There are great over-the-counter anti-histamines such as: Claritin (=Loratidine), Allegra (=Fexofenadine), Zyrtec, or even Benadryl. Claritin & Allegra are not likely to cause sedation, though Zyrtec might & Benadryl almost certainly will (so take them at night!). Also, note that the first 3 work for 24 hours, whereas Benadryl works for only 4-6 hours, so you will need to take it more than one time per day, & you will likely be very sleepy! On the other hand, if you have a stuffy nose, you probably want to try a decongestant such as Sudafed (=Pseudoephedrine) orPhenylephrine which are both OTC. You need to know however that decongestants often cause an increase in blood pressure, heart rate &anxiety, so you might want to ask your doctor if they are safe for you! If you cannot take decongestants, your doctor can prescribe Astelin(which tastes horrible but will both dry & unstuff your nose), or perhaps anasal steroid such as Flonase(=Fluticasone), or even Singulair or Accolate which decrease inflamation in the respiratory tract. As a last thought, remember if a medicine name includes "D," that medication includes a decongestant, so beware that it might increase your blood pressure, make your heart beat fast, &/or cause you to feel anxious! Such is the case with Claritin D, Allegra D, & even Mucinex D (which has a decongestant, whereas Mucinex DM has a cough suppressant called Dextromethorphan).
A cost-saving tip: Claritin is over-the-counter, but you can buy the generic version (Loratidine) from the Pharmacy with a prescription. The Loratidine from the Pharmacy should cost only $4 for30 pills at WalMart, KMart, Sweetbay, Publix, Target, Sam's Club, & Costco. Thus the prescriptionmed is a lot cheaper than the OTC med, so ask your doctor for a prescription! This is the case with several meds, so ask your doctor orPharmacist, or even check the $4 WalMart list!
Medication Side-effects on Commercials:
A listener commented that he doesn't understand how the FDA would ever approve medications given the horrible side-effects listed on commercials. Well, I certainly understand the comment, but there is some information that lay people need to know. When a drug is being tested in clinical trials, the patients are told to report any & all changes in their health while enrolled in the study. Thus headaches & "flu" are frequently reported, as are heartburn & back pain. Obviously these are common problems in the general population, so it is no wonder why they are frequently reported. Realize that these reported "adverse events" are then listed on the drug's list of "side-effects" even though cause & effect have not been proven! Therefore drugs which are studied during the flu season, often list "flu" as a side-effect. Again, that does not mean that the drug "caused" the flu, though the commercial will not make that distinction as the FDA does not allow that! If you have concerns, ask your doctor which side-effects are most likely, as we know that information & use it to help us prescribe appropriately.
Also, remember that some disease processes, rather than the medicines themselves, cause the side-effect. You might remember the recent concerns involving Zoloft which was accused of causing people, especially teens, to commit suicide. Though I can't prove it, I would suggest that thefailureof Zoloft to fully treat the depression is more likely what caused the person to commit suicide as depression itself is usually the cause for suicide. In my opinion, the failure of Zoloft to work well or to be appropriately managed is a better explanation for this "side-effect." Similarly, diabetics are more likely to haveheart attacks & strokes than the general public, so it is likely that diabetic meds will show more of these adverse events than meds like antacids which are used in healthy people as well as diabetics. There is a question in many people's minds as to whether or not statin medications (which are used to treat high cholesterol) cause forgetfulness. The problem is that once again,highcholesterol itself can cause mini strokes which can cause forgetfulness... so if a person with high cholesterol takes a statin & gets confused or forgetful, do we blame the medicine or the high cholesterol itself? Obviously, if you stop the statin & the patient's memory returns to normal, I would be convinced that the statin was the culprit, but if nothing changes, I would resume the statin medication to help lower the cholesterol & hopefully decrease the risk of further cardiovascular events, including tiny strokes!
So take the commercial disclaimers with a grain of salt! Talk to your doctor to get more appropriate information & to make better decisions. Remember, if you read the side-effects of aspirin, Tylenol, birth control pills, or even alcohol, you would likely never take any of them!
On that note, I'll end, so here's to our health!
Doctor Gigi
PS Don't forget to check out the live radio show on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1:00PM Eastern time, or on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. And I would love to hear from you regarding any medical concerns or comments you might have. You can reach me via phone during the radio show (866-TAN-1340) or any time via e-mail (DoctorGigi@SkipShow.com).
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https://doctorgigi.com/blogs/news/gastroparesis-pre-menopause-teens-birth-control-pills-foot-ankle-pain2012-03-19T01:06:00-04:002020-08-04T01:22:54-04:00Gastroparesis; Pre-Menopause; Teens & Birth Control Pills; Foot & Ankle PainDawn Hackney
The following is information we discussed on Let's Talk Medical with Doctor Gigi on Friday March 16, 2012. Feel free to refer to the podcast version posted onwww.SkipShow.com, & please contact me via DoctorGigi@SkipShow.com if you have comments or questions.
GASTROPARESIS:
Gastroparesis is a slowness of the stomach to digest food, or what I often call a partial paralysis of the stomach. It results in food staying in the stomach for a long time after you eat it. This results in nausea, a sense of fullness which lasts a long time, & sometimes belching (which might be reminiscent of food you ate HOURS ago). The symptoms are sometimes confused with ulcer problems, but they don't get better with typical ulcer medicines. It is most often seen in people with diabetes, but can be associated with many medications, especially medications known as "anti-cholinergic" medications. These are meds that block the neurotransmitter acetylcholine in nerves, & they are commonly used for many different disease processes. They often cause dry mouth & drowsiness. The following is a list of some anti-cholinergic meds: Anti-histamines = Benadryl, Atarax Anti-depressants = Elavil, Pamelor, Paxil Anti-nausea meds = Phenergan, Compazine Anti-psychotics = Clozaril, Zyprexa, Mellaril Vertigo meds = Antivert, Scopolamine Heart meds = Lasix, Digoxin, Procardia Stomach meds = Bentyl, Lomotil, Levsin, Librium, Tagamet, Zantac Muscle Relaxants = Flexeril, Norflex Urinary meds = Ditropan, Detrol, Sanctura If you have symptoms of gastroparesis, it can be confirmed with a gastric emptying study or perhaps an upper GI series with small bowel follow-through. If you have diabetes, you should aim for good diabetic control, but you will likely need medication such asReglan or Domperidone. Reglan is an old drug which is cheap, but it has odd side-effects, the strangest of which is a tightening of the neck muscles which causes a person to feel as though his head is stuck turned to the right or left. Of course this is frightening, but resolves when the drug is discontinued. I would suggest trying the Reglan, but start with a low dose & increase according to your tolerance of the med & how well it works for your symptoms. Some people get by with Reglan 10mg with the largest meal of the day, whereas some need the highest dose which is 10mg with each meal & at bedtime. If you are on medications which might be causing the gastroparesis, you should ask your doctor to change them to something else if at all possible.
PRE-MENOPAUSE:
Menopause is an absence of ovarian function, so this occurs when the ovaries are removed during surgery (surgical menopause)or when the ovaries get old & "die" which usually occurs between the ages of 48-52. If you have a natural menopause, meaning that the ovaries die, this will be evidenced by the fact that you will go one year without a period. Before you stop having periods, you get irregular periods. Early on they get closer together... every 2-3 weeks... whereaslater they get further apart... every 2-4 months. Once you goone year without a period, we call you "menopausal," & once you are menopausal, you are always menopausal. And if there is anything good about menopause, it is the fact that when the ovaries stop working, they also stop releasing eggs, so menopausal women cannot get pregnant... at least not with their own eggs, though they can carry a pregnancy as a surrogate!
Pre-menopause or peri-menopause is the time BEFORE the menopause when the ovaries are "sputtering" & thus not producing their hormones appropriately. This means that the lady's estrogen, progesterone, & testosterone levels are variable due to the failing health of the ovaries. It is like being on a rollercoaster ride due to the fluctuating hormone levels, & unforunately it can last for 1-5 years! It is during this time that women are most symptomatic with hot flashes, mood swings, & poor sleep. Thin women suffer the most, whereas heavier women are less symptomatic. This is due to the fact that fat cells produce some estrogen... so if you have fat, those cells continue to produce estrogen so you are not entirely without estrogen when your ovaries stop working. It is interesting to note that this is why heavy men have breasts... their fat cells produce estrogen which stimulates breast development!
As the peri-menopause can cause both physical & psychological problems, many women chose to treat this syndrome with birth control pills. These pills basically give the body estrogen & progesterone, which in turn shuts the ovaries off. In doing this, the ovaries do not release an egg, so one cannot get pregnant. Additionally, the rollercoaster ride stops as the hormone levels are predictable & smooth. As you get older, the doctor will change the birth control pills to menopausalhormone replacement, & over time the doses will be decreased. Not everyone wants or needs treatment, but birth control pills are generally considered safe if used at low doses & if used in women who are non-smokers, have no history of blood clots (pulmonary embolus or deep vein thrombosis), & have no history of stroke. If you have miserable peri-menopausal symptoms (or if those around you think you do!) talk with your doctor about options to lessen those symptoms as you really don't have to suffer through it!
BIRTH CONTROL PILLS FOR YOUNG WOMEN WITH PAINFUL PERIODS:
We received a note from a father whose 15 year old daughter was placed on birth control pills due to painful periods. It is not uncommon for young women to havepainful & irregular periods for several years, as the ovaries are young & trying to figure out how to do their job properly! This can lead to the young lady having unpredictable periods which can lead to embarassing accidents. Sometimes there is so much discomfort that she will miss school or other functions. As noted above, there is no reason to suffer with period problems when the young lady can take birth control pills which effectively shut the ovaries off & provide predictable, hopefully less painful periods. With proper timing, we can even make the periods begin on weekends so there is less effect on school attendance.
Of course, a parent might fear that this looks as if they've granted permission to their daughter to go out & have sex. Certainly this is not the case, but if you think it, she might think it... so use this as an opportunity to speak with her about sex. And realize that pregnancy is not the worst thing that she can get from sexual activity! Sexually-transmitted diseases such as HIV, Hepatitis B or C, & even HPV (Human Papilloma Virus) are worse than pregnancy as they can be deadly! Even Chlamydiacan be a life-altering disease as it can lead to internal scarring which can make her unable to conceive in the future!
So parents, if your daughter suffers with her periods, do not fear putting her on birth control pills, but do seize the opportunity to educate her about sex & reiterate the need for SAFE SEX practices despite her being on birth control! So enlighten her regarding the absolute need for using condoms, & consider getting the Gardasil vaccine series to protect her from HPV (which is the cause of cervical cancer).
FOOT & ANKLE PAIN WITH RUNNING:
One person complained about foot & ankle pain when he runs, as well as afterwards. He wants to keep running as he knows this is great for his cardiovascular system. He has tried orthotics, but has never seen a Podiatrist.
Certainly, running is great for the heart, but if your feet hurt a lot after running, I suggest you should see the Podiatrist so you can run without hurting yourself. The Podiatristspecializes in feet & ankles, & I recommend a Podiatrist instead of an Orthopediast for this reason. The podiatrist can x-ray your feet to look for problems such as arthritis or fractures. This is best done with youstandingup on the foot. Note that most x-ray offices do not do foot x-rays in a standing position, but most Podiatrists will do standing x-rays in their offices! The Podiatrist can also look for bunions & flat-footedness, as well as ankle sprains. He might recommend & fit you for orthodics which should align & support your foot so it functions properly & is less prone to pain or injury. If you have orthodics, realize that they do get old & also that your foot does change over time, so they might not fit properly after a while. Be sure to bring them with you to the Podiatry appointment so they too can be checked! And realize that all orthotics are not created equal. If they were purchased over-the-counter or fitted in a shoe store, they might not be as effective as a custom-fitted pair from the Podiatrist.
If you want to delay spending the money on the Podiatrist, you might try running on a soft surface, as concrete & asphalt are hard on the feet & legs. I suggest that you find a running track at a high school or college as these are rubberized & thus absorb some of the pounding. If these are not available, try running in the grass, just to the side of the sidewalk... but watch for holes & sprinkler heads which can trip you or cause ankle sprains! If you live near a park or forest, find a running trail there... & enjoy some nature during your run!
As always, thanks for reading my blog! If you find it interesting or helpful, please share it with your friends & family! And don't forget, you can listen to Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1PM Eastern, or via computer at www.SkipShow.com (live or podcasts). Be a part of the show by calling me at: (727)-441-3000 or toll-free at: (866)-TAN-1340.
Until next week, here's to our health!
Doctor Gigi]]>
https://doctorgigi.com/blogs/news/colorectal-cancer-awareness-month-tinnitus2012-03-11T01:06:00-05:002020-08-04T01:22:54-04:00Colorectal Cancer Awareness Month; TinnitusDawn Hackney
The following information reflects highlights of Let's Talk Medical with Doctor Gigi as it broadcasted live on Friday March 9, 2012.
Colorectal Cancer
March is Colorectal Cancer Awareness month. Colorectal cancer is cancer which affects the colon or the rectum. The colon is your "large bowel" whereas the rectum is the pouch at the end of the colon where you store your poop (or stool) until it passes. Though they are slightly different cancers, they are similar enough to lump together. Though colorectal cancer is common & potentially deadly, the reason we harp on routine screening for it is that it is usually very slow-growing. Thus, screening will often find it in a pre-cancerous form (which is treated during colonoscopy as opposed to major surgery) or at an early stage when surgery itself is curative. When it is diagnosed later, treatment will likely also involve chemotherapy, & a "cure" is not as easy to achieve. Obviously, if you get colorectal cancer, you hope to find it early, so let's talk about that.
Usually we begin screening with stool cards which look for "occult" blood... which is blood that is in the poop, but which you cannot see with the naked eye. You take these cards home & follow the instructions to collect the samples. The usual cards test for any blood, so you must follow a diet which eliminates other sources of blood such as red meat, especially if not fully cooked. These cards usually require 3 different stool samples. There is another occult blood test which tests for blood which has human DNA, so this is a more specific test, & you need not worry about red meat or your diet. Usually these cards require 2 stool samples, so in general they are better & easier to collect, but more expensive. Most people should begin doing ANNUAL stool cards at 40-45 years of age, though if colorectal cancer runs in your family, you might begin as early as 35. If your stool cards are positive, this means that you have blood in your stool, but it does not mean that you have colorectal cancer... it means you need further studies, such as a colonoscopy, to look for a source of the blood, as hemorrhoids & anal fissures, as well as many other things can cause bleeding in the GI tract! If your stool cards are negative, it does not mean you do not have colorectal cancer, but in the absence of other signs or symptoms, it is likely that you do not.
So let's say you've done your cards as recommended & they have been negative, but now you turn 50 years old or perhaps a family member develops colorectal cancer. Well, now you need to proceed with the more definitive test for colorectal cancer... a colonoscopy! This is a procedure usually performed by a Gastroenterologist (or occasionally a Surgeon or even a Family Practitioner) which involves pushing a scope with a camera on the end through the anus & into the rectum, then through the entire large bowel. As it literally goes from your rectum, up the left side of your colon, across your belly & down the right colon to your appendix area, it requires that you be under sedation. Thus, a colonoscopy should not be painful, as the doctor will give you anesthesia. This is different from a flexible sigmoidoscopy which uses a shorter scope & thus does not evaluate the right colon, nor does it necessitate the use of anesthesia. I almost never request a patient undergo a flex sig as they are potentially painful & not as complete as a colonoscopy. Either procedure will require the patient have a bowel prep the day before... this is to empty the bowel of stool so the doctor can see the bowel wall fully. Thebowel prep is actually the worse part of the colonoscopy, as it sometimes makes you nauseated, & almost always makes your anal area sore. I recommend you ask for a prep called "Movie Prep" as it requires you drink 8 ounces of the prep every 15 minutes for 1 hour, then you rest for about 4 hours & repeat the process once. Thus the prep involves a total of 64 ounces of fluid, which is less than in some preps. Also, your anal area will thank you if you rub Vaseline around it before the prep starts & after each loose bowel movement!
There is a thing called a "virtual colonoscopy" which is a CT scan of the bowel. It eliminates the need for anesthesia yet still looks at the entire bowel. Sounds great, but it has limitations! As it is only an x-ray study, it can only show an abnormality or not. If there is an abnormality such as a mass in the bowel, you will still need a colonoscopy so the doctor can actually see the mass AND so he can biopsy or remove it. Remember, you will need a bowel prep for the virtual colonoscopy, & if you have an abnormality, you will need a real colonoscopy... and that likely means a second bowel prep!
The above information refers to things we do to screen for & to diagnose colorectal cancer, but what should you look for as warning signs or risks for this type of cancer. Obviously, physicians recommend screening for everyone, but we worry even more about people who have one or more of the following: 1) bowel changes - such as diarrhea or constipation or just something different from your usual, 2) thin or flat stools - which can be due to pressure on the stool as it passes a mass or stricture, 3) blood in the stool - though this can be from a benign cause so don't freak out, just get further studies to determine the cause, 4) unexpected weight loss - which to a doctor is worrisome for a cancer of any type, not just colorectal cancer, 5) anemia - which means you are bleeding or not producing enough blood cells, so again it does not mean you have cancer, but it is a clue that something is wrong & needs further study such as a colonoscopy, 6) abdominal or pelvic pain, & 7) risks, which include: a) family history of colorectal cancer, b) previous glandular cancer, such asbreast cancer or prostatecancer, c) a diet high in fats, d) being overweight, & e) smoking - which is associated withlung cancer & bladder cancer, as well as heart attacks & strokes!
As a final helpful hint, when you attempt to collect your stool sample for the occult blood cards, I recommend you start by turning the water off at the toilet. Then you flush the toilet to empty it. After you poop, you can easily collect the sample for the card, then turn the water back on & flush! This is easier & less messy than using the paper supplied with the kit!
I have one last point to make. If you have a normal colonoscopy, you likely do not need another one for 10 years... UNLESS something changes, such as new symptoms, a family member being diagnosed with colon cancer, or stool cards which are positive. So you still need to check the occultblood stool cardsYEARLY! If you have benign polyps or tumors, you probably won't need a repeat colonoscopy for 3-5 years. And if you have pre-cancerous or cancerous polyps you will likely need a repeat colonoscopy in 1 year.
Tinnitus
Tinnitusis a ringing or other noise in the ear. It is very common & many times it has no specific cause... which unfortunately means there is often no great treatment. It can be due to: wax in your ears, pressure in your ears (such as with Eustachian tube dysfunction), or Menierre's syndrome, or other hearing problems. Aspirin in high doses can cause tinnitus, so be sure to cut back on aspirin use if you have this problem! Though a cause is often not found, you should see an Otolaryngologist(Ear, Nose, & Throat doctor) for an evaluation, as some of these things are easily treated. If no treatable problem is found, the only recommendation which I have is tonever be in quiet places! You need to find a way to always have "white noise" in the background, such as that created by a sound machine like the one sold at Brookstone's. This creates sounds which will make you unaware of the ringing in your ears without engaging your brain. So listen to the sound of waves or sounds of a thunderstorm, & you will be less likely to notice the ringing. Note that musicis not white noise if itengages your brain, so music is OK only if it is instrumental & you don't know or want to sing the words.
By the way, there is an app for that! The iPhone,iPad, & iPod have an app called White Noise Lite which is free. It plays white noise such as thunderstorms, waves, an oscillating fan, chimes, & true white noise. You can set the timer so you can try to fall asleep with it on. They also have an upgraded app which costs a little, & I am certain the other Androids, etc. have a similar app!
Hopefully this helps you or someone you love! If you find the information useful, please become a "follower" of my blog, & please share with your Facebook & Twitter friends, as well as with your family! Remember to always discuss with your own physician, as this blog is meant to educate you & prepare you better for those doctor visits! And until next week, here's to our health!
Doctor Gigi
PS Remember to listen live to the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Petersburg, Florida area. If you are not local, you can listen live or to the podcasts via the computer at: www.SkipShow.com. If you want to speak with me about a medical question, please call during the live show via: (727)-441-3000 or toll-free at (866)-TAN-1340. And if you are too shy to talk to me, you can e-mail your questions to me at: DoctorGigi@SkipShow.com.]]>
https://doctorgigi.com/blogs/news/obesity-is-it-your-fault-food-labels-nighttime-leg-cramps-overdose-on-supplements-lactose-intolerance-insomnia2012-03-04T01:07:00-05:002020-08-04T01:22:53-04:00Obesity - is it Your Fault?; Food Labels; Nighttime Leg Cramps; Overdose on Supplements; Lactose Intolerance; Insomnia.Dawn HackneyLet's Talk Medical with Doctor Gigi aired live on Friday March 2, 2012. Following are the highlights of which we spoke, with a bit more educational content. As always, I hope this information is useful to you & your loved ones, & please feel free to respond here or via e-mail (DoctorGigi@SkipShow.com) if you have further questions or concerns. The blog is not simply a transcript of the show, so also feel free to refer to the recorded podcasts if you prefer to listen, especially as some content there is not repeated here.
Several people were apparently a bit offended by the conversation Skip & I had the week earlier when we discussed weight loss. There is a new weight loss drug available, & I believe it will help certain people with obesity. The drug is named Q-Nexa, & you can refer to last week's blog for more specific information regarding what it is & how it works. During our conversation we discussed that diet & exercise are still utterly important to achieve longlasting weight loss, & some felt that we were insinuating that a person who is overweight is that way due to his or her own choosing or fault. It isnot necessarily a person's fault if he is overweight, but without making appropriate dietary changes & without doing some form of exercise, it is not likely that he will lose weight & keep it off. A few helpful hints will follow, but if you truly struggle with obesity, consider seeing a dietician to help review your eating habits, as you might not know what you are doing wrong, AND consider beginning some sort of exercise regimen. I tell my patients to be sure to eat 3-6 times per day, as people who "graze" tend to be thinner than those who eat 1-2 times per day. Of course, you need to eat small meals, so I sometimes recommend dividing each meal into 2 meals. Thus you would eat 1/2 of your breakfast, then finish the other 1/2 about 2 hours later. You would do the same with lunch & supper. Also, try to include protein in every meal as protein makes you feel full, whereas carbohydrates make you hungry shortly after eating. Remember that fats have more calories per gram so eat less of them... carbs & proteins each have 4 calories per gram, whereas fats have 9 calories per gram! Also, do not eat "empty calories"... these are foods that have calories, but essentially no nutritional value... such as soda, sweet tea, & alcohol. As for exercise, you don't need to run a marathon, you just need to expend more energy than you are right now. It is simple & free to take up a walking program. Start walking slowly, & increase the speed & distance as you get in shape. Try to talk or sing as you walk, as that actually uses more energy, or better yet, carry a 1-2 pound weight in each hand & swing your arms as you go. If you need more structure, consider joining a gym such as You Fit (which is fairly inexpensive & seems to attract REAL people rather than just those who look like they don't really need to go to the gym!). Though I can give all these helpful hints, I know from personal experience that it is not easy to lose weight... I have been to weight loss clinics, & I have had a suction lipectomy to remove fat from my hips & thighs... I have even worked in weight loss clinics. But... I am still overweight & don't like my body! It does seem that I have to work hard to lose 5 pounds, but by the same token I don't gain more than about 5 pounds even when I eat poorly & "forget" to exercise. It is as though my body just likes weighing about 135-145 pounds! So I agree thatthere is more to obesity than just calories in (what you eat) & calories out (what you exercise off). No one seems to have a grip on that yet however, so for now, your best weight loss success will likely come from a combination of good dietary choices & good exercise habits, both of which should be done for a lifetime, & brief episodic use of medications like Q-Nexa.
There was a brief discussion regarding food labels. I am not a nutritionist, so I am not an expert in regards to this! I do know however that the most misunderstood part of the label is the "serving size." This often leads us to make bad choices & to overeat, so let's talk about it briefly. The serving size is of course what the food producer feels is an appropriate serving, but the misunderstanding comes when we assume that the entire package is ONE serving! For example, a Big Gulp is a 32ounce soda, but one serving of soda is likely 8 ounces. So you must look at the label & do a little math. If a serving size is 8 ounces & that has 150 calories, then you must realize that if you drink the whole Big Gulp you will get FOUR servings, & thus 4 times the calories... which is 600 calories! Apparently, the Mars company recently agreed that people do not understand serving size & have agreed to stop producing king size candy bars in an attempt to help America with her obesity dilemma! Their candy bars will be sized to an appropriate serving, so people will hopefully eat less & get less calories. If you want more calories you can eat 2 or 3 bars, but you will be more likely to understand the number of calories you are getting in this manner.
A gentleman wrote a note requesting help for his wife who often awakens with severe leg cramps. Though this is a common complaint it is not one for which we have a great answer. I suggest that someone with significant nighttime leg cramps should discuss this with his physician, who in turn will hopefully order blood tests. Generally these tests should include: a Calcium, Magnesium, Potassium, Phosphorus, & Vitamin D level, as deficiencies of these minerals & vitamins can certainly cause cramps. If these are normal, you might also need further tests to include: thyroid studies (TSH & T4), muscle studies (such as a CPK & an LDH), & tests for connective tissue disorders (such as an ANA, Rheumatoid Factor, & Sed rate). I had a patient with severe cramping, & as I could not help her, she sought a Neurologist for another opinion. The above work-up came from him, so I learned some tricks! If any of the labs show a significant abnormality, that should be further evaluated, but as is often the case, my patient had no abnormalities. The Neurologist treated her with a muscle relaxant (such as Flexeril or Skelaxin) at bedtime. I know that the old remedy was Quinine, but many of the over-the-counter products with Quinine have been taken off the market. Not to fear! If you want to try Quinine, look no further than your local liquor store where you can purchase Quinine water, & try several ounces just before bedtime! If you don't like the taste or need to limit your fluids, perhaps you can find a pill with Quinine, such as Hyland's Leg Cramps with Quinine. Lastly, as I am a fan of old remedies, some of my patients tell me that putting a bar of soap in the bed near their feet stops the cramps... to which I say, why not try it???
One point of interest is the fact that you should not just increase your intake of vitamins or minerals without first discussing with your doctor, as some are toxic in excess. In other words, you canactually overdose on certain vitamins & minerals! The potentially toxic vitamins are the ones that are fat-soluable, so they can "build up" in your body. These are Vitamins A, D, E, and K, so if you take them in doses above the recommended daily amount (=RDA), be sure to occasionally check a blood level. Minerals such as potassium & calcium can also lead to problems if taken in excess, & in fact I believe the Veterinarians still use Potassium as the injection for euthanasia, as it causes the heart to stop beating when given in a large amount intravenously!
Mandy asked about why she might have lactose intolerance. Well, first, lactose is the sugar found in dairy products, such as milk & ice cream. Lactase is the enzyme which digests or breaks down thelactose. Babies obviously have lactase, but evolutionarily it is not necessary to have this enzyme once you get teeth... as that is when your mother generally stops breastfeeding you! Though many people have this lactase enzyme all their lives, others lose it... at varying ages... & thus become lactoseintolerant. Without the enzyme to breakdown the lactose, this sugar passes through the intestines & ferments, leading to gas,cramps, & diarrhea! Thus lactose intolerance is not really a disease process, though it can really make you feel bad! If you are unfortunate enough to have lost your lactase enzyme, I recommend you try getting some lactase pills from the health food store. You take these pills with the dairy product, thus correcting your deficiency, & thus appropriately digesting the lactose before it ferments! Though this doesn't work for everyone, it does work for many, so give it a try! You might also want to try Lactaid which is a milk that already has the digestive enzyme in it.
Our last topic was in regards to a 51 year old gentleman who has sleep problems. Time did not permit a long conversation nor a long answer, but perhaps we can delve into this deeper in the future! The short answer was that not sleeping well might just be a nuissance OR it can be a significant health issue! Some people have what is called "poor sleep hygiene" which means that they do things which keep them from sleeping well. This might include: watching TV in bed, reading a book inbed, falling asleep on the couch (only to awaken later & have to get yourself to bed after you lock the door, brush your teeth, etc.), & sleeping with pets or partners who make noises which awaken us. My sleep specialist has a rule that thebed is for sleep & sex, but nothing else! When you go to bed, you go to sleep! Do not lay in it awake reading a book or watching TV, as your mind can get confused if you do not give it proper clues as to when it is appropriate to sleep. By the same token, you must have quiet & dark, so try to create this in your bedroom. If your pets, partner, or neighbors are noisy, tryearplugs! Certainly a Sleep Doctor can help you further with these techniques, but more importantly he can help diagnose more severe sleep issues such as sleep apnea. Sleep apnea is a common problem, especially in overweight people, & it is associated with high blood pressure & premature death! It is caused by obstruction of the airway, so literally you stop breathing during yoursleep. When the brain perceives it desperately needs oxygen, it arouses you & you take a biggasp to open your airway. This results in you awakening briefly, but you re-establish breathing... at least briefly. This cycle repeats through the night, resulting in you having stressed your heart & body with the low oxygen episodes. As a result of your multiple arousals, your body does not get into deepsleep, & in the morning you feel as if you never slept! This results in daytime fatigue & sleepiness. If this sounds like you, I suggest you see your doctor & consider getting a sleep study to see if you indeed have sleep apnea, as it can often be successfully treated with something calledCPAP which provides pressure to keep your airway open. Weight loss is often helpful, & in rare casessurgery is necessary. As a last thought, do not use alcohol to help you sleep! It will cause you to "pass out" but it does not cause you to sleep... in other words, you do not go through the proper sleep cycle, so you will not feel well rested!
Here's to our health!
Doctor Gigi
PS Feel free to check out the radio show at 1PM Eastern time on Fridays via www.SkipShow.com or listen to the podcasts via the same site. If you want to be a part of the show, call me live at (727)-441-3000 or toll-free at (866)-TAN-1340.
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https://doctorgigi.com/blogs/news/hepatitis-c-new-weight-loss-drug-approved-by-fda-gout2012-02-27T01:07:00-05:002020-08-04T01:22:52-04:00Hepatitis C; New WEIGHT LOSS drug approved by FDA; GoutDawn Hackney
On Friday February 24, 2012, Skip & I discussed several interesting topics. We started with the helpful hint that you shouldprepare for all doctor's visits by writing down what you want the doctor to know. This should include your symptoms & concerns, how long you've been ill, what refills you need (& whether you need 1 month vs. 3 months at a time), & any new medications or tests ordered recently by other physicians. In fact, it is very helpful to briefly tell all of this to the staff which gets you ready for the doctor... as they can sometimes get the refills or test results in advance of his arrival, thus making the visit much more effective. By having everything written down, you can expedite things, & it is more likely that the doctor will address all of your issues, or at least he will help prioritize the concerns into a gameplan of future visits & tests.
There was an e-mail question regarding screening for Hepatitis C. Hepatitis C is a viral infection which attacks the liver, & can lead to liver failure & thus death. It is spread like HIV infection... by blood. Thus you are at risk if you use IV drugs & share needles, if you receive a blood transfusion or an organ transplant from someone who is Hep. C positive (though the Blood Bank screens blood & organs for this... at least since 1992!), & if you are a healthcare worker who is exposed to a Hep. C positive patient's blood via a needle stick. Unprotected sex is another option for spread, & although this is not the most common way, the risk increases if you have multiple sex partners. Since it is passed to others via blood, note that it can even spread via a shared toothbrush or razor! Two weeks to six months after exposure a person might have acute flu-like symptoms which can be benign enough to go unnoticed, while others never have symptoms from the acute infection. Once you have the Hepatitis C virus, you likely ALWAYS have the virus, though it is sneaky in that it usually causes no symptoms for years, though you can certainly spread it to others during this time! It is most often diagnosed when a person has routine blood work & is found to have elevated liver enzymes, as this is a reflection of liver inflamation. If your liver tests are elevated, your doctor will do more tests to try to find out why... usually to include a hepatitis profile which includes Hepatitis A, B, & C tests. It might also be found when a person tries to donate blood as the Blood Bank screens every unit for this... & they will politely call to request you NEVER donate again if you are found to be positive! Once a person is diagnosed with Hepatitis C, further tests can determine how sick his liver is, & this will dictate treatment. Some people who are not very ill might opt for watchful waiting while at the same time being kind to their livers by avoiding liver-toxic agents such as alcohol, Tylenol, & certain other medications. Others might need medication, such asInterferon & Ribovarin, though these are harsh agents which often make the patient feel ill & all too often do not lead to a cure. Just recently the FDA approved a new drug Incivek (=Telaprevir) which is to be used with Interferon & Ribovarin, & which is reported to have a 90% CURE rate... exceptional news as we have not had anything like this before! Lastly, patients who are very ill with liver failure due to Hepatitis C may need a liver transplant. Though this buys valuable time, it is nota cure, as the person still has the virus in his body & it obviously will infect his new liver! Thus you can see the excitement over this new drug Incivek, as it offers a good chance of a cure. Another interesting point is that there is NO vaccination fo prevention of Hepatitis C, but anyone with Hepatitis C infection should get Hepatitis A & Hepatitis B vaccinations as obviously you would not want a sick liver to get a 2nd or 3rd infection! And finally to answer the question, "yes" screening would likely decrease the spread of Hepatitis C, but it must be done as early as possible in the disease process & this is difficult to pinpoint as it will likely vary person to person. So if you have never been tested, do so, especially if you have risk factors. This can be done either via a Hepatitis C antibody test (which is the most specific test), or with a Comprehensive Metabolic Profile (=CMP) which measures liver enzymes as well as multiple other common tests, or even via a blood donation. And if you are found to be positive for Hepatitis C, see a Gastroenterologist to get further studies & treatment options, & be careful not to expose friends, family, sex partners, or healthcare workers to your blood!
And on to a timely topic... obesity! With so many of us being overweight, God knows we need help! Now, I agree with everyone that there are no easy answers, & that proper diet & exercise are an absolute necessity, but it looks like we just got some much needed assistance in the form of a newly approved medication named Q-Nexa! I was involved with one of the studies of this drug, so I have some experience with it. I also worked years ago in an obesity clinic where we prescribed PhenFen, & I myself had a suction lipectomy in 1984, so obesity is a topic of special interest to me! Q-Nexa is not really a new drug. It is simply a combination of 2 old drugs... a bit like PhenFen which was never ONE drug, but rather 2 drugs made by 2 different Pharmaceutical companies, used in combination by doctors. However, unlike PhenFen, Q-Nexa has actually had clinical trials done which evaluated the safety & efficacy (how well it works) of the drug combination, thus leading to its approval as ONE drug. It is an interesting combination of Phentermine (an amphetamine which causes increased metabolism & decreased appetite) and Topamax (which is an anti-seizure medication which causes weight loss as a side-effect). Each drug can be used in low dose as they both cause weight loss, & their side-effects are minimized not only by the low-doses, but also because they offset one another. Whereas Topamax causes drowsiness & sedation, the Phentermine acts like "speed" to awaken the person. Where Phentermine can increase blood pressure & heart rate, Topamax does not. So keep your eyes open for this new option to help with weight loss, but remember diet & exercise will speed the process if done in addition to just swallowing the pill. Also, since Q-Nexa is just 2 old drugs in a combination, consider asking your doctor to get you the 2 generic drugs instead of buying the expensive name-brand. And for the record, Phentermine which is a component of Q-Nexa is in fact the same Phentermine which was part of PhenFen, as only the Fenfluramine component of PhenFen was taken off the market.
Another listener asked for information about gout as he has had some recurrent pain in his feet. Gout is a disease in which the person has a high level of uric acid in his body. This can occur due to a genetic predisposition or due to one's diet. Foods that increase your uric acid level include: alcohol (especially beer), fructose-sweetened sodas, rich cream sauces, certain seafood, & organ meats... as well as many other foods, so you might want to search for a list if you have concerns yourself. It has long been known as a "rich man's" disease as in the past only wealthy men could afford to indulge in the rich foods & alcohol that lead to its development. Gout is often diagnosed by the history: a red, hot, swollen, terribly painful joint, especially the joint of the big toe where you get bunions, athough it can affect the ankle, knee, wrist, or elbow. Usually the pain is so bad that even your bedsheets touching the joint or the wind blowing over the joint can be excruciating! This history along with a blood test showing a high uric acid level usually leads to the diagnosis of gout, & typically your primary care doctor or a podiatrist will make the diagnosis. If there is a question regarding the diagnosis, the doctor can stick a needle into the affected joint to aspirate fluid, which in turn should show uric acid crystals. Uric acid in the blood is not a problem, but if the blood level gets high enough, the uric acid can form crystals in the joints causing gout or in the kidneys causing kidney stones. These crystals look like a pin with 2 sharp points, so you can imagine how painful it is when these poke around in the joint, resulting in inflamation of the joint bursa! Treatment of gout requires us to realize that there are 2 aspects with which we must deal: the high uric acid level itself, & the painful flare-up when the crystals are actively irritating the joint. If you have the painful flare-up, you need an anti-inflamatory medication such as Colcrys, Indocin, Ibuprofen, or even Prednisone. Do NOT start treatment to lower your uric acid level DURING an acute flare! Instead, wait until 1-2 weeks later, then start one of these anti-inflamatory medications to decrease the risk of a flare-up being so painfully debilitating. After you are stable on this "prophylactic" (=preventive) medication for 1 week, youthen begin a medication to help remove the uric acid from your body... such as Allopurinol, Febuxostat, or Probenicid. These drugs must be monitored for safety as well as to see how well they lower the uric acid level, as the goal is to find the dose that gets the uric acid levelbelow 6.0. Once that level is achieved & maintained for 6 months, it is unlikely that an acute flare-up will occur, so at this point theanti-inflamatory can be discontinued... but the uric acid loweringmedication is continued indefinitely in order to maintain the uric acid below 6.0! Though gout is an old disease, it is often mistreated, so understanding the above will help you to get the best treatment with the least amount of pain!
Again, I hope you find this interesting & helpful... if not for yourself, hopefully for someone for whom you care! Here's to our health!
Doctor Gigi
PS As you know by now, this blog reflects the topics discussed during the radio broadcast of Let'sTalk Medical with Doctor Gigi, which can be heard live on WTAN 1340-AM in the St. Petersburg/Tampa/Clearwater area at 1:00 on Fridays. You can also listen live or to the recorded podcasts via: www.SkipShow.com. I welcome phone calls during the live show, & can be reached locally at (727)-441-3000 or toll-free at (866)-TAN-1340. If you prefer, you can always e-mail me via: DoctorGigi@SkipShow.com.]]>
https://doctorgigi.com/blogs/news/turf-wars-cash-practices-choosing-a-professional-to-do-a-procedure-pain-in-tailbone-area-inflamation-chronic-diseases2012-02-24T01:08:00-05:002020-08-04T01:22:52-04:00Turf Wars; Cash Practices; Choosing a Professional to Do a Procedure; Pain in Tailbone Area; Inflamation & Chronic DiseasesDawn Hackney
Once again I begin with an apology for the lateness of this post. No excuses... I've just been very busy this past week! We began Let's Talk Medical with Doctor Gigi on Friday February 17, 2012 with conversation regarding a bit of a turf war. Two different professionals had previously spoken about how each of them would treat a patient with plantar fasciitis, which is a painful inflamation at the heel where the tissue at the bottom of the foot attachs. The Chiropractor had one approach, whereas the Neuromuscular Massage Therapist had another. There were apparently some judgements regarding whose treatment is "right." Well, I proposed that the treatment will vary according to the professional's training. For plantar fasciitis, I generally recommend treatment which differs from either of their approaches: a soft-soled shoe, an arch support, ice stretches, & an anti-inflammatory (such as Ibuprofen). If the patient does not improve, I often recommend Physical Therapy, or perhaps a referral to a Podiatrist (who often gives a steroid injection & possibly fits the patient with an orthotic). As you can see, the treatment depends upon which type of doctor or therapist you see... and no one treatment is right or wrong! It is good to know that there are multiple options, so you can choose the best one for you. Of course, you might have to try several options before you find your best regiment. Though most medical professionals believe that their specialty provides the best treatment, realize that we are limited by our training & often do not even know what other professionals know or do! So, we should all remember that we are complimentary, not competitive, as we should provide the care we know & understand, but welcome other therapies in which we lack training & knowledge... as long as all the treatments help the patient!
Skip stated that it seems that multiple physicians are changing their practices & seeing fewer patients. He expressed a hope that they are getting away from the rat-race of medicine & perhaps doing as I am... abandoning insurance & taking "cash only" so I can actually work for the patient. Reality is that most of the physicians who are changing their practices are not doing this, but instead are incorporating cosmetic procedures for which patients pay cash. Unfortunately, this helps the physician make a better living, but takes a well-trained professional out of the true practice of medicine. Also, since these cosmetic procedures do not involve insurance & thus provide an excellent source of revenue, many professionals are trying to get into the act. As a consumer, you should realize there are many people who will profess to have the appropriate training to do a cosmetic procedure, & in fact they are likely telling you the truth. To be certain however, don't hesitate to ask to see a person's credentials, as that will let you know if they in fact have the proper credentials & exactly what training they have had. And did you know that payment is usually based on the procedure itself, not on the training or expertise of the professional doing the procedure. So... if you want Botox injections, a Plastic Surgeon will likely do it for the same price as a Family Practice doctor or a Nurse Practitioner. But... the Plastic Surgeon has years of training dedicated to cosmetic procedures, whereas the other 2 likely have had only limited training in that or a few cosmetic procedures. When you pay cash, realize that people compete for your dollars, so shop around & ask questions. As they say, "buyer beware," as licensure does not always translate to expertise!
On a different note, Gene sent an e-mail indicating that he occasionally has sharp pain beneath his tailbone when he is in bed. First, I would look for a pilonidal cyst as these are painful cysts which occur at the bottom of the tailbone (at the top of the buttocks crease). However, Gene would likely have redness & swelling in this area, with perhaps some discharge, & the pain would probably occur at any time... not just in bed. It is more likely that the discomfort is due to some musculoskeletal problem as it is positional (occurs when the body is in a particular position). He might consider whether or not he needs a new bed, & he might investigate this by sleeping in a different bed for a while to see if he feels better. If he is a side-sleeper, he might try a small flat pillow to support the tissue between his ribs & his hips, as most of us have an hour-glass shape which allows us to torque at the waist when we lay on our sides. If these simple things do not help, Gene likely needs to see his doctor for an evaluation, which should include a physical examination to look for a pilonidal cyst, as well as for a boney or soft-tissue abnormality. X-rays might be ordered, as they might show arthritis or masses, & if there is no big problem found, perhaps a physical therapy evaluation or chiropractic evaluation might be helpful. I did point out that since Gene said the pain sometimes feels like a gas bubble, it might in fact simply be gas. If that is the case, I would expect that he would be aware that he has pain, then he passes gas, & then he feels better! Lastly, I believe that if Gene continues to have this pain, he should have a rectal exam to evaluate his prostate & rectum, and perhaps even a colonoscopy, as problems in the prostate or rectum might cause pain of this nature.
Colleen posed a question about chronic inflamation & chronic diseases. Certainly "inflamation" is the buzz-word lately, & science is apparently showing that many chronic diseases such as diabetes & heart disease are associated with chronic inflamation. This does not mean however that inflamation is the cause of these disease processes. I propose that the disease process itself leads to inflamation, not vice versa. Thus inflamation does not likely cause diabetes, high cholesterol, or high blood pressure, but rather poor control of diabetes, cholesterol, & blood pressure likely cause an inflamatory reaction in the body which in turn causes damage to blood vessels & other organs in the body. So treatment of inflamation actually requires treatment of the disease process itself, not just an anti-inflamatory medication. So if you are worried about inflamation be sure to control your blood pressure, blood sugar, & cholesterol, and stop smoking. Also, there is a belief that statin medications (such as Zocor, Lipitor, Mevacor, & Pravachol) not only lower cholesterol, but also lower inflamation in blood vessels. Similarly, Ace-inhibitors (such as Lisinopril, Vasotec, & Univasc) or ARB's (such as Cozaar & Benicar) not only lower blood pressure, but also decrease intravascular (=inside the blood vessel) inflamation. Some people with high risk for strokes & heart attacks opt to take a statin & perhaps even a low-dose Ace-inhibitor even if they have normal cholesterol & normal blood pressure... simply to try to decrease inflamation & perhaps keep their blood vessels healthy! Most of us know that Cardiologists recommend aspirin to decrease one's risk of heart attack & stroke. Most strokes and heart attacks are caused by clumps of platelets which lodge in & block blood vessels, leading to a lack of blood flow to the brain (a stroke) or heart (a heart attack). Aspirin is known to stop platelets from clumping, thus aspirin decreases the likelihood of strokes & heart attacks, but perhaps they also help prevent these things simply by virtue of their anti-inflamatory effects, as aspirin is a great inflamation reducer. Lastly, a little known source of chronic inflamation is the mouth. Teeth with "cavities", & gums with "gingivitis" result in chronic inflamation, & there are reports that people with these problems are less healthy & more likely to suffer from cardiovascular disease. So if you want to be healthy, be sure to brush daily, floss often, & see your dentist regularly!
Here's to our health!
Gigi
PS Don't forget to listen to me on Let's Talk Medical with Doctor Gigi at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Pete/Clearwater area, or via www.SkipShow.com where you can listen live or to the recorded podcasts. And please don't hesitate to call or e-mail if you have a medical question or comment: (727)-441-3000 or toll-free at (866)-TAN-1340 or DoctorGigi@SkipShow.com. New blog to follow soon...
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https://doctorgigi.com/blogs/news/maybe-you-should-fire-your-doctor-bad-bugs-in-hospital-whats-contagious-national-heart-month-heart-info-get-well-nanci2012-02-15T01:08:00-05:002020-08-04T01:22:52-04:00Maybe You Should Fire Your Doctor; Bad Bugs in Hospital; What's Contagious; National Heart Month, & Heart Info; Get Well NanciDawn Hackney
So first I apologize for the late posting, but we were late getting the Podcast on the website. The radio show of February 10, 2012 touched on many issues. First, Skip sent "Get Well" wishes to The Fabulous Sports Babe (Nanci) who has been ill. Though we did not discuss it, Nanci is also a friend of mine, & I echo his sentiments: Get Well & know that we all care!
I was not feeling well & had left work early, so Skip wanted to know how a person knows that he should not go to work. I indicated that generally VIRAL syndromes are more contagious than bacterial infections when they involve the respiratory tract. Thus a typical "cold" or "flu" is likely much more contagious than bronchitis or pneumonia which often are more likely caused by bacteria. Viruses often spread via coughing & sneezing as the virus particles are very small (bacteria are larger, so less likely to spread via these droplets of fluids). Thus, you are most likely contagious (& thus a danger to your co-workers) when you have a fresh viral upper respiratory tract infection with coughing, sneezing, & fever. Days later you may still have symptoms, but you are likely less contagious, expecially if the fever has resolved. So I would recommend that you stay home when you are first sick, as that is usually the time when you are most infectious. Now, certainly some bacterial infections DO spread from person to person, but these are not usually respiratory infections. MRSA (Methicillin-resistant Staph. aureus) can cause bad skin infections & is very contagious. C. diff causes severe diarrhea, & is very contagious. Meningitis can be viral or bacterial, & both forms are VERY contagious. So it is obvious that a simple answer does not exist, but when in doubt, take off work when you think you have a fresh viral infection... & if in doubt, consult your doctor... or your boss, as many employers would prefer you take a day off as opposed to getting the whole office sick!
Another point was made regarding the fact that people with allergies that affect their eyes & noses often think they have a virus or an infection. Allergies usually do not cause fever, nor do they usually cause colored phlegm. So if you have a clear runny nose & runny eyes, but no fever, it might be wise to try an antihistamine (such as Loratidine or Allegra or Zyrtec which are all over-the-counter) as these "fight" the allergy & just might "cure" you. Also, if you keep feeling like you have a "cold" that just won't go away, that might be an allergy. Due to the warm winter we've had, we are starting to see allergy problems earlier this year than usual... at least in the Florida area.
Someone sent a note that he had a primary care doctor who would not make a "referral" to a specialist, & he wanted to know other options, as without the referral his insurance would not pay for the specialist's opinion. My gut response is that he should get a new doctor! But let's look at the whole picture. First, a "referral" is a form that a doctor completes indicating that he has recommended that the patient see another doctor or get a certain test. Not all insurance companies require a "referral," but if yours does, you will have to get it in order to have guarantee that the insurance will pay for that consult or test. In the old days, primary care doctors were the "gate-keepers" who helped the insurance company conserve finances by only giving referrals which they deemed medically necessary. The problem was that often the doctor got a BONUS if he did not waste the insurance company's money... thus if he withheld medical care he actually made more money! Obviously this is in direct conflict with the doctor-patient relationship, so hopefully few plans incorporate this protocol, but if yours does, I recommend you change insurance plans if at all possible! So let's get back to our friend who needs a referral. Know that if you ask me to send you to a specialist, I as a good physician will want to treat you first... if I think it is appropriate. I don't want my colleagues to think that I am stupid or don't try to take care of you. So, if I ask you to do something or try something, do it. If you don't get better, I will be happy to refer you. Also, know that if the referral or test will not likely change our treatment plan, perhaps you can wait a bit before pursuing it. For instance, if you have back pain (but no neurologic changes) & ask for an MRI of your back, I will likely ask: "if you have a herniated disc, will you go for surgery?" If the answer is "yes," then we get the test. If however you answer that you would more likely choose a trial of physical therapy or medications, then I would suggest that you simply try that first, & only get the MRI if you don't improve. Obviously, good communication with your physician is a must, & if you don't have that, again perhaps you need a new physician. Occasionally a patient has no choice but to work with a certain doctor, & if rapport is a problem, perhaps that patient should go out-of-network & pay a non-insurance doctor for an opinion. In the long-run, this can be more cost effective than paying for the test or specialist visit yourself. Ask the non-insurance doctor to educate you & arm you with the ammunition you will need to "convince" your insurance doctor to do what you want him to do!
Our same friend indicated that he (or she) does some sort of work at several hospitals, & seems to be getting some sort of "bug" from that exposure. Well there certainly are very resistant bacteria in our hospitals, & despite every effort to erradicate them, they live on to infect more people! Trust me, you do not want to be in the hospital if you do not have to be there... & if you must be there, WASH YOUR HANDS & insist that those who care for you do the same! Doctors & nurses are likely guilty of spreading many of these bugs due to poor handwashing... & apparently the computer keyboard is one of the likely culprits! As for our friend, we don't know where he goes in the hospital, nor do we know what he keeps getting, thus it is hard to give much feedback, except... I recommend that he speak with the Infection Control nurse at the hospital, as this person will be able to help evaluate if the hospital really has a problem.
February is American Heart Month! Easy to remember due to Valentine's Day! First, remember that women DO get heart disease, it just starts later in women than in men, & women often don't have classic symptoms. So men get heart disease in their 40's, whereas women usually are in their 50's when they get heart disease. Whereas men often have crushing chest pain with nausea, vomiting, & sweating, women might only have heartburn. So, ladies, you are potentially at risk, & if you have "risk factors" (see below), you should see your doctor for further tests of your heart. When we speak of "cardiovascular" issues, realize that we are really talking about blood vessels. These blood vessels bring blood & thus oxygen to tissues, & if they get blocked, those tissues suffer damage. Thus, diseased or blocked vessels can lead to heart attacks, strokes, kidney problems, & even painful legs when you walk. So cardiovascular risks are the things that cause your blood vessels to block up, & they include: High LDL (Lousy) cholesterol, Low HDL (Healthy) cholesterol, Hypertension (high blood pressure), Diabetes, Cigarette/Cigar use, being a Man or a menopausal Woman, & having a family history of heart disease before 55-60 years of age. Try to control all of your risk factors if you want to decrease your chance of having a heart attack or other vascular event. Basic guidelines are: 1) get your LDL below 100, 2) get your HDL above 40 & preferably above 60 (and know that below 30 is BAD!), 3) get your blood pressure below 130/80 or 130/85, & if you have diabetes, get it below 120/70, 4) get your average blood sugar below 150 (HgbA1c of less than 7.0), 5) stop, or at least limit, smoking, & 6) SORRY, but changing your sex probably won't help, & you just can't change your family genetics!
Lastly, we talked about the different parts of the heart, as not all "heart problems" are the same. The heart obviously has blood vessels which supply it with blood & oxygen, & if these block up, we get the classic heart attack, with part of the heart potentially dying due to lack of oxygen. The heart itself is a big muscle. Part of this muscle can die if it's blood supply gets blocked, but other things (such as alcohol, viral infections, & poorly controlled hypertension) can cause it to get weak & thus to pump inefficiently. There are also heart valves which separate the 4 heart chambers (which hold the blood & pump it around). If a valve is leaky, it allows backwards flow of blood in the heart & can enlarge a chamber. If a valve is stenotic (restricted or pinched to a smaller size) it can cause the heart to have to squeeze harder to pump the blood through that small opening, resulting in an enlarged chamber or a weakened heart muscle. Lastly, there is an electrical wiring system in the heart which conducts the electrical impulse which controls the heart beat. If this electrical system is sick, it can result in abnormal heart beats, some which increase your risk of stroke, & some which are fatal. Sometimes people will say that their family member died due to a heart attack, when in fact they died "sudden death" due to a fatal irregular heart beat rather than a blocked blood vessel. So... try to be specific when describing your or your family member's "heart trouble" to a doctor, as not all heart trouble is the same, & not all heart trouble has a genetic basis.
On that note, I bid you a belated Happy Valentine's Day, & here's to our health... heart & all!
Gigi
PS Please check out the radio show as sometimes hearing this is more effective than reading it. We can be heard live on Fridays at 1PM Eastern time on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can listen live or to the recorded podcasts via the web: www.SkipShow.com. If you have comments, leave them here, or contact me at: DrGigi@SkipShow.com, or call us live during the show via: (727)-441-3000 or toll-free at (866)-TAN-1340. ]]>
https://doctorgigi.com/blogs/news/dr-thorpe-chiropractor-computers-in-the-hospital-off-label-use-of-meds-benadryl-for-sleep-thyroid-cancer-mammograms-emergency-rooms-are-not-for-primary-care-new-time-slot-is-1-302012-02-05T01:09:00-05:002020-08-04T01:22:51-04:00Dr. Thorpe, Chiropractor; Computers in the Hospital; "Off label" use of meds; Benadryl for sleep; Thyroid Cancer & Mammograms; Emergency Rooms are not for primary care; New time slot is 1:30!!!Dawn Hackney
First, I must admit that I have been remise in saying "thank you" to my colleague Dr. Lorraine Thorpe. She is a chiropractor, & like myself, she practices in St. Petersburg, FL. Though we approach the patient from different angles due to our different professions, we are very similar in our committment to the patient & his or her health! I respect the care she provides to her patients, & I am honored to be associated with her! Though it may seem strange to some that a Chiropractor and an MD "get along," please realize that they call it complimentary medicine for a reason: the different approaches to the evaluation & treatment of the patient compliment one another & lead to better care in the long run. So again, I thank Dr. Thorpe for her sponsorship of the show, & I am pleased that we are all getting to know more about what she does in her chiropractic clinic!
As you have heard many times, I as well as many in the medical profession (doctors, nurses, physical therapists, hospital administrators, etc.) are totally frustrated with the computerization of medicine. The idea is great, but the implementation is painful, & in my opinion unhealthy! I find that I spend an awful amount of time running interference trying to find computer errors that otherwise could lead to patient harm. In fact, I recently read that there are documented cases of several patients dying due to computer errors. So I would suggest that if you are hospitalized you should pay attention, talk with your medical professionals, & always ask about medicines before you swallow them: what is it, what is it for, & who ordered it! Keep notes if you can, & if at all possible, have a friend or family member stay with you to act as your advocate. It is also a good idea to have a physician who will be your primary care doctor as well as your hospital doctor. He will already be vested in a relationship with you before your hospital stay, & thus will have better rapport with you & your family during the hospitalization.
We had a question regarding the use of medication "off label." When a medication is first invented, it goes through rigorous studies to prove it is safe & that it works for a particular disease process (what we call "efficacy"). These studies are overseen by the Food & Drug Administration, & in the end, they review the data & approve or disapprove the medication. When it is approved, it is "labeled" in regards to how it is used & for what disease processes. When the drug hits the market, the pharmaceutical representatives set about educating the doctors about it & it's use. They are not allowed to speak about anything other than what the studies have "proven," but many times physicians use medications in ways that have not been proven. We do this because we assume that medicines in a similar class will behave similarly. Thus, if a new anti-depressant hits the market, I will likely use it like I would any other anti-depressant. A great example of this is a new medicine called Savella. It is an SNRI (like Effexor), so one would assume that it can be used to treat depression. But... one would be WRONG! Forest Pharmaceuticals owns Savella, & they opted to get it to market as a treatment for fibromyalgia. Thus they did fibromyalgia studies, & ... viola... they proved it helps fibro. pain. Thanks to these studies, we now can prescribe Savella for treatment of fibromyalgia, but since there were no studies to evaluate it as an anti-depressant, we are not supposed to use it for that. I pose the question however: if a person has tried other anti-depressants with poor tolerance or poor response, would you prescribe Savella for him? Remember, it is an anti-depressant, & we know its side-effects, so in certain situations it might be an appropriate treatment. I call this "off label" use of medicine the "art of medicine." It is not always scientifically based, but it is not necessarily quackery or bad medicine. In fact, it helps determine new uses for old drugs. Such is the case with Elavil (an old Tricyclic anti-depressant), which is not indicated for, but is commonly prescribed for treatment of chronic pain, prevention of migraine, & treatment of TMJ (temperomandibular joint) syndrome. If you wonder why we don't do more research to get the label for these disease processes, the answer is simple: MONEY! It is not cost effective to spend millions or billions of dollars to get indication for a rare disease, nor is it effective if the drug will soon lose it's patent & go generic. Doctors have the right to prescribe "off label," but with the ever increasing oversight by insurance companies & the government, as well as the growing legal arena in which we practice, I suspect we will see less of this "art" being practiced in the future!
Irene had called last week regarding Tylenol PM which she took regularly for sleep. We suggested that she stop Tylenol PM (which has Tylenol AND Benadryl) & instead take only Benadryl (=Diphenhydramine). She reported she was sleeping well with Benadryl 25 mg 1 1/2 tabs (which is 37.5 mg total) each night with good results. She wanted reassurance that this is safe to do for years. The maximum dose of Benadryl is 50 mg 4 times per day, so that is a total of 200 mg per day. As you can see, she is well below the daily maximum, & is not even at the max for a single dose (50 mg), so I reassured her that this should be safe... & is certainly safer than the Tylenol PM she used to take. As always, she should be sure to tell her physician that she takes this (& any other over-the-counter meds) so he can help ensure there are no contra-indications with her other meds or medical conditions.
Skip mentioned that Dr. Oz has been speaking about the fact that thyroid cancer is becoming a common cancer in women. One wonders why women, & why not men. Well, the supposition is that mammograms might be causing the thyroid cancer! Though no one knows that for certain (yet), we discussed that there is no harm in asking the x-ray tech who does the mammogram to cover your thyroid with a lead thyroid guard. Though it is apparently not common practice for them to do this as a matter of protocol, again there is no harm in requesting that they do it for you. In fact, when you call to make your mammogram appointment, ask if they will use the thyroid guard. If so, then schedule your mammogram with them. If not, tell them thanks, but schedule with a different x-ray department that will accomodate your request!
We discussed a question posed on the January 29, 2012 blog. It was in reference to a young lady with abdominal pain & back pain, associated with eating. You can refer to the blog for more details, but I did respond that she might have a stomach ulcer, as ulcers can cause pain in the middle of the belly (just below the breast bone) which radiates straight through to the back, & which often gets worse when you eat... as the sick stomach must then try to work to digest your food. I think the teaching point in the story however is not specific to this situation, but rather a general understanding of how Emergency Rooms work. This patient indicates that she had been to the ER where they had "ruled out" several conditions, but had not made a diagnosis. Please understand that the Emergency Room is just that... a place to go when you have an emergency! There the medical staff will evaluate you for deadly conditions, but if they do not find one, they send you home. It is not their job to DIAGNOSE your illness... they just want to make sure you will not DIE from WHATEVER is wrong with you! This patient has been to the ER & had a negative work-up. That does not mean she has nothing wrong, it just means she likely has nothing horrible that is likely to kill her soon! She absolutely must see a primary care doctor to have a proper evaluation including a history, physical exam, & possibly labwork. That doctor will either treat her or refer her to a Gastroenterologist (stomach doctor) for further studies. The point is to not use the ER as your primary care doctor... you will not get the kind of care you need & deserve!
Remember that next week the Skip Show will move to 1:00-2:00 PM Eastern time. Therefore, Let's Talk Medical with Doctor Gigi will be broadcast at 1:30 PM on Fridays, so look for us in our new time slot! And don't forget, if you miss the live show, you can still check out the podcast on www.SkipShow.com, or catch this blog... same place & same time!
Here's to our health!
Gigi
PS Please feel free to comment on these blogs, or e-mail me with questions or concerns via: DrGigi@SkipShow.com. If you are not too shy, call during the live show at: (727)-441-3000 or toll-free at: (866)-TAN-1340.]]>
https://doctorgigi.com/blogs/news/how-to-be-prepared-as-a-patient-more-medical-legal-issues-menopausal-hormone-replacement2012-01-16T01:10:00-05:002020-08-04T01:22:50-04:00How to be Prepared as a Patient, More Medical-Legal Issues, & Menopausal Hormone ReplacementDawn Hackney
Topics discussed on the January 13, 2012 radio show included some hints to help prepare people to be better patients, some more issues illustrating how legal matters affect medical care, as well as some thoughts regarding hormone replacement for menopausal women.
First, one must always remember that YOU, the patient, are the best source of medical data, & as such, you should document that information for future use. If you have access to a computer gadget you can find an "app" to help you organize & record that information. I have an iPod & have found a very useful app called "My Medical," which is a free app which I use to organize my personal medical information. It allows you to input personal information such as your name, address, & date of birth. It then guides you to input your personal medical information such as blood type (if you know it), medical illnesses, past surgeries, allergies, medications/doses, & your physicians' names & numbers. You can also enter the dates of your last mammogram, colonoscopy, immunizations, etc. Once you input the data, you can print it out for doctor visits, & in case of an emergency, the data is available to appropriate medical personel. Be sure to keep the data current... & to do so, consider reviewing it BEFORE appointments or surgeries, as well as afterwards! Though there is a move toward a single computerized medical record, the system is not perfect & YOU are still the best source of information regarding your medical history... IF you apply yourself & keep it up to date! And don't forget, a pen & paper work very well if you are not thrilled with computers!
Also, though a single computerized record (or national data base) of all your medical information sounds like a great advancement in medical care, we discussed issues related to problems that occur when the data recorded is wrong. Often diagnoses are based on a doctor's best guess, so they are not always "proven." Such is the case whereby a person presents to his physician with complaints of sadness, fatigue, & weight gain. Many physicians would empirically (by educated guesswork) diagnose "depression." However, if the patient failed to respond appropriately to treatment for depression, the doctor might then order lab tests to see if there is another cause for the depressive symptoms. In this case he might find that the patient has hypothyroidism (a slow thyroid) which can make a person look & feel depressed. Stopping the anti-depressant medication & starting appropriate therapy with Synthroid (or a similar thyroid supplement) will correct the patient's problem, but the computerized record might continue to indicate that the patient has/had "depression" when in fact that is an incorrect diagnosis! Also, unlike a paper source which allows a doctor or nurse to correct inaccurate data with an obvious single scratch-through line, the computer record requires an ADDENDUM be placed at the end of the note indicating the change... and these are easily overlooked! It is also much easier to make data entry errors when typing as opposed to handwritten data capture. I recently saw an Emergency Room report which indicated that my 60 year old patient was not a drinker nor a smoker, but it said she was a drug-abuser, which she was not! Obviously someone hit the "yes" button instead of the "no" button! When I saw this in her record I asked her to go to that hospital to have the information corrected... & I think it took her 3 different attempts to have them complete that task... but again, they would only write it as an addendum, so unless the record is scrutinized, she is a drug-abuser! We also made comments regarding misdiagnoses, such as a person who was in a car accident (not as the driver) after attending a party. As the non-designated driver, he had had a few drinks, & his alcohol level was consistent with being drunk. The ER doctor incorrectly "diagnosed" him as "alcoholic," though I learned that an alcoholic is someone who continues to drink in spite of negative consequences. This person was in an accident, though it was not his fault, as he was not driving. And though he was drunk, he was not breaking any law. As to whether alcohol was negatively impacting his life, I doubt the ER doctor spent enough time with him to gather that knowledge. So in short, I think this was a misdiagnosis, but unfortunately he will probably never get that off of his record!
On to other ramblings... it is NOT necessary to know your blood type, unless you are simply curious! When or if you donate blood, they will be able to tell you your blood type. Also, the Blood Bank does many compatibility tests, not just the ABO & Rh factors which most of us know. In other words, even if you have the same blood type as someony else, you might not be able to donate blood directly to her, as there are many (not just 2) factors that must match. If you are trying to donate for someone who is ill, the Blood Bank will gladly take your blood, though your friend or family member might not receive that blood. Instead, they will give it to the person whom it matches best, & your friend or family member will receive "credit" for the donation. Others who donate will hopefully match your friend or family member, so we encourage all healthy people to consider donating blood as this gives us more likelihood of finding a good match for everyone! And remember, the Blood Bank is very strict in regards to who is allowed to donate. This is what is necessary to provide SAFE blood for all of us. So if you are healthy & take few medications, consider giving blood. You never know who you might help with your generosity! And don't forget to ask them how you can also be evaluated to be a bone marrow donor, as I understand it just takes a small sample of your blood (not a bone marrow sample!).
The topic of death certificates came up as an example of medical & legal intertwinings. Did you know that your primary care doctor is charged by the law with completing your death certificate? Only if the Medical Examiner feels your death warrants further investigation will you have an autopsy. This means that your primary care physician can ASK for an autopsy, but the Medical Examiner can refuse, & in this instance your primary care doctor MUST complete the death certificate within 2 days of your death. I had this happen years ago when a 60'ish year old patient (& friend) died suddenly. The ME did not feel an autopsy was necessary as the patient was older than 50 years, & as she had cardiovascular risks. I argued that there was no history of cardiac symptoms, & requested that an autopsy be performed as I was not able to determine her cause of death. I was told by the ME that if I did not complete the death certificate, I would be in breech of the law. I still refused, which got me a phone call from Tallahassee... the Dept. of Vital Statistics. They informed me that "the Death Certificate is NOT a legal document" & as such cannot be used in a court of law. Thus it is acceptable to guess as to the cause of death! They further informed me that if the "family" wanted an autopsy, they could pay for a private one, but I still MUST fill out the Death Certificate as that is the law! I later got a copy of the law from my malpractice attorney. It indicated that the Medical Examiner shall conduct an autopsy "when the patient dies suddenly while in apparent good health." I wrote to the group that oversees the Medical Examiners in the state of Florida, & I asked them whether that is determined by the primary care doctor who knows the patient or by the ME who does not. Their reply in writing was: "We don't have to answer that question." I don't know about you, but that seems like a bureaucratic answer to a simple appropriate medical question!
In cases where the person has a life-insurance policy, the cause of death might affect the pay-out. In these circumstances, if the family disagrees with the Medical Examiner or primary care doctor's assessment of the cause of death, they must pay to have a private autopy performed to trulydetermine the cause of death. However, sometimes it is better not to know the truth, as was the case with one 40'ish year old patient who "drowned." The Medical Examiner determined that it was an accidental death by drowning, but the wife believed he had suffered a heart attack. She requested a private autopsy, but after reviewing his life insurance policy, she cancelled the request. The policy would provide a benefit of $100,000 upon her husband's death, BUT it would provide $200,000 if the death was accidental. Since the ME felt it was accidental, she & her family would easily recieve the higher benefits... as long as there was no evidence to the contrary!
Lastly, we briefly discussed menopausal hormone replacement, & why men might care in the long-run. Menopause is in essence an absence of ovarian function... either they stop working or they are surgically removed. Without the ovaries, women do not produce estrogen, progesterone, & testosterone. This causes many changes in women, such as hot flashes, mood swings, & poor sleep. Not all women suffer severely, but thin women generally have more symptoms, as heavier women have fat cells which produce some estrogen. The choice as to whether a lady takes hormones after menopause is a personal decision which is based upon her medical history, family history, degree of symptomatology, & personal preferences. In general, a woman with a history of blood clots (in the lungs or in the legs), or one who has had a stroke or heart attack is not a good candidate for hormone replacement, nor is a woman with a personal history or family history of breast cancer. It is best to discuss these issues with your Primary Care doctor &/or your Ob-Gyn, & then make your choice. There are pills, patches, & creams that will deliver these hormones, & that choice is also one of personal preference as pills are generally cheaper, but patches & creams are probably safer. The idea of "bio-identical" hormones is envogue, but they will never be identical to what you had before menopause UNLESS you measure those levels in your youth, as everyone has different levels of estrogen, progesterone, & testosterone based upon genetics. On the other hand, "bio-identical" hormones might also indicate that they replace what the body makes... in other words, estrogen, progesterone, AND testosterone, as until recently physicians only replaced estrogen & progesterone. In the long run, though it is the woman's choice, it will affect her partner, as one of the other side-effects of menopause is "atrophic vaginitis." This is a condition which is caused by a lack of estrogen which results in the vaginal tissues being dry. Often the dryness & loss of elasticity leads to pain with intercourse, thus affecting our intimate relationships as well!
Again, here's to our health!
Gigi
PS Don't forget the radio broadcasts on Fridays or on Podcasts... www.skipshow.com.]]>
https://doctorgigi.com/blogs/news/migraine-headaches-pediatric-tylenol-medical-marijuana2012-01-12T01:10:00-05:002020-08-04T01:22:51-04:00Migraine Headaches; Pediatric Tylenol; Medical MarijuanaDawn Hackney
Migraines affect many people, & those of us who have had one know how debilitating they can be! Some get them while they are young & some when they are older. Many women get "menstrual migraines," which occur monthly with their menstrual periods. Others, like myself, get them with menopausal changes. Some people get them due to food or alcohol. These headaches often have "warning signals" such as neck stiffness, food cravings, emotional changes, & irritability which can occur 1-2 days before the headache. Some people have an "aura" which occurs before the headache as well. These can be visual, such as seeing squiggly lines or flashes of light, but they can even be as frightening as stroke-like symptoms, including pins-&-needles sensations, difficulty with speech, & even weakness in an arm or leg. Once the headache strikes, it is generally on one side of the head, & the pain is usually throbbing or pulsating in nature. There is usually an increased sensitivity to light & sound, as well as nausea & vomitting. Some people feel light-headed or dizzy. These headaches often last 4 hours to 3 days if not treated, & once they resolve, the person still might feel exhausted for a day or two.
If you have a severe migraine, especially one with neurologic changes, you will want to see a physician to be sure it is not a stroke or brain mass, as your first episode will be frightening, even to your doctor! However, once you are diagnosed with migraine headaches, you can rest pretty comfortably in knowing that your migraine will usually follow a predictable pattern... that is to say that although we can describe migraines in many different ways, each person's pattern will be unique yet reproducible! So if you get neurologic symptoms followed by a severe headache, that is your unique pattern, & should not be frightening unless something changes!
Once you have established that you have migraines, you can try over-the-counter medications such as Excedrin Migraine to treat them. If this is not strong enough, you might want to get a prescription medicine such as Esgic Plus (which is similar to Fiorinal Plain), or perhaps Midrin. If this is not effective, the doctor can prescribe stronger medicine such as a "tryptan." These include Imitrex, Maxalt, Amerge, Axert, Relpax, Frova, & Zomig. These stronger medications have become the mainstay of treatment for migraines as they work so well, but they can be very expensive... consider trying Imitrex as it has a generic, so it should be cheaper! Also, there are various forms of these tryptans: some are pills to swallow, some are pills that melt in your mouth (good if you need to take a dose immediately & have nothing to drink), some are nose sprays, & some are even injected by the patient. If you have cardiovascular disease (such as chest pain from your heart, previous heart attack or bypasses, stroke or near-stroke called a TIA) you should probably avoid the tryptans as they do change blood flow in your body & can trigger chest pain, heart attack, or even stroke. Don't forget, some migraines respond well to Chiropractic treatment or Physical Therapy, so it is worthwhile to see one of these specialists for evaluation & treatment. I have had therapy with great results, & since I had cold laser treatment by Diane Hartley at Hartley PT, I have not had a full-blown migraine! Dr. Thorpe of Thorpe Chiropractic also does treatment for migraines, which likely involves treatment of the neck (cervical spine).
Now that we've discussed treatment of migraines, let's go backwards a bit to talk about prevention of migraines. First, if you can identify something that triggers the headaches, try your best to avoid it! If that doesn't work, you can always treat the headahces as above, but if you experience frequent or truly debilitating migraines, you should consider asking about something to prevent them. These options include several blood-pressure medicines: 1) Beta-blocker medicine such as Corgard, & 2) calcium-channel blockers such as Verapamil. These are very affordable, but they might both slow your heart rate (especially the Beta-blocker) & lower your blood pressure. The Verapamil might also constipate you & can cause your legs to swell. Your physician will be able to help decide if one or the other is appropriate for you. Elavil is another very affordable option to prevent migraines. It is an old tricyclic anti-depressant which works great, but which can cause constipation, sleepiness (so take it at night!), & weight gain. To treat depression you would have to take at least 150 milligrams per day, but you only need 10-30 milligrams for headache prevention. It also helps treat TMJ (temperomandibular joint dysfunction) & tension headache, both of which can somewhat mimick migraine! Lastly, Topamax is an anti-seizure medicine which also prevents migraine. It's downfall is the drowsiness it causes, thus it is sometimes called "dopamax." If you try it, start with a low dose & slowly increase it, as this helps you tolerate that side-effect. It is interesting to note that it causes weight loss, but desite this, very few people will take it long-term!
Obviously there is a lot to know about migraine, & a lot of choices when it comes to treatment &/or prevention. Be sure to pay attention to your pattern, & then discuss with your doctor to choose the best option for you. And remember, it might take several tries to find the best regiment for you!
Did you know that there was a change in the formulation of pediatric Tylenol? Apparently there was some confusion because there were different strenghts of the Tylenol liquid which lead to over or under-dosing of children. So Tylenol has been re-formulated to one standard concentration: 160 milligrams per 5 cc. Note that 5 cc are equal to 1 teaspoon, so there are 160 milligrams of Tylenol in 1 teaspoon of the new suspension. If you buy this strenghth, it can be used for newborns as young as 1 day old & 6 pounds to children 11 years old & 95 pounds. Of course, always speak with your physician before you give Tylenol to infants less than 3 months old, as these little guys often do not give us big hints that they are ill. Something as simple as a low-grade fever can be a sign of a very significant illness, & as such would warrant further evaluation INSTEAD of simply masking the illness by treating the one symptom (fever) with Tylenol!
Lastly, someone brought up the issue of marijuana being used to help with chronic pain. She indicated that she uses chronic narcotics for pain control, but when she had the opportunity to use marijuana, she was able to decrease the narcotic use. She noted that this is legal in New York state, though it is not in Florida. I am not aware of any legislation to legalize this in Florida, but I would love to see something other than narcotics available to help chronic pain patients! As you likely know, Florida is the number 1 state for narcotic abuse, so there is no denying the problem we have with narcotics! Though I have no proof of the safety of marijuana, I must say that I have no knowledge of a "pot-head" who murdered for his fix, much less one who "overdosed" & died getting his fix! I hope there is more research being done, & I hope this is NOT going to be another situation where politics block access to good medicine! Stay tuned, & stay involved!
Here's to our health!
Gigi]]>
https://doctorgigi.com/blogs/news/medical-drama-vs-reality-nursing-physician-degrees-hemorrhoids-tylenol-sleep-meds2012-01-12T01:09:00-05:002020-08-04T01:22:51-04:00Medical Drama vs. Reality; Nursing & Physician Degrees; Hemorrhoids; Tylenol & Sleep MedsDawn Hackney
As we discussed many issues during the radio broadcast Friday January 27, 2012, this blog will be a bit scattered. I guess that is how medicine is though, as it encompasses many issues... in fact probably many more issues than you realize. If any of this bores you, please pass the info on to a friend, as I am certain that someone in your life can benefit from this knowledge if not yourself!
First, there is the issue of how realistic medical dramas are. Well, during medical school I was a St.Elsewhere addict, & so I am biased that it was a great show! To my recall, it was pretty realistic, showing the dilemmas of doctors in training. I recall my favorite episode in which one of the residents (a doctor in his specialty training) had lost his wife due to a head injury. His teacher, an older more experienced doctor was trying to offer some comfort, & told him a story. The elder doctor stated that when he was a young boy he had asked his father "why do people die," to which his father had replied, "that, son, is why you should become a physician." The teacher then commented, "I now know how people die, but I still don't know why." It was this sort of deep emotional drama that made me love that show, & I do believe it more fairly represented medicine than the newer shows. ER was of course very realistic in appearance as they were the first to use that special camera that allowed 360 degree filming of the actors as they moved about to save people in the ER. This did make you feel like you were right there, which was great if you like ER drama. But, all of medicine is not like that, & in fact I HATE the ER! To me it is nerve-racking. I prefer to keep people healthy so they can hopefully avoid the ER, & then I can too! Over time, ER became less realistic & that likely lead to its cancellation. Bring in House. Now, I must admit that I have only watched it once or twice, so it's probably not fair for me to judge, but I do know that if a doctor has an addiction problem, his is commanded to get treatment or his license to practice medicine is revoked. If he takes pain meds responsibly, I guess he might get away with it, but apparently that is not the case with Dr. House. Also, we live in a time when most doctors do not own hospitals, & as such we are all dispensable. If a doctor is guilty of misconduct, either with a patient, a nurse, another doctor, or a hospital administrator, he is reprimanded, & if the conduct continues he is "kicked off" staff. There are actually groups of our peers who review our work & our conduct (Peer Review Committees), & who thus have the right to remove our privileges at the hospital. A lot of what happens in these medical dramas is based on some fact, but of course it is hyped-up to sell the show. If you think you learn something medical on one of these shows, be sure to run it past your doctor to check it's accuracy! For me, some of the frustration of watching these shows lies in the fact that they often get some of their medical facts WRONG, as well as the fact that I do not lead the glorious life that they often portray. Contrary to popular representation on these shows, the hospital does not run amuck with personal affairs & sex does not happen in the closets!
Robert wanted to know about nursing degrees, & as I said, I have never been a nurse, so I am not the best to answer that question. I do know that there are levels of education in nursing, from LPN to RN, & within the RN there are "diploma" programs & "degree" programs. RN's can get a Bachelor's degree (BS), or they can go on to get a Master's or even a Doctorate (PhD). Many RN's are continuing their education & becoming ARNP's, which are nurses who function independent of doctors... they can run their own practices with some limitations, but basically serve as primary care "providers" much like myself. I would advise you to speak with someone in nursing to sort out the differences, but I do know that a profession in Nursing is definitely a good one! There is a shortage of nurses that is expected to worsen as our population ages, so it seems that there should be guaranteed employment in this field.
Skip asked about the difference between a doctor who has an MD vs. one with a DO. Again, I am an MD, so I am not that knowledgable about the DO program. I believe that we train similarly, with 4 years of medical education for each program. But I think the DO program has a 5th year of training as they learn not only what we learn, but additionally they learn manipulation much like a Chiropractor. I often wish I had that knowledge and expertise, as I think I would be more effective at evaluating & treating many of my patients' musculoskeletal problems! One must also realize that the doctor that one becomes is more based upon your Residency training than on your medical school training. That is to say that medical school is probably very similar program to program as this is basically learning medical literature & facts. On the other hand, residency training involves hands-on training, as well as the application of critical thinking. I trained at a hospital where there were only 2 residency programs, Family Practice & Ob-Gyn. As such, I feel I had great training as there were no Internal Medicine residents or ER residents or Surgery residents with whom to compete. I basically was the Internal Medicine resident when I did that "rotation," so I learned a lot! Every residency is unique, & in fact some DO doctors do their residency training in an MD program! Such is the case at Bayfront Medical Center where I trained with several DO's. Now that we are in private practice, I am certain that we practice very similarly despite our different medical school training. Again, I encourage anyone who is interested in becoming a physician to study hard & apply for MD & DO programs both. Go to which ever one accepts you, & become the best doctor you can, as ultimately the doctor you become is up to YOU! And by the way, medical school applicants do not all need to have degrees in science. The Admissions Committees for medical schools like diversity, & you can get into med school with a degree in Liberal Arts, Political Science, Landscape Architecture, or just about anything for which they give a Bachelor's degree. The Committees know that diversity in background leads to diversity in doctors, & this leads to new discoveries in the field of medicine. So do the science prerequisites, but study what you love, & apply! Also, if you don't get in the first time, try again... I got in after my second application, & I know people who got in after a third try!
Hemorrhoids... a literal pain in the ***! These are basically varicose veins in the anus or rectum. This means that they are veins that have become overstretched & thus hold too much blood. If you could see them, they look just like the varicose veins in one's legs. They can occur to people of all ages & don't care if you are male or female. They are the result of increased intra-abdominal pressure, so they often occur during pregnancy, or when someone does heavy lifting or straining. Thus if you do heavy lifting at work or during work-outs, you should wear a belt around your waist like those worn by Home Depot employees. This helps take the pressure off of your bottom side, & also helps lessen the chance of getting a hernia which is also due to too much intra-abdominal pressure. If you have constipation, this too can cause hemorrhoids, so try to keep your stools soft & don't strain to have a bowel movement! Be sure to take a stool-softener (like Colace), but avoid laxatives as they are addicting to the bowel & can lead to a need for more & more laxatives over time. There is one safe laxative which I freely recommend to my patients... Miralax. I guess that means "miracle laxative," as it is safe to take daily! It is Glycerin, which is a slippery substance, & as your body does not absorb it, it basically mixes with your food & helps it to slip through your intestines more easily. Note that it should be taken daily & not just when you are constipated... as that is a little late, based upon it's mode of action. Back to hemorrhoids... they can also form due to prolonged sitting, so lay down or get up... don't allow the pressure of your body to press down on your rectum too long! And certainly don't sit on the toilet too long, as this position allows for a lot of pooling of blood in your rectum/anus. If you must sit for a long time to have a bowel movement, sit on the toilet with the top DOWN so it supports your bottom side, & only open it when you are truly ready to have the BM! We all know that the symptoms of hemorrhoids involve pain or itching in the rectal area, as well as perhaps bleeding (usually with a BM, but sometimes even without) or a lump in the anus area. Be sure to have a doctor or other qualified medical professional take a look as sometimes rectal CANCER can have the same symptoms! Treatment involves changing your behavior regarding straining, & the over-the-counter meds, including things that numb (or anesthetise) such as Pramoxine which is found in Proctofoam, or vasoconstrictors (which shrink the tissue) such as Phenylephrine which is found in Preparation H. There are stronger forms of these meds which your doctor can prescribe, & often they include a steroid to shrink the tissue. I usually prescribe Proctofoam HC which includes Pramoxine (to numb) & a steroid (to shrink). Don't forget the good old-fashioned Sitz bath... just run some warm water in the bathtub & sit in it! This increased warmth increases circulation to the hemorrhoid & helps heal the tissue with healthy new blood. And if all else fails, or if you just don't want to deal with recurrences, consider surgical type options. This includes the Ultroid procedure mentioned by Scott. He called in to say he had this non-invasive in-office procedure with great results. Talk to your doctor or google to see options, though the Ultroid looks great as this procedure is done in an area of the rectum where there are no nerve endings, thus there should be NO PAIN! The websites indicate that insurance usually pays for this procedure & it only takes about 10-15 minutes to complete... makes me think it should be done sooner rather than later!
Irene wondered if taking Tylenol PM every night was bad for her. She uses it each night to help her sleep & is concerned about taking the Tylenol as she knows it is bad for her liver. Well, first we should understand that Tylenol PM is a drug which contains TWO drugs: Tylenol (=Acetaminophen) and Benadryl (=Diphenhydramine). Tylenol is a pain reliever, whereas Benadryl is an antihistamine which also causes sleepiness. If Irene takes Tylenol PM just to help her sleep, I would recommend that she get pure Benadryl, as she probably does not need the Tylenol component unless she has pain which interrupts her sleep. Remember, if you take over-the-counter meds, they too have side-effects. It is a good idea to discuss any meds or herbs that you take frequently with your doctor, just to be sure they are safe & to be sure the doctor is not concerned as to why you need that product often. Tylenol should not be taken in doses greater than 1,000 milligrams at once, & no more than 3-4,000 milligrams per day. They recently suggested that 3,000 mg per day should be the max, so I guess that has been down-graded. Regardless, remember that Tylenol is toxic to the liver, so even in low doses it can be dangerous if you have liver disease, if you drink a lot of alcohol, or if you take a lot of medications which are metabolized by your liver. Again, speak with your doctor or Pharmacist who can help you decide what is your safe dose! And lastly, in honor of January which is National Blood Donor Awareness month, we thank those of you who can & do donate blood! America uses 44,000 units of blood per day to help those who have bled or who have anemia due to chronic illnesses, cancer treatment, surgery, etc. Only about 1/3 of the population is able to donate for one reason or another, so the other 2/3 of the population depends upon your generosity! So thank you!!! And if you want to donate, please contact your local Blood Bank to see if you are qualified to donate... & while you're there, see if you can register to be a bone marrow donor as well!
Here's to our health!
Gigi
Tune in Fridays for the Let's Talk Medical with Doctor Gigi radio show! We're on about 3:30-4:00PM Eastern time on WTAN 1340-AM or on www.SkipShow.com where you can listen live or to the PodCast version!]]>
https://doctorgigi.com/blogs/news/legal-issues-that-affect-your-medical-care2012-01-08T01:11:00-05:002020-08-04T01:22:50-04:00Legal issues that affect your medical care.Dawn Hackney
If you listened to Let's Talk Medical with Doctor Gigion Friday Jan. 6, 2012, you have heard the following issues as Skip & I discussed them live. This blog will simply put that conversation in print & give me a second opportunity to "think" before I speak!
We spoke about a 60 year old man who presented to a Walk-in Clinic with complaints of leg pain after falling off of a ladder. The clinic did an x-ray of the injured leg & diagnosed an acute fracture. The patient was given a splint & was told to see an Orthopedic doctor... which would be delayed by at least 3 days due to the New Year holiday. The patient's wife later called me (as I was "on call" for the patient's primary care doctor) to ask for help, as the Tylenol & Advil were just not controlling his pain. When I asked why the Walk-in Clinic had not provided a narcotic pain prescription, the wife replied that they had a big sign posted indicating that they "do NOT give narcotic medicines." Needless to say, I think that the care rendered by the physician was less than complete, as I suspect that if he/she had a broken leg, he/she would have demanded to have appropriate pain management! I did help the patient, but many physicians would not have, as we are fearful of losing our licenses to practice medicine if anyone questions that we are over-prescribing narcotics... which are horrendously abused throughout the US, but especially in Florida (where I practice). I am certain that the posted disclaimer is to dissuade drug-abusers from going to the Walk-in Clinic to get refills of narcotics "after-hours," but apparently it has also hampered others from getting much needed appropriate care!
We also discussed that I had to meet a patient in person to hand him a handwritten prescription to refill Ritalin. Ritalin is basically "speed" which is prescribed for ADD (Attention Deficit Disorder), & in these people it acts "backwards" to slow them down & allow them to focus appropriately on tasks such as work & study. Again, I see the great potential for abuse, but based upon the Pharmacist's records, he was not an abuser & was appropriately due for a refill. Again, I did the right thing & went out of my way to get the prescription to him, but as per the law, I could not phone it in & thus had to actually meet him to hand it off. I don't know about you, but I feel this is over-involvement of the government which burdens me & makes it difficult for patients with this disease to get appropriate care. It seems to me that I have the knowledge & the responsibility to practice medicine, but unfortunately I am losing the RIGHT to do so freely & in the best interest of my patient!
The point of all this is to make you realize that when you hear news regarding new laws that affect healthcare, remember that those laws might have negative impact on your care! I am not a lawyer, so I find it difficult to practice medicine when medicine itself has become a business heavily regulated by legal constraints. Have you noticed that when you are in a car accident most of you end up seeing a lawyer who then refers you to a doctor with whom he works? That is because many physicians refuse to see cases which will wind up in court, as we feel unprepared to negotiate the legal system in a manner that will help our patients. To this end, there are physicians who work in that arena all the time... yet these are not your usual primary care doctors... you know, the one's who know you best & can probably care the best for you!
We also discussed that sometimes a dying patient's wishes are not followed, as doing so might result in a lawsuit against the doctor or hospital. Let's say the patient wants to be a "no code"... indicating that he refuses heroics to just keep him alive if there is no hope for meaningful recovery... but a family member shows up & wants all heroics. As I say, the patient will not sue me if he is vegetative, but the family member might sue if I "let the patient die." Since I don't have time or money to deal with this legal dilemma, I am likely to do what the family requests though I know it is terribly wrong & definitely in oppostion of the doctor-patient relationship!!! The moral of this story is to make sure that your medical & legal paperwork is in order, AND make sure that you discuss this with your family to ensure they follow YOUR wishes and not their own!
It is worth mentioning that if you want a physician to care for you, it is best to establish with that doctor on a "good" day so the doctor has a baseline as to what "normal" is for you. Thus when you are ill, he will be better able to judge the severity of that illness & provide the best plan of care for YOU... the individual that you are! In other words, a cough is less significant in a young healthy non-smoker than in an elderly smoker who uses breathing medicines on a normal day.
One e-mail which I received brought up the subject of getting free medicine from the pharmaceutical companies. This is through a program called the Patient Assistance Program. If you cannot afford a medicine that your doctor prescribed, first ask if there is a generic (not name-brand) medicine that will suffice, as these are much more affordable on the average. If this is not an option, Google the medicine name & find the manufacturer. Go to the manufacturer's website & see if they have a PatientAssistance Program, & if they do, print the application. You will need to complete some information regarding your income & your diagnosis, & perhaps your physician will have to fill out a part as well. After mailing the completed application to the manufacturer, they will review it, & if you qualify for assistance, they will mail the medicine to your doctor who will notify you to pick it up.
There was a question regarding how safe our blood supply is in regards to HIV. You see, when a person first contracts HIV, he will feel as though he has the flu. With such general symptoms, it is not likely that he will see a doctor, & even if he does, he is not likely to be diagnosed with HIV. This acute illness lasts for several weeks, & during this time, the patient will be HIV negative as his body has not yet responded to the HIV virus by making an "antibody." Unfortunately our HIV tests look for the antibody rather than the virus itself, so there are several weeks between acute HIV infection & our ability to diagnose HIV. Thus a person could conceivably donate blood which is acutely infected with HIV virus but not yet HIV positive... so the Blood Bank would take that blood & give it to an ill person not realizing how infectious it is! Obviously our teaching point here is that receiving a blood transfusion is a little risky, & it is always best to receive blood from a family member who you know & trust! But in the absence of a well-known donor, we can only hope that the Blood Bank continues it's rigorous questioning of donors, as it is the donor's history of illness, travel, medications, etc. which help them to determine whether or not they will allow that person to donate blood.
Lastly, I promised to put in print information regarding 2 exciting programs to help women with breast health. These are 2 programs for low-income, non-insured women in Pinellas County. They are:
1. The Mammography Voucher Program - for women 40 - 49 years old. For information & eligibility requirements, call: (727)-820-4117.
2. Florida Breast & Cervical Cancer Early Detection Program - for women 50 - 64 years old. For information & eligibility requirements, call: (727)-824-6917.
Remember that these programs will assist you to get a mammogram if you qualify, AND they will provide further assistance with follow-up studies such as Ultrasound or even biopsy. They will even help with treatment for breast cancer such as surgery & chemotherapy! BUT you must start the process with them... meaning that if you get the mammogram from the program, they will provide further necessary care! DO NOT get the mammogram elsewhere FIRST, as they will not help you once that has been done! And remember, these programs are for full-time residents of Pinellas County. If you live in a different county, parish, or even state, ask your local Health Department if they have similar programs.
Until next time, stay healthy & check out my live radio show Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Petersburg area Fridays from 3:30-4:00PM Eastern time, or on www.skipshow.com, where you can listen live OR you can listen to the recorded version via Podcast. And don't forget, you can call in with questions during the live show via: (727)-441-3000 or tollfree via: (866)-TAN-1340. If you prefer, you can e-mail me at: DrGigi@skipshow.com.
Here's to our health!
Gigi]]>
https://doctorgigi.com/blogs/news/heres-to-a-happy-new-year-a-new-endeavor2012-01-04T01:11:00-05:002020-08-04T01:22:50-04:00Here's to a Happy New Year & a new endeavor!Dawn Hackney
So 2012 has arrived! Despite predictions that it will be our last year on Earth (the Mayan calendar reportedly ends on 12/21/12!), I hope to pursue a goal of educating friends, family, & other followers in matters of health. I am a Family Physician who has practiced in St. Petersburg, FL since 1990. I currently run a solo Family Practice office & conduct clinical research as well. I attempt to provide full service medical care to my patients & their families. I see patients in the office, care for them in the hospital, & assist during their surgical procedures. Though I "survived" a 3 year residency in Family Practice (now renamed Family Medicine), I no longer practice the full scope of medicine for which I was trained... for many reasons... most of which have to do with legal issues, reimbursement issues, time constraints, etc. I have found myself extremely frustrated by our present medical environment, & I fear that the incredible medical industry which was built up from the 1960's to the 1990's, has been in a downhill spiral since the late 1990's. I worry that in a world where we have the most medical knowledge, we lack the ability to appropriately communicate & deliver high-quality medical care! I see a lack of understanding of basic scientific principles, & a lack of critical thinking, as well as a lack of true "caring" from our "caring professionals." I see an ever growing dependence on "cookbook" medicine & clinical pathways which attempt to treat patients as diagnoses rather than as individuals! I have witnessed the shift from the 1990's when primary care physicians such as myself provided a "medical home" for the patient... caring for him in the out-patient, as well as in the in-patient (hospital) setting, to the present time when many primary care physicians no longer provide hospital care. As you may know, there is now a push to get patients "in & out" of the hospital as quickly as possible, thus the industry has created a new specialist... the Hospitalist... who only cares for hospitalized patients, & thus has no other appointments or phone calls to distract from doing that job as quickly as possible. The problem is that this significantly fragments the patient's care, as there is no longer a primary care physician who has full knowledge of & involvement with all aspects of that patient's medical care.
Because of these concerns & frustrations, I have sought ways that I might educate people to be better at navigating the health care system, & thus to become better consumers of health care. To that end I have been broadcasting a radio talk show: Let's Talk Medical with Doctor Gigi. The show airs on Fridays on WTAN 1340-AM from 3:30-4:00PM in the St. Petersburg/Tampa area. Computer access to live broadcasts, as well as to the recorded podcasts, is available via www.skipshow.com. The format of the show is education in regards to medical issues. This involves any & all aspects of medicine, including preventive care, diseases, immunizations, economics, insurance, & politics... to name but a few! I do not propose to be an "expert" in any of these arenas, but 21 years of active practice have certainly given me an abundance of experience in most things medical! The radio show allows for people to call in (727-441-3000 or toll-free 866-TAN-1340) or e-mail (DrGigi@skipshow.com) with questions or concerns regarding the medical industry. In the absence of callers, we simply talk about something medical which I think might be helpful for people to know or understand. Though I CANNOT diagnose or treat people via the radio show, I CAN educate them. As opposed to the impact of seeing & caring for one person at one appointment, the radio show offers me the opportunity to touch many people at once.
As an extension of Let's Talk Medical with Doctor Gigi, I intend to use this blog to expound upon issues, & to post information which followers might wish to see in print. I will also use it to "correct" myself... as I am far from perfect, & as live broadcasts inherently lend themselves to occasional errors!
So despite the predictions that the end of the world is near, let's undertake a new endeavor in regards to health. Let's spend some time together... on the radio, or on a podcast, or even on this blog... and Let'sTalk Medical! Hopefully it will educate you to take better care of yourself, or perhaps to better understand a loved one's illness. You just might be a better patient, a better healthcare consumer, & you just might learn to be your own best advocate in times of health, as well as illness!
Here's to our health!
Dr. Gigi
PS Happy New Year, & Laissez les bon temps rouler!!! That's French for: Let the good times roll!!! And yes, I am from Louisiana!]]>