Maybe You Should Fire Your Doctor; Bad Bugs in Hospital; What's Contagious; National Heart Month, & Heart Info; Get Well Nanci

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) cholesterolLow HDL (Healthy) cholesterolHypertension (high blood pressure), DiabetesCigarette/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!


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:  If you have comments, leave them here, or contact me at:, or call us live during the show via:  (727)-441-3000 or toll-free at (866)-TAN-1340.