Car Seats

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

Rear Facing in the back seat:

• Birth to one year of age and
• 20 lbs or under

Forward Facing in the back seat:

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

Booster seat in the back seat:

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

Seatbelts in the back seat:

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

Seatbelts in either the back or front seat:

• Teenagers 13 years old and older

Here are some enlightening statistics:

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

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

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

Thank you.

Happy Holidays!

Wishing everyone a safe and joyous Holiday Season!!!

Water and Infants

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

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

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

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

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

Cocaine and the Heart

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

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

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

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

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

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

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

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

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

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

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

Postpartum Depression

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

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

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

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

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

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

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

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

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

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

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

Hand Foot and Mouth Disease

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

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

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

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

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

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

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

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

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

Osgood Schlatter Disease

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

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

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


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

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

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

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

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

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

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

For more information, contact your primary physician.

Lyme Disease

A 15 year old female presented to the office with a month long complaint of fatigue and body aches. Otherwise she felt well. Her medical history was unremarkable. She denied pregnancy. Her exam was unremarkable with no evidence of rash. Laboratory investigation was performed including a blood count, thyroid, glucose, and Lyme antibody. Her Lyme test was positive and then confirmed by a Western Blot test. She was given 21 days of Doxycycline and recovered well.

Lyme disease is the most common tick borne illness in the United States. The disease was first reported in 1975 in Lyme, Connecticut due to a cluster of cases involving arthritis in children. Since then, there have been thousands of cases with an annual incidence of 0.5% in endemic areas. The peak months are from May to August and the high risk states include Connecticut, Delaware, Maryland, Rhode Island, New Jersey, New York, and Pennsylvania.

The causative bacteria is Borrelia burgdorferi (type of spirochete). The organism is carried by the white tail deer and the white footed mouse. The bacteria is transmitted from the animal to human by the deer tick (Ixodes). If the tick is removed within 24 hours, the chance of contracting the disease is virtually zero percent. Also, less than 5% of tick bites result in Lyme Disease.

The signs and symptoms include:
1. "Flu-like" symptoms usually several days to several weeks following the tick bite
2. Erythema Migrans (characteristic rash of Lyme Disease)
3. Joint pain
4. Fever
5. Fatigue
6. Headache
7. Neck pain

Erythema Migrans is defined by the CDC as a skin lesion that typically begins as a red spot and expands over a period of days to weeks to form a large round lesion, at least 5 cm (about 2 inches) across. As it grows, it may look like a bull's eye rash.

The symptoms, if untreated, can progress to severe arthritis, cardiac problems, neurologic complications, ocular problems, gastrointestinal complaints, and hepatitis.

Diagnosis is made by blood work (Lyme titer via ELISA and Western Blot). If there are neurologic symptoms, the CSF needs to be tested for meningitis.

Treatment includes:
1. Tick removal
2. Contact your primary physician
3. Antibiotics (Doxycycline, Amoxicillin, or Cefuroxime) for at least 21 days
4. If the symptoms are severe, IV antibiotics may be necessary

Prevention includes:
1. Wear enclosed shoes and light-colored clothing to spot ticks
2. Check clothes and any exposed skin frequently for ticks while outdoors
3. Stay on cleared, well-traveled trails
4. Use insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes
5. Avoid sitting directly on the ground or on stone walls
6. Keep long hair tied back
7. Do a full-body tick-check at the end of the day (also check children and pets)

To remove a tick, follow these steps:
1. Using a pair of pointed tweezers, grasp the tick by the head right where it enters the skin. Do not grasp the tick by the body.
2. Pull firmly and steadily directly outward. Dn not twist the tick out or apply petroleum jelly, a hot match, alcohol or any other irritant to the tick in an attempt to get it to back out.
3. Place the tick in a vial of alcohol to kill it.
4. Clean the bite wound

Contact your primary physician for more information.
Also check the CDC link on Lyme Disease.

Have a safe Thanksgiving Holiday!

Honey and Babies

During my newborn intake exams, I usually give a fair amount of education and advice. The one advice that I get the most perplexed looks is the recommendation of NO honey for babies.

Honey should not be given to infants one year or younger.

The reason is an infection called botulism. The botulinum spore is found in honey. When a baby ingests honey, the spores grow in the digestive tract and then the toxin spreads into the body. The infection does not typically cause problems in adults or children but in babies can cause a multitude of complications.

Most cases of infant botulism are mild but few are progressive.

The potential signs and symptoms include:
1. Constipation (typically first sign) in two to thirty days following ingestion
2. Increased listlessness/lethargy
3. Poor cry
4. Decreased feeding
5. Diminished gag or suck (as the disease progresses)
6. Loss of head control
7. Respiratory arrest
8. Temporary paralysis

If the signs and symptoms are progressing, contact your primary physician. Diagnosis can be made with lab work. Some babies may need to be hospitalized.

Treatment is supportive care. Some infants may need mechanical ventilation as they recover. There is an anti-toxin available to help with treatment.

The fatality rate is less than 1% due to increased awareness and prevention.

Honey should never be placed on the pacifier to sweeten it or added to baby food.

The bottomline is do not give honey (of any kind) to infants one year of age or younger.

Contact your primary physician for more information. Thank you.

Quotations

"The only way to keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not."
Mark Twain

"He who has health has hope, and he who has hope has everything."
Arabian Proverb

"Nature, time and patience are three great physicians."
H.G. Bohn

Update

Several patients made a suggestion that I should be more regular on my blog postings. Therefore, I will post a new case every Monday. Also, check out some of my older posts. I hope this blog has been informative. Thank you.

H1N1 Questions and Answers

I was recently on WBOC news to answer questions about the H1N1 influenza. WBOC arranged a telephone and online chat helpline which was very successful and helped alleviate some of the concerns about the flu. Here are some of the more frequently asked questions:

Who qualifies for the vaccine?
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Healthcare and emergency medical services personnel
4. Persons between the ages of 6 months and 24 years old
5. People ages of 25 through 64 years of age with chronic health disorders or compromised immune systems.

What are some of the chronic health disorders?
1. Cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury
2. Chronic lung disease, asthma, chronic obstructive pulmonary disease, cystic fibrosis
3. Congenital heart disease, congestive heart failure, coronary artery disease, heart attack
4. Sickle cell disease
5. Diabetes
6. Kidney disorders, end stage renal disease
7. Liver disorders, cirrhosis, hepatitis, Crohns disease
8. Metabolic disorders and mitochondrial disorders
9. Weakened immune system due to disease or medication (such as people with HIV, cancer, or those on chronic steroids)
10. People younger than 19 years of age who are receiving long-term aspirin therapy

This list is NOT a complete list, please contact your physician for further information

Why are individuals over 65 years of age not being vaccinated?
Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, providers should eventually offer vaccination to people over the age of 65.

Is the H1N1 vaccine safe?
Yes. The H1N1 vaccine is FDA approved. The vaccine is made just like the seasonal flu.

Who should NOT get the vaccine?
1. People who have a severe allergy to chicken eggs
2. People who have had a severe reaction to an influenza vaccination
3. People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously
4. Children younger than 6 months of age (influenza vaccine is not approved for this age group),
5. People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

What are the side effects of the vaccine?
1. Soreness, redness, or swelling where the shot was given
2. Fainting (mainly adolescents)
3. Headache
4. Muscle aches
5. Mild fever
6. Nausea.
If these problems occur, they usually begin soon after the shot and last 1-2 days.

I received my vaccine. What are the concerning side effects?
After vaccination you should look for any unusual signs or symptoms, such as a high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, swelling around the eyes or lips, hives, paleness, weakness, a fast heart beat or dizziness. If any unusual condition occurs following vaccination, seek medical attention right immediately!!!

What is the difference between the seasonal flu and the H1N1 flu?
The symptoms of both are very similar, which includes fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, vomiting and diarrhea.

The main difference is H1N1 is a novel virus which means it is a new strand to humans. Children and young adults are prone to getting this strand because their immune system has no previous experience battling it. Older adults may have some immunity protection from prior exposures to similar viral strands.

My child has asthma. Can he get the nasal mist vaccine?
No. The mist is only for healthy individuals 2 years to 49 years of age who are not pregnant.

I am breastfeeding. Can I get the vaccine?
Yes.

My child has asthma. The school is giving out the mist form. Can he go to school?
Yes. It is safe for a child with asthma to go to school and be around the children who received the mist vaccine. He/she should not get the mist vaccine but instead receive the injectable form.

The estimated risk of getting infected with vaccine virus after close contact with a person vaccinated with the nasal-spray flu vaccine is low (0.6%-2.4%).

What is the difference between the nasal mist and the injectable vaccine?
The nasal mist is made with a weakened, live virus. The injectable is made with an inactivated killed virus.

When does immunity begin?
8 days to two weeks

Why does my 5 year old need two shots?
The CDC recommends that the two doses of 2009 H1N1 vaccine be separated by 4 weeks in children 9 years of age and younger. The first dose only provides moderate immunity. The second dose provides up to 96% effectivity.

Where do I get the vaccine?
If you fall in the priority groups, contact your primary physician. If it is unavailable, contact the state health department. WBOC has the links on their webpage.

How many people have died from the H1N1 flu?
There have been approximately 4,000 deaths.

Are more vaccines coming?
Yes. The Federal Government has purchased about 250 million vaccines and about 40 million have been already allocated.

I do not qualify for the vaccine. How do I prevent myself from catching the flu?
1. Cover your nose and mouth with a tissue or elbow/upper arm when you cough or sneeze.
2. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
3. Avoid touching your eyes, nose or mouth.
4. Try to avoid close contact with sick people.

I think I have the flu. How do I get tested?
Testing is done via nasal swab/washing. Testing is performed by the physician's discretion but is currently limited to hospitalized individuals and severely ill patients.

Do I need the H1N1 vaccine if I had the H1N1 flu?
If the flu was confirmed to be H1N1, it is not necessary to be vaccinated.

Contact your primary physician for more information. Other useful websites include
CDC
WBOC flu resource page

Thank you.

Aspirin and Children

Due to the increased number of pediatric flu and cold cases, the use of Tylenol and ibuprofen has elevated. Recently, a patient asked me why not a baby aspirin.

Aspirin should not be given to children because it may cause a rare and potentially fatal disease called Reye's Syndrome.

Reye's syndrome is a condition which causes encephalopathy (disease of the brain) with brain swelling and fatty infiltration of the liver. The mechanism is unknown but it has been associated with aspirin usage during a viral illness. Reye's syndrome is rare...about 2 reported cases per year and mortality has decreased due to early and aggressive intervention. The best way to prevent this disease is to not give children aspirin. Usually, the first signs of this syndrome are severe vomiting and lethargy several days after the viral illness, so contact your physician immediately.

Other products (not a complete list) containing aspirin (or salicylates...aspirin is a type of salicylate drug) include:
1. Alka Seltzer
2. Pepto-Bismol
3. Bufferin
4. Excedrin
5. Pamprin
6. Ecotrin

Aspirin may be given to children with certain medical conditions (but only with physician supervision) including Kawasaki's Disease, heart disease, rheumatoid arthritis, blood clot prevention in children with blood disorders, or rheumatic fever.

Therefore, if your child has a fever, try the following treatments:
1. Lots of fluids
2. Acetaminophen (Tylenol)
3. Ibuprofen (Motrin/Advil)
4. Lukewarm bath
5. Light cotton pajamas
6. Keeping the room temperature between 70-74 degrees

Bottom line- No aspirin for children

For more information, talk to your primary physician. Thank you.

Cholesterol and Diet

Over 100 million Americans have elevated cholesterol (over 200 mg/dL)!!!

That is a staggering statistic. Like most primary physicians, we see quite a few patients with high cholesterol. We try various treatments to help bring the numbers down including diet, exercise, and medications. Medications definitely help but I am a fan of at least attempting diet modification.

Cholesterol is a fat-like substance that the body needs to function. It is used to produce hormones, healthy cells, fat-soluble vitamins, and bile acids to break down fat. Unfortunately, when the levels exceeds the body's needs, the excess deposits on the arterial walls and creates blockages. These blockages lead to heart attacks and strokes. Cholesterol is basically broken down to good and bad cholesterol.

Good cholesterol (high density lipoprotein or HDL) transports bad cholesterol from the tissues of the body to the liver so it can be eliminated. You want this level as High as possible.

Bad cholesterol (low density lipoprotein or LDL) at high levels build up on the walls of the arteries and lead to blockages. You want this level as Low as possible.

Triglycerides are a type of fat in the body and blood stream and also contribute to blockages.

The numerical goals are:

Total Cholesterol under 200 mg/dL
LDL under 100 mg/dL
HDL preferably over 50 mg/dL
Triglyceride under 150 mg/dL

Recently, I have been recommending these foods (in conjunction with exercise) to help improve cholesterol levels without the use of medications.

Lowers LDL
Red grapefruit: 1 daily reduces levels by 20 percent
Steel-cut oatmeal: 3/4 cup daily reduces levels by 15 percent
Pecans: 1 oz daily reduces levels by 13 percent
Pistachios: 3 oz daily reduces levels by 12 percent
Promise activ spread: 3 servings daily reduces levels by 10 percent
Macadamia nuts: 1.5 oz daily reduces levels by 9 percent
Pinto beans: 1/2 cup daily reduces levels by 7 percent
Walnuts and almonds 1 oz daily reduces levels by 7 percent
Peanuts: 1 oz daily reduces levels by 6 percent

Raises HDL
Orange juice: Three 8 oz glasses daily boosts levels by 21 percent
Hazelnuts: 1.5 oz daily boosts levels by 13 percent
Dark chocolate: 2.5 oz daily boosts levels by 11 percent
Extra-virgin olive oil: 2 Tbsp daily boosts levels by 4 percent

Lowers triglycerides
Fish oil: 4 grams daily reduces levels up to 45 percent
Peanuts: 3 oz daily reduces levels by up to 24 percent
Pistachios: 2 to 3 oz daily reduces levels by 10 points

The American Heart Association also has a good patient handout about lowering cholesterol.
Click here

Medications may be necessary, especially when there are multiple risk factors for heart disease and/or stroke. Talk to your physician about a treatment plan (including diet and exercise) to help lower cholesterol. Hopefully with improved health, we can lower the amount of heart disease in this country.

The Power of Yogurt

Whenever I prescribe antibiotics, I usually recommend eating yogurt. I have also recommended yogurt to patients with lactose intolerance and irritable bowel syndrome. The reason is Probiotics.

Probiotics are microorganisms (bacteria and a few yeast types) that are similar to the beneficial organisms in our digestive system (the gut has about 400 types of probiotic organisms). They are also called "good bacteria." They promote a healthy digestive tract and reduces the number of harmful bacteria. The most common probiotics are Lactobacillus and Bifidobacterium. Probiotics are found in yogurt, fermented and unfermented milk, miso, soy drinks, fermented foods (pickled vegetables, kimchi, sauerkraut, etc...), and dietary supplements.

The GI tract needs to maintain a healthy balance of good bacteria. When antibiotics are taken, the good bacteria may also be killed, changing the balance and leading to gas, cramping, or diarrhea (and potentially Clostridium difficile colitis). Studies have shown there is up to a 50% reduction in antibiotic associated diarrhea with the use of probiotics.

Other potential benefits by taking probiotics include:
1. Managing lactose intolerance
2. Suppress or reduce bad organisms associated with traveler's diarrhea, infectious diarrhea, irritable bowel syndrome, vaginal infections, Helicobacter pylori gastritis, inflammatory bowel disease, and tooth decay
3. Prevent colon cancer...studies pending
4. Possibly reducing blood pressure and cholesterol
5. Improving immune function
6. Managing eczema
7. Improving irritable bowel syndrome symptoms
8. Reducing inflammation associated with colitis

Probiotics are considered safe. Dietary supplements (capsules, powder, liquid extracts) are not regulated by the FDA so consult your primary physician for more information.

Yogurt is a good source of probiotics. Make sure the label states "active culture." Probiotics can potentially help with overall health. Studies are ongoing.

When taking antibiotics though, consider consuming two servings of yogurt a day to reduce antibiotic associated complications like diarrhea, gas, cramping, and nausea.

As always, talk to your health care professional before you start any supplements.

Quotation

"Drugs are not always necessary. Belief in recovery always is."
Norman Cousins

"The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease."
Thomas Edison

Shoulder pain

During baseball season, I saw a 17 year old male come to the office for right shoulder pain. He was playing summer ball as a pitcher and centerfielder. On one of the games, a ball was hit into the gap and he attempted to make a diving catch. Unfortunately, he did not make the catch and started writhing in pain. He was sent to the emergency room for evaluation. He explained how he could not move his arm and had to keep it braced. According to records, he had several xrays and underwent a shoulder reduction. He was told to follow-up in the office and obtain an orthopedic evaluation.

The patient was diagnosed with a shoulder dislocation and after months of treatment (including rest and then therapy), he was throwing again.

Shoulder dislocation (or glenohumeral dislocation) occurs when the head of the upper arm bone (humerus) is out of the socket of the scapula (glenoid). Typically, it is caused by direct trauma or sports injury (younger patients) or falls (older patients). In this patient, it was caused by a fall on an outstretched arm and also indirectly being a pitcher (possibly causing instability). About 90% of the time, the dislocation is anterior, where the head of the humerus is sitting in front of the shoulder blade. Posterior dislocations are rare and are seen after electrocutions or seizures.

The signs and symptoms of a dislocation include:

1. PAIN

2. Difficulty moving the arm

3. Cavity in the shoulder area

4. Arm locked in place

Diagnosis is made by examination, history, and radiographs.

Treatment includes:

1. Reduction or "popping" the shoulder back into place.

2. Immobilization for one to three weeks

3. Rehabilitation, improving range of motion and strengthening

4. Possible surgical intervention

Depending on the sport and severity, athletes can return to play 3-4 months after injury.

Here are some statistics regarding shoulder dislocations:

1. About 90% who experience a SD under 20 years of age will experience a second SD.

2. Patients (30 years or younger) who experience a SD have a 50% recurrence rate.

3. The shoulder is the most commonly dislocated joint in the body.

4. 95% of SDs occur due to a traumatic event.

Shoulder pain can be caused by other problems including rotator cuff injury, clavicular fractures, shoulder separation (injury of the acromioclavicular joint), humeral fractures, and non-orthopedic conditions such as pneumonia, heart disease, and peptic ulcer disease. The history and physical are the keys to determining the etiology of shoulder pain.

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

Soft Drinks

My wife recently went to a seminar on the bad effects of soft drinks. Ever since then, I was banned from drinking my usual Diet Coke. It has been difficult...it was my daily caffeine fix, but the sacrifice was warranted.

The consumption of soft drinks has increased by 500% over the past fifty years. Americans drink about 50 gallons of soft drinks per person per year. Therefore, the soda industry grosses $40-50 billion per year.

Why are soft drinks bad?

Soft drinks contain simple sugars or artificial sweeteners, caffeine, and food additives. Due to their ingredients, soft drinks have been linked to many health problems.

12 ounces of regular soda contains about 10 teaspoons of sugar!!! A can of regular soda has about 150 calories (empty calories). Think about what this could cause...weight gain, diabetes, depressed immune system, and heart disease. Diet soda has also been implicated in weight gain so beware!!!

Sodas (regular and diet) increase the risk for tooth decay. The acid dissolves the enamel in twenty minutes. The more you drink, the worse the decay. The acid has been linked to calcium loss which contributes to the development of osteoporosis and also reflux disease (heartburn).
Of note, the pH of soda is about 2-4, while human blood pH is about 7.35.

Caffeine is linked to anxiety and sleep disorders. It can also increase blood pressure, cause palpitations and possibly reduce calcium stores.

Soft drinks also contain sodium which can contribute to elevated blood pressure and dehydration.

Soft drinks typically have no nutritional value. Unfortunately, many children are replacing milk, water, and fruit drinks with sodas. Also beware of energy drinks...they contain larger doses of sugar and caffeine plus other stimulants.

Interestingly, soft drinks can remove rust off metal surfaces, clean corrosion from car batteries, and possible clear clogged drains.

Due to my wife's advice, I have been drinking more water and fruit juices. Try to replace the sodas with water, teas (loaded with antioxidants), milk, and fruit juices (low sugar of course).

Hope this was informative.

Vitamin D Deficiency

Vitamin D Deficiency is becoming a more prevalent health issue. Here are some surprising statistics that confirm this growing problem:

1. Approximately 9% of children are Vitamin D deficient
2. About 60% of children are insufficient (the level prior to being deficient)
3. 40% of Americans are deficient
4. About 30% of physicians and medical students are Vitamin D deficient!!!
5. 48% of young girls are deficient

Why is Vitamin D important?

Deficiency may cause osteoporosis, Rickets (childhood disorder causing growth impairment and deformity of the long bones), fatigue, bone pain, increased risk of falls, muscle aches, low back pain, and osteomalacia (bone thinning disorder).

It may also play a role in the following conditions:
1. Cardiovascular Heart Disease
2. Colon Cancer
3. Depression
4. Diabetes
5. Multiple Sclerosis
6. Hypertension
7. Asthma in children

What are the causes/risk factors of Vitamin D deficiency?
1. Inadequate sunlight exposure (UVB rays)
2. Inadequate consumption/diet
3. Dark skin
4. Certain digestive tract disorders
5. Obesity
6. Sedentary lifestyle
7. Breastfeeding exclusively with no Vitamin D supplementation
8. Age greater than 65
9. Medications interfering with absorption or metabolism (steroids, seizure medications)
10. Liver disease
11. Kidney Disease

Diagnosis is made by blood work. Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L).

Treatment and sources of Vitamin D

1. Sunlight. People obtain 90% of Vitamin D from the sunshine. Researchers have suggested 5-30 minutes of sun exposure at least twice a week to maintain adequate status.
2. Food. Cod liver oil, mushrooms, salmon, mackerel, sardines, tuna, fortified orange juice, fortified milk and milk products, eggs, and fortified cereals.
3. Vitamin D supplements with pills or injection.

The recommended adequate intake dose for Vitamin D is:
1. Children and adolescents: 200 IU daily
2. Adults up to 50 years: 200 IU daily
3. Adults 51-70: 400 IU daily
4. Adults 71 and over: 600 IU daily

The Pediatric Academy recently recommended doubling the intake for children to 400 IU daily.
In adults, Vitamin D deficiency should be promptly treated with the above sources and then the maintenance dosages should be between 800-1000 IU daily.

Be aware of Vitamin D toxicity. Signs and symptoms include headache, nausea, metallic taste, and pancreatitis.

Please contact your primary physician for more information on Vitamin D. Thank you and have a nice day.

Quotation

"Walking is man's best medicine."

Hippocrates the "father of medicine"

Quotation

"Medicine is a science of uncertainty and an art of probability." Sir William Osler

H1N1 Vaccine

My office has been receiving many calls in regards to the H1N1 vaccine. There has been a tremendous amount of information presented by the media and internet about the vaccine. Here are some facts.

There are two types of H1N1 vaccines: the inactivated vaccine (injectable form) and the weakened live virus (nasal mist form).

The targeted groups include:
1. Pregnant women
2. Parents and caregivers of children under 6 months of age
3. Health care personnel
4. Individuals between the age of 6 months to 24 years
5. Individuals 25 years to 64 years with chronic medical conditions or compromised immune systems

Two doses 3-4 weeks apart are necessary for children 9 years and under to provide adequate immunity.

The H1N1 injectable vaccine does contain thimerosal, a preservative, but there is no convincing evidence that it will do any harm to children or pregnant women. It may cause localized swelling and redness at the injected site.

The vaccine is FDA licensed which means it has gone through clinical trials and has been found to be safe and effective. There is a probability that next year's seasonal flu vaccine will contain the H1N1 strand.

There has been over 11 million doses shipped throughout the United States. Schools have begun administering to students. The Federal Government has purchased about 250 million doses so there will be more vaccines available in the upcoming months.

The nasal mist (FluMist) is approved for healthy individuals between the ages of 2 years to 49 years and who are NOT pregnant.

FluMist should not be given to:
1. Pregnant women
2. Kids under two years or adults over 50 years
3. People with chronic medical conditions such as COPD, asthma, heart disease, or immuno-compromising diseases
4. Children under 5 years with history of wheezing
5. Children receiving aspirin
6. People with history of Guillain–Barré Syndrome that occurred after receiving influenza vaccine
7. People with allergy to eggs

The side effects of the H1N1 vaccines include:
1. Soreness and redness at the site of injection
2. Headache
3. Muscle ache
4. Low grade fever
5. Nausea
6. Runny nose with the nasal mist

Contact your primary care physician or go to the ED if the following occur:
1. High fever
2. Behavior changes
3. Difficulty breathing, hoarseness or wheezing
4. Swelling around the eyes or lips
5. Hives
6. Paleness
7. Weakness
8. Fast heart beat
9. Dizziness

The most frequent question I get is do I recommend the vaccine?
The answer is Yes.
I plan to give my daughter the mist when it arrives. I have also recommended my staff to get the vaccine in addition to their young children.

The second most frequent question is where to obtain the H1N1 vaccine. That is a difficult one to answer...it is state dependent. In Delaware, schools are currently getting their supply as are physician offices (if they pre-registered). Delaware Division of Public Health Clinics will also be providing the vaccine to high risk individuals by appointment only. For more information, please go to the Delaware Division of Public Health Website.

For more information about the H1N1 vaccine, please go to the CDC website.

Lactose Intolerance

I had a 30 year old female present with complaints of intermittent abdominal cramping for months and diarrhea (non-bloody). She denied any vomiting, fever, chills, or urinary complaints. She attempted a food diary but found no direct correlation. Her medical and family history were unremarkable. Her medications included a birth control pill and over the counter Imodium and Tums (which slightly helped). The patient was told in the past she had irritable bowel syndrome. Diagnostic tests were performed and revealed results consistent with lactose intolerance.

Lactose intolerance is a condition where the body does not have enough lactase (an enzyme) to break down lactose (type of sugar found in dairy products) into glucose and galactose. Symptoms occur 30 minutes to two hours after eating or drinking milk or milk products. Severity is usually based on the amount of lactose consumed. Symptoms include:

1. Abdominal bloating and cramping
2. Diarrhea
3. Gas
4. Nausea
5. Foul smelling stools
6. Weight loss

Here is a short list of foods with lactose:

1. Dairy and dairy products
2. Bread and baked goods
3. Processed breakfast cereals and foods (doughnuts, waffles, pancakes, etc...)
4. Instant potatoes
5. Instant soups
6. Salad dressings
7. Margarine
8. Coffee creamers
9. Processed meats (bacon, ham, hot dogs, etc...)
10. Candy
11. Protein supplements and bars
12. Pizza
13. Mosts foods that are creamed, buttered, or breaded

Diagnosis is usually based on history but there are diagnostic tests (Hydrogen breath test and Lactose tolerance test).

Treatment includes:

1. Dietary modification (Good bye pizza)
2. Calcium supplementation (adults should maintain 1200-1500mg per day)
3. Lactase enzyme supplements (Lactaid pills)

Colitis, Celiac disease, irritable bowel syndrome, and infections can also present with abdominal pain and diarrhea. Contact your primary physician for further information.

Now here are some interesting statistics:

1. Nearly 100% of American Indians and Asians have some degree of LI.
2. Nearly 75% of people worldwide have some degree of LI.
3. Up to 80% of African Americans and Hispanics have LI.
4. 30 to 50 million Americans suffer from LI
5. About 1 in 9 Americans have a form of LI.
6. Lactase levels start to decline around 4 years of age and decreases with age.

Hope this was informative and have a nice day!

Lung Cancer

A 66 year old female presented to my office with a chronic cough and right sided chest pain. She denied any fevers, chills, or weight loss. Her medical and family history were unremarkable but she did admit to smoking one to two packs a day for decades. Labs and ECG were normal but her chest xray demonstrated a "mass." CT of the chest was done the next day which confirmed a 5 cm lesion. Bronchoscopy was performed and she was diagnosed with small cell carcinoma (lung cancer).

Lung Cancer is bad. Tobacco is directly linked to about 80-90% of all lung cancers!!! I counsel patients daily on tobacco use and cessation but unfortunately people continue to smoke. The statistics are staggering:

1. Adults in the US who smoke: over 40 million
2. High School students who smoke: 3.5 million
3. Packs of cigarettes used by kids each year: 800 million/$2 billion in sales revenue
4. Kids who become new regular smokers each day: 1000
5. Health care costs caused by smoking: $80 billion and rising
6. Smokers lose an average of 13 years to their lives
7. Smoking during pregnancy causes more than 1000 infant deaths per year
8. Consumer cost of cigarette smoking per year: $3400
9. 3000 Americans die each year due to second hand smoke
10. Smoking kills over 400,000 people each year in the US
11. Smoking causes one in five American deaths
12. Someone dies from smoking every 72 seconds
13. 3000 young people begin smoking every day
14. Children of smoking parents have a higher risk of developing asthma, bronchitis, ear infections, etc...
15. 90% of smokers began before the age of 20.

As you can see, tobacco is deadly. Here are some statistics on lung cancer:

1. There have been over 200,000 new cases of lung cancer this year
2. Over 150,000 Americans have died from lung cancer in 2009
3. Lung cancer is the leading cause of cancer death
4. The overall 5 year survival rate for lung cancer is about 15%
5. The number of lung cancer deaths exceeds the total of breast, colon, and prostate combined!!!
6. About 400,000 people alive today have been diagnosed with lung cancer at some point in their lifetime.

What are the strategies for tobacco cessation???

1. You need to want it!!!
2. Set a quit date (anniversary, birthday, New Years)
3. Counselling/Behavioral support (Delaware Quitline 1-866-409-1858 or National Quitline 1-800-QUIT-NOW)
4. Reward yourself when you quit
5. Be prepared for relapse and keep trying
6. Nicotine replacement such as gum, patches, spray, lozenges
7. Medications such as bupropion, nortriptyline, or Chantix
8. One puff can cause a relapse so do not be exposed to a potential smoking environment
9. Quitting smoking does not increase anxiety!!!
10. For smokers with asthma, quitting smoking can improve lung function scores by 15 percent in less than two months
11. Combined therapy is best...About 35% are successful.

For more information, click on the following links

Quit Now
Delaware Quitline
American Lung Association

Breast Cancer

A 44 year old female came to my office complaining of a right breast lump. She had done a self breast exam three days ago and noticed the lump. On examination, she had a palpable mass at the upper area of her breast with no surrounding redness. Her medical history was unremarkable. Diagnostics tests were performed which confirmed the mass and she was referred to the surgeon for further evaluation. She was diagnosed with breast cancer and eventually underwent cancer therapy and mastectomy.

I cannot stress enough the importance of breast cancer screening. Screening includes mammography, physician clinical exam, and the self breast exam.

Click here to see how to perform a self breast examination.

Here are some interesting Breast Cancer facts. Hopefully, with improved technology and surveillance, breast cancer will be beaten.

1. Breast cancer is the second most common cancer in American women. (Skin Cancer is number one).
2. One in eight women will develop breast cancer.
3. There will about 190,000 new cases of invasive breast cancer in the United States this year.
4. Every 13 minutes, a woman dies of breast cancer.
5. Breast cancer is the leading cause of cancer death in women between the ages of 15 and 54.
6. There are about 2.5 million breast cancer survivors!!!
7. About 400 men will die from breast cancer in the United States.
8. About 20-30% of women diagnosed with breast cancer have a positive family history.
9. Breast cancer risk increases with age but about 2-7% of breast cancers occur in women under the age of 40.
10. Women who perform regular self exams find 80-90% of all breast masses.
11. Breast cancer is the second leading cause of cancer death in women after lung cancer.
12. One percent of breast cancer occur in men.
13. Unfortunately, 10-15% of breast cancers are not detected by mammography (stressing the importance of clinical exams and self exams).
14. Over 90% of women who find and treat breast cancer early will be cancer-free after five years.
15. Breast cancer deaths rates have been declining by about 2% since 1990.

Hope the information is helpful. To learn more about breast cancer, click on the links below.

Susan G. Komen for the Cure
National Cancer Institute
American Cancer Society

Seatbelts

Seatbelts saves lives. Plain and simple.

I will usually ask during the first visit, whether or not the individual wears seatbelts. Most of the time the answer is yes but unfortunately there is an occasional no!

Here are some statistics:

1. Over 60% of people killed in accidents are NOT wearing seatbelts.
2. It is estimated that seatbelts save about 9000 lives annually.
3. Data suggests young males age 16-25 are the worst offenders.
4. Nationwide data shows 84% of people wear seatbelts.
5. Wearing a seatbelt cuts your risk of being seriously injured or killed by 50%.
6. When parents are buckled up, children are too...when parents are not buckled up, children usage goes down to 59%.
7. The fine in Delaware for not wearing a seatbelt is about $40.00.
8. The leading cause of death in people under 35 (not including newborns) is car accidents!!!

Please wear your seatbelt...you are not only protecting yourself but also your family and friends!!!

Weight Loss

I get asked a lot about weight loss. It is a difficult complaint because many factors contribute to being overweight/obese. Here are some basic ideas to help shed off the extra pounds.

1. Walk, Walk, Walk...I recommend purchasing a pedometer and walking 10,000 steps a day. This is about five miles and about a 500 calorie loss each day. Several suggestions include taking the stairs, parking farther away, walking around the neighborhood, walking the dog, vacuuming, or walking with family or friends.
2. Exercise...the recommendation is at least thirty minutes of moderate activity (or three 10 minutes sessions) each day five times a week. Examples include walking a mile in 20 minutes, treading water, bicycling about 10mph, dancing, yard work, vacuuming, and actively playing with children.
3. Healthy Diet...Refer to the new food pyramid at www.mypyramid.gov. Dieticians recommend having colorful meals on smaller plates. Also, avoid "white" foods such as white rice, white potatoes, white pasta, or white bread. Also, eat fiber...veggies, whole grains, fresh fruits, beans, etc...
4. Eat breakfast to boost your metabolism.
5. Weight lifting twice a week will burn calories.
6. Set a realistic goal. 20 pounds in one year is more attainable and sustainable than 10 pounds in one month.
7. Try to eliminate 250-500 calories per day either by exercising, eliminating dessert, or switching from Coke (one soda has about 15 teaspoons of sugar!!!) to Diet Coke.
8. Drink water!!!
9. Know your BMI (Body Mass Index) and waist circumference.
10. Never go grocery shopping hungry.

There are many other ideas for weight loss. There are also medical conditions that make it difficult to lose weight such as cardiac disorders, thyroid disorders, hormonal disorders, and certain medications (antihistamines, progestins in birth control pills, Lithium, and beta-blockers).

Talk to your health care professional for further information about weight loss. Weight loss can be done but it is a long-term process. Always stay positive and drink a cold glass of ice water.

Quote

"A healthy man has many wishes, a sick man has only one."

Seasonal Flu

A five year old girl came to my office with a fever for three days. Her mother stated it had been as high as 102 but goes down with Children's Motrin. She also complains of cough and belly pain. The girl had no significant medical history and received her flu shot earlier in the month. Her physical exam was unremarkable. She was sent to the lab for testing and her results came back positive for Influenza A. Her mother was advised to provide supportive care and to follow up if the symptoms don't improve in several days.

There has been a lot of focus on the flu, especially the H1N1 virus. I have seen a decent amount of patients with "flu-like" symptoms but only a handfull who were positve for the H1N1 virus. The concern for the H1N1 is warranted with over 500 deaths in the US but we should not lose our focus on the seasonal flu. The seasonal flu typically hospitalizes 200,000 people each year and over 30,000 die due to the flu and its complications. Approximately, 10-20% of Americans get the flu. So, how do we prevent this disease???

1. Get a flu shot. (but you still can get a type of the flu that is not covered by the vaccine)
2. Wash your hands frequently.
3. Eat healthy and get enough sleep.
4. Cover your mouth when you cough or sneeze.
5. Avoid individuals with confirmed flu.

What are the signs and symptoms of the flu?
1. Fever (often over 101)
2. Cough
3. Stuffy nose
4. Body aches
5. Chills
6. Fatigue
Patients have told me that it's like being hit by a truck.
According to the CDC, the H1N1 is potentially more severe with associated vomiting and diarrhea.

The flu could last as short as two days or as long as 14 days. It can cause complications, especially with individuals with other medical conditions such as asthma, diabetes, and heart disease.

How do we treat the seasonal flu?
1. Drink, Drink, Drink...stay hydrated!!!
2. Use Motrin/Tylenol for the fever and aches (use the appropriate dose)
3. Saline nasal sprays
4. Rest!!!
5. Anti-viral medications if indicated but will need to be started within 48 hours of onset of symptoms

Is there a test for the flu?
Yes...there is a rapid nasal swabbing test that can be performed. This test does not differentiate between seasonal and H1N1 flu. For instance, as of this posting, Lebron James was tested and confirmed to have Influenza A on nasal swabbing but not H1N1. H1N1 and the seasonal flu are subtypes of Influenza A therefore if your rapid comes back positive for A it may or may not be H1N1. There is a test for H1N1 called RT-PCR but may take several days to return but usually does not alter typical influenza treatment.

Usually with some rest, fluids, TLC, and over the counter medications, the flu will subside. If the symptoms do not improve over a week, call your health care professional. In children, if the following symptoms occur, please contact their primary care physician:

1. Trouble breathing
2. Bluish or grayish skin
3. Not drinking well
4. Not urinating well
5. Not acting normally
6. Rash
7. Fever getting better then returning several days later
8. Being irritable even after the fever goes down

I hope this was informative. Keep those hands clean!!!

Women and Heart Disease

At first I thought about posting a case about the flu but this case is more life-threatening...

I recently saw a pleasant 60 year old female who presented with the complaint of nausea. She also stated that she was getting more winded for the past couple of weeks. She denied any chest pain. Her medical history included tobacco use, elevated blood pressure, and high cholesterol. An ECG was performed which revealed "changes" and she was promptly sent to the emergency room. She was found to have heart disease and underwent cardiac catherization which revealed multiple blockages. The patient was treated and is doing well today.

This case illustrates the importance of understanding heart disease in women. Heart disease is the LEADING cause of death in women over 65 years of age. Almost half a million women die each year due to heart disease. Another surprising statistic is that heart disease kills more women over 65 than do all cancers combined. WOW!!!!

The most common symptom is chest pain, but in my experience (and from peers), they can present with "not" typical findings such as nausea, dizziness, fatigue, upper back pain, and shortness of breath. The risk factors include high blood pressure, Diabetes, family history, obesity, high cholesterol, smoking, post-menopause, and mental stress.

How do we stop heart disease????
First if you smoke...QUIT!!! More than half of heart attacks in women under 50 are associated with smoking.
Exercise...30-60 minutes per day five times a week. Also walk 10,000 steps per day.
Eat Healthy...Low fat, low cholesterol, low salt (watch the ketchcup).
Keep a healthy weight!!! Know your BMI (Body Mass Index). 25 or less is good.
Take your medications as instructed.
Please know that Hypertension (high blood pressure) is silent but potentially deadly so please, please, please take the medications!

If you have any risk factors or heart disease, please talk with your physician and develop a plan. Many of the factors are reversible or controllable such as smoking and obesity so talk with your primary physician.

I hope this increases awareness of heart disease in women. There are many useful websites such as the American Heart Association and FamilyDoctor.org.

Welcome

Welcome to my blog. I am a small town family physician in Delaware. My purpose of this blog is to educate patients. I plan to present interesting cases from my practice and my colleagues. I also plan to increase awareness in various medical issues. This blog is for informational purposes only. Thank you and have a nice day.