Friday, July 31, 2015

Doctors' innermost thoughts

The Rutgers Robert Wood Johnson Medical School is fielding a new online evaluation (CasPER) to learn more about the personal side of potential med students. They are the first to delve into this.

The Assn of American Medical Colleges identifies 15 core competencies for incoming med students.

These fall in four categories--interpersonal, intrapersonal, thinking and reasoning, and science.

CasPER measures ethics, empathy, collaorbation, resiliency and advocacy, among others. The applicants view 12 video or text-based scenarios and respond in writing to three questions about each.

I hope maybe they can weed out weird phobias--such as disdain for weight or the desire to get in a power struggle with patients who may not buy into everything said or offered.

I also once saw a show where a gynecologist hated feet and was wrinkling his nose in disgust because a woman's feet in the stirrups were close to his head.

Who knows what these people are thinking...

Well, maybe Rutgers.

Thursday, July 30, 2015

When kids get headaches

When we kids said we had a headache, our parents would say kids don't get headaches. We sort of accepted this and felt better.

But, of course, kids do get headaches. According to a pediatrician at Cincinnati Children's, 10% of school age kids and 15-27% of teens experience them from time to time.

The most common causes in children are:

Poor hydration--not drinking enough water, especially in hot weather.

Diet.--does your child skip meals?  Too much caff in soda can also cause headaches.

Sleep--kids in middle school need 10-12 hours a night. Less than 10 hours means not being well rested.

Stress--obviously this can result in head pain.

Vision problems--these can definitely cause headaches. Get your child's eyes checked.

Family history--it never falls far from the tree--if a parent gets headaches, the child may be prone to them, too.

For a headache, try giving the child water and ibuprofen. Follow the dosage on the package carefully. Don't give this more than three times a week--more often and call the pediatrician.

If the child wakes from a severe headache or vomits--this may need more investigation.

If it is something like a migraine, they have behavioral and pharmaceutical approaches that can make a big difference.

Wednesday, July 29, 2015

OK, preggos--here goes your excuse

As a lifelong fat person (with a couple of short-lived thin periods), I could not wait to eat for two when I got pregnant.

Now, those killjoy scientists at the Imperial College of London say that pregnancy hormones may make your intestines swell so you can get more nutrition out of a normal amount of food.

Eating for two is unnecessary, they say. "Our internal organs are not a fixed size," one commented somewhat disturbingly.

Wait--these experiments were done in fruit flies. Mice, rat, and cow guts get larger during pregnancy, the scientists noted hopefully.

Keep at it, docs. But for now, the most convincing remark I ever heard about why one does not need to chow down unduly is that the baby is only the size of a peanut and then maybe a pear and then on up. How much does it need to eat? Even full fledged toddlers only eat a few spoonfuls a meal.

Still, I remember scarfing quite a few stuffed grapeleaves. Remember it fondly.

Tuesday, July 28, 2015

Homing in on how drugs actually work in the body

For many drugs, the substance is swallowed or injected and spreads out and affects many body organs and processes. This can lead to so-called side effects.

Now researchers at Columbia have developed a computer algorithm that lets scientists "see" how the drug is producing the effects--the wanted and unwanted ones. This is published in Cell.

Mapping the genome  has allowed doctors to search the entire set of proteins that govern a drug's activity.

Their new approach is called DeMAND (Detecting Mechanisms of Action by Network Dysregulation).

First they create a computional model of the network of protein interactions in a diseased cell. Experiments are then performed to track gene expressions when exposed to the drug. Then DeMAND combines data from the model with that from the experiments to identify the proteins most affected.

It also can identify molecules affected in addition to the target molecules.

Still a work in progress, DeMAND has already found a drug that affects ovarian cancer could, because of the proteins involved, be used to treat bowel inflammation or rheumatoid arthritis, too.

Pretty neat. March on!

Monday, July 27, 2015

Moms can get bad baby advice

I want my pacifier--and I want it now.
One thing almost everyone has an opinion on--how to raise kids. The most bossy--those with no kids. But I digress.

Tara Haelle, HealthDay, says new mothers get conflicting advice. Well, no kidding.

Often this advice goes against that of the American Academy of Pediatrics.

Babies do not come with manuals--or in some cases, there are too many manuals (books). Parents are more likely, studies show, to follow advice from medical professionals--but not always.

Researchers in a recent Pediatrics study, looked at 1,000 mothers with tots between two and six months old. They asked what advice the moms got on vaccines, breast feeding, pacifiers, and infant sleep position and location.

Mothers got most of their advice from doctors--but those doctors did not follow AAP advice.

Fifteen percent of the advice from doctors on breast feeding and pacifiers did not match AAP recommendations. Twenty-six percent on sleep positions contradicted AAP recommendations. And nearly 29% got contradctory advice on where babies should sleep.

Mothers also got advice from family members between 30% and 60% of the time. More than a fifth of the family advice on breast feeding did not match AAP recommendations.

More than a quarter of mothers who got vaccine advice from the media received information not suported by the AAP.

While getting most info from doctors was good--don't be afraid to discuss and question, the researchers said.

I remember the nurse in the hospital handing our daughter to her dad, who joked, "They bounce if they hit the floor, right?" She looked horrified!

Friday, July 24, 2015

Yipes--the kid is bumpy!

Hives are common--I have had them. All of a sudden you get a soft pillowy itchy rash or bump. Then another...

This can go away in minutes or hours. But with children, they may not want to wait.

The causes can be almost anything your largest organ--the skin--decides it does not like--dust, animals, medication, viruses, exercise, stress, cold temps. insect bites, pollen, sun.

To care for your child at home--consider using an oral antihistamine, such as Benadryl. Check doses carefully.

Apply a cool washcloth.

Keep the child's fingernails short and distract the kid from scratching.

If they are really suffering, try a lukewarm oatmeal bath for 10 mins or so. You can get colloidal oatmeal at the drugstore.

Keep the child in loose-fitting cotton clothes.

In summer, turn up the air.

If you know what caused the hives, avoid it. (Duh.)

Also obvious--if the child has trouble breathing or vomits, go to the ER.

Thursday, July 23, 2015

Medicare testing a hospice combined with treatment program

Many people and families want hospice care for patients in the end stages of life--but at present, getting hospice means you are given six months or less to live and agree to stop curative treatments in favor of comfort (palliative) measures.

Over the next four years, Medicare will allow some 150,000 patients to receive hospice but still see doctors and get medical treatments.

Research shows better quality of life and maybe a longer lifespan from combining the two approaches.

Many doctors would prefer this--but were constrained from treatments because Medicare would not pay.

"It's hard to say you don't want more chemo," one doctor added.

So many hospices wanted to be in this trial, they randomly selected half to start in 2016, the other half in 2017.

They will compare these against hospices that did not apply.

Some people worry that unscrupulous hospices may sign up patients that don't need hospice and have nothing to lose because they can still get traditional care.

Well, boo to them! I say it's worth a try. I don't get into it, but our experience with hospice in my mother's case was less than positive. I do know others who swear by it, though.

Wednesday, July 22, 2015

Ew ew, poisonous spiders

Don't even ask where hubbie is.
When I was a tot, they found a black widow spider under our sandbox--turned it over, and there were tons of them! So that was charming. My dad collected they up and put them in a jar and the milkman saw it and wanted them (yes, they had spider-loving milkmen in those days).

Still, there are some poisonous spiders around--in many temperate areas of the US. Suparna Kumar, MD, of the Tennessee Poison Control Center at Vanderbilt, says knowing what they are and how to treat the bites is important.

Brown recluse spiders are native to the southern and midwestern states. They are medium-sized, light yellowish brown to dark brown in color--and have a violin-shaped mark on their backs. They like dark, warm, dry areas--attics, closets, porches, barns, basements, woodpiles, old tires.

If you get bitten by a brown recluse, there may be mild stinging pain that worsens in 2-8 hrs.  The bite may be itchy and red, then becomes an extremely painful area blue or purplish in color, surrounded by a grayish ring. They call this a bullseye.

Wash the area with soap and water, apply ice, maybe get a tetanus shot.

But some people can get the breakdown of red blood cells, fever, rash, muscle pain. A urine test will determine if blood cells are breaking down (don't wait on this with kids under 12). Call a doctor then and you may be be hospitalized.

Black widows are glossy black with a reddish or orange hourglass shape on the abdomen. They are found in dark spaces, electrical boxes, crawl spaces, piles of firewood.

The bite is sometimes not noticeable at first. If it is just a little red, wash with soap and water, maybe apply ice or get a tetanus shot.

But some black widow bites can cause much worse effects. Two to four hours later, you may experience headache, nausea, vomiting, changes in heart rate and BP, muscle cramping, muscle twitching. This requires hosp care.

Sooo...this sounds like fun--watch it reaching into dark places, I guess. Or playing in sandboxes.

Tuesday, July 21, 2015

Women into Facebook less likely to compare bodies

According to researchers at the University of North Carolina, women who are invested in Facebook and have lots of Facebook friends are less concerned with body size and shape and are less likely to compare their bodies to their friends' bodies.

In the study, 128 college-aged women completed an online survey aimed at discovering disordered eating. They were asked such things as did they worry about diet pills, vomiting after meals, or going on fasts.

They also delved into the women's Facebooking--did they post a picture of themselves to get their friends to post a body picture. Apparently few did.

Having a good social support system--even on Facebook--seemed to tamp down negative body feelings.

So much for the theory that being on social media contributes to a bad body image.

Personally--and this is anedotal--I know women who go on Facebook to see if their peers look old. More particularly--older than they do!

Monday, July 20, 2015

LA high school students work with stem cells

Now this is a summer activity. Twenty-one students are participating in hands-on research at Cedars-Sinai.

This is the fourth annual Research Week.

The students never cease to amaze, their mentor said.

They will work all week with scientists and listen to lectures by noted authorities in the stem call area.

Stem calls are part of rengenerative medicine--regrowing or replacing diseased cells.

This should give these kids a boost into research or in some cases, suggest different fields they might want to pursue.

Think about this the next time a young person blasts you with hip hop. They may have another life as a life saver.

Friday, July 17, 2015

Using art to build more observant doctors

Caroline Wellberry, MD, PhD, published a piece in the July 8th Academic Medicine, about using art and fiction to teach physicians to tune in better to patient cues and small symptoms.

She calls it intense and mindful observation.

As face-to-face time with patients decreases, these skills are needed more.

A 2012 study showed that interns and residents spend only 12% of their training in contact with patients.

Reduced time and focus in the physical exam can miss signs such as lesions on fingers suggesting rheumatoid arthritis or facial expressions linked to depression.

Close observation is an essential scientific habit.

A close reading of nature writing reveals not just a forest, but a hustling flurry of activity of small animals and insects.

Poetry has an exactness that can be used in medical care.

Interpreting short narratives can translate to interpretation of patient experiences, which are often presented in a disjointed way.

Close analysis of architecture and design can point out ways hospitals can be made more humane.

Even examining great works of art can reveal goiters and abnormalities in the subjects--aha!

And I would add this would make doctors more well-rounded, more affable, more cultured. Not so sciency all the time.

Thursday, July 16, 2015

Silent heart attacks--you might have had one

Yes, you can have a heart attack without knowing it.

Isn't that special?

You may be stoic--think it's heartburn--or your body may cowboy up to mask the symptoms.

Charles Chambers, MD, a cardiologist at Penn State Hershey, says the five big risk factors for all heart attacks--including silent ones--are high cholesterol, high blood pressure, diabetes, smoking, and genetics.

Typically, heart attack symptonms include chest pain radiating up the neck and down the arm, sweatiness, shortness of breath, and nausea.

In the silent variety, most common in women and diabetics, you may experience deep fatigue, no center-of-chest pressure.

In acute heart attacks, clots form quickly closing off blood flow. In silent ones, smaller coronary arteris have time to grow and form connections that mute symptoms and protect the heart from worse damage.

Sometimes people feel nothing at all--it has to be picked up on an EKG.

Damaged heart tissue becomes scar tissue, but we can tolerate a certain amount of that.

If you did have an episode of terrible fatigue--maybe check it out.

Wednesday, July 15, 2015

Yuck--beach poo

According to the American Chemical Society's publication Environmental Science & Technology, fecal contamination on beaches actually affects sand more than water.

In a study financed by the Univ of Hawaii, when a "No Swimming" sign is posted for contamination, people tend to stay on the sand--but the sand can be 10 to 100 times ickier than the water.

Sewage-polluted coastal waters can lead to stomachaches, diarrhea and rashes.

To see how long these pesky microbes stick around, the researchers created microcosms of seawater and sewage and the communities of microbes degraded much more slowly on the sand.

So--I guess--don't let babies eat sand, don't put sandwiches down on the sand, shower after the beach, pack some sanitizer--or just figure it will boost your immunity.

Make sharks look good, doesn't it?

Tuesday, July 14, 2015

New one for you--Infectobesity

What if--stay with me here--obesity were caused by a virus? Would that help account for the difficulty people have in losing and keeping weight off and the rising incidence of obesity in poor countries formerly suffering from malnutrition?

I first wrote about Dr Nikhil Dhurandhar, now a professor  and chairman of the Department of Nutrition Sciences at Texas Tech, when I was writing for WebMD.

His research is based on the human adenovirus 36, which seems to cause obesity in humans and animals while at the same time reducing blood sugar. At the time I talked to him, he was looking into the virus's making chickens fatter when they were sick. He found this virus in a significant portion of obese humans' blood.

At that time, many universities did not want to get into this--he worked in Canada, I know.

Now at Texas Tech, with a grant he got while at another university, he is focusing on the lowering blood sugar part. He isolated the protein in the virus that does this--and other researchers have replicated his results. Testing in humans may come.

The protein works independently of insulin. This means, if it tests out, it would work with Type I diabetes (absence of insulin) and Type 2 (presence of insulin).

I would like to hear more about the fattening properties of adeno 36. Could it possibly--even in our dreams--be like the discovery that a virus caused ulcers? Something curable causing obesity?

Monday, July 13, 2015

Online symptom checkers horrible diagnosticians

If you get a tummy ache and go to a symptom checker site or app and put in stomach pains, British researchers say you may find out what's wrong only a third of the time. (Br J of Med)

Of course, they often also tell you to go to the doctor.

The study of three symptom checkers showed also that when they listed 20 diagnoses--the answer were there only 60% of the time.

Worse, they also suggested tests or procedures that were not needed.

They loaded 45 more or less real patient vingettes--a third suggesting need for immediate attention (such as a stoke), someone who should see a doctor but was not in immediate danger (ear infection), and someone who could care for himself (cold).

They were risk-averse, the study showed--usually recommending checking with a doctor.

Interestingly, the results matched pretty well with call-in checkers.

All were better than Dr. Google. You have to go to medical school to make sense of some of the hits on Dr. G.

Friday, July 10, 2015

Make exercise into a habit


Developing any habit means a routine--doing the thing over and over.

At Iowa State in Ames, they are studying how to make exercise not only a habit but one that is hard to break.

Alison Phillips, assistant prof of psychology, focuses on instigation habits--habits and cues that make you exercise in the first place. What makes you automatically go to the gym or hit the bike trail?

--For instance, you can always exercise at the end of the day. When the day ends, your car heads for the gym.

--For others, the alarm in the morning may be the cue--time to work out.

It takes a month or longer to lock this in as a habit.

Or you can develop--over a longer period of time--the urge to move after say, sitting many hours.

You need to find the cue that works for you.

For many this may be the instigation habit--you seek some exercise--but the type can vary and thus you avoid boredom.

If all you ever do is jog, that may be a habit, but it is also a rut.

Thursday, July 09, 2015

Disaster--Pimple on the big day

Wedding day, class photo, big date--ack, a giant honking pimple!

Dr Kaleroy Papantoniou of Advanced Dermatology has some tips for emergency action.

--Ice it. Put a cube in a soft cloth and apply to the area for 20-30 seconds. Rest a minute. Repeat. Don't press hard and don't leave it on too long.

--Apply an over-the-counter acne preparation containing benzoyl peroxide or salicylic acid. A 2.5% of  concentration of the benzoyl peroxide is enough.

--Apply an over-the-counter hydrocortisone cream--1%. (Do not use every day--just for emergencies.)

--Eye drops that "take the red out" can reduce redness and irritation. Look for tetrahydrozoline hydrochloride.  You can even chill the drops first.

--Conceal the blemish with a heavy-duty cosmetic concealer. Blend carefully.

DO NOT:

--Pick, pop or squeeze.

--Don't use aspirin, toothpaste or other home remedies.

--Don't expect a facial or chemical peel to be a quick fix.

--Don't overuse astringents. Natural astringents include witch hazel and and lemon juice (dilute with water),

--Don't use undiluted tea tree oil.

For a total emergency, your doctor could inject low potency cortisone. That would have to be some hair-on-fire emergency!

Charles of the Ritz used to make a preparation called DISASTER CREAM...liked that name.

Wednesday, July 08, 2015

Anti-vaccine parents coming around

According to the University of Michigan, compared to a year ago, 25% of parents surveyed said they now consider vaccines safer than they did. Seven percent said less safe. And 68% said they felt the same as a year ago. (C.S. Mott Children's Hosp poll)

Possibly affecting these numbers were the many outbreaks of measles and whooping cough across the country.

One-third of the parents surveyed said they now saw more benefits from vaccines. A fourth said vaccines were safer than a year ago.

Rsearchers said such a large shift was "quite remarkable."

Are the vaccines "safer"? Most doctors say they weren't that unsafe to begin with. But if people believe this, more will be vaccinated.

We will all benefit--so the "benefits" are better.

Tuesday, July 07, 2015

"Here comes the sun" (no, not what you think)

I remember the positive thinker Norman Vincent Peale saying when he got depressed he just thought about the sun and felt better.

I have tried it--it works!

The Univ of Southampton, Oxford, Manchester, and Newscastle--they did a  study of musical lyrics about weather.

More than 900 songwriters or singers have written or sung about weather. The most common--Bob Dylan, followed by John Lennon and Paul McCartney. Seven percent of weather-related songs are in the 2011 Rolling Stones release of the top 500 greatest songs of all time.

Frequently more than one type of weather is mentioned--indicating a range of emotions.

These can range from Bob Dylan's "Blowin' In the Wind," to "Bus Stop" by the Hollies.

The study was published in the journal called Weather.

Observations: Some songs, such as the 1969 hit "Here Comes The Sun" (Geo Harrison), were based on the first day of spring or something mundane. But they also noted that bad weather was more evident in the stormy 50s and 60s, as opposed to the quieter 70s and 80s. I would dispute the 50s were so stormy or the 70s so quiet. Also "you don't need a weatherman to know which way the wind blows" did not mean a weatherman like on the news.

But hey.

For the list, go to  http://bit.ly/1lfrtoL . You can also add more songs if you know of some.


Monday, July 06, 2015

Focus on dignity and respect for patients

Everybody knows your dignity goes out the window in the hospital--those backless gowns (ask for two and put one on backwards to cover your fanny), people calling you sweetie and hon (or "youngster," the WORST for older people), ignoring people who can't articulate needs quickly and clearly, on and on.

My mother, who suffered from dementia, was once in the hosp with a urinary infection and they got sick of taking her to the john, so they told her to just go in her pants and they would clean it up later. She was crying because she didn't want to.

Beth Israel Deaconess Medical Center, a big woo teaching hospital in Boston, has done pretty well in cutting physical injuries to patients and is now zeroing in on emotional injuries.

"Emotional harms can erode trust," says the doc in charge of this initiative.

When patients evaluate care, sure enough, they tend to focus on emotional slights.

Thy started a database of emotion complaints similar to the physical hard one. They defined emotional harm as failure to respect the patient as a person. Inlcuded were things not resulting from lack of respect, such as the person requiring a colostomy bag.

I remember once being hospitalized and refusing to get weighed. I did not require medication based on weight. I have found--over time--that the first-thing weigh-in tends to slant every comment and treatment toward weight. They put on the white board that I refused to get weighed. This was supposedly to alert new caregivers coming on, but one took it as a challenge--she used the scale in the bed to weigh me and then triumphantly announced my weight.

Well,, good for you, honey--I never went to that hosp again.

Friday, July 03, 2015

Don't blow off a finger--OK?

I guess most people know fireworks are explosives and explosives are dangerous.

Even so-called "safe ones," such as sparklers, can be 2000 degrees F.

In 2014,  more than ten thousand people turned up in ERs with fireworks injuries. Most of t these were around July 4, of course.

Keep these away from kids--even if you supervise--more than half of kids injured were being supervised. Dad--hear that?

Some safety tips:

--Observe all local laws.
--Never allow kids to play with or light fireworks--even sparklers
--Older children should be closely supervised
--Buy from reliable sellers
--If packaged in brown paper--they may be for public use and thus filled with lots of whallop
--Read and follow labels (again, Dad)
--Be sure everyone is out of range before lighting
--Light fireworks on smooth dry surfaces--never around dried grass or leaves
--NEVER relight duds that did not go off!
--Light one at a time
--Dispose of by soaking in water 15 mins after firing and then put in trash
--Never light fireworks in a glass or metal container
--Never point fireworks at someone, even in fun
--Don't carry fireworks in your pocket
--Whoever lights the fireworks should wear ear and eye protection
--Use long matches, not cigarettes or lighters
--Never shorten or lengthen a fuse

Whew.

We used to wave sparklers around. I loved those curling black snake things...but they were hot, too.

My father also had a little cannon his dad had brought back from the Spanish-Am War. He set it off on the Fourth. The police always showed up. But then they started helping.

A different time, no doubt. But wouldn't you rather eat ice cream than sit in an ER?

'

Thursday, July 02, 2015

Scoliosis usually spotted in school age kids

Scoliosis is a disorder in which a normally straight spine curves to one side.

It affects 2-3% of the population (National Scoliosis Foundation). This is 6-9 million people.

It  is found in all ages, but mostly develops in kids from 10 to 15 and is most common in girls.

Parents most often notice it and it can be detected in screenings at school. Eighty to 85% of cases have no known cause, although it does seem to run in families.

It also apparently cannot be prevented, no matter how much you emphasize good posture. So don't feel guilty, parents.

Scoliosis can sometimes seem like it appeared overnight. The curve of the spine may be waiting for a growth spurt to become evident. One should may seem higher than the other. On hip may be higher.The head may seem off-center. When the child bends forward, one side of the back may seem higher than the other.

According to Fabien Bitan, MD, an spinal surgeon at the Atlantic Spine Center, the treatment starts with observation and repeated examination (curve under 25 degrees). Maybe every six months.

Bracing may be recommended to keep the curve from getting worse. Some braces are worn all the time, some at night. They don't reverse the curve but can keep it from getting worse. If the curve stays below 40 degrees until the child stops growing, it will slow, gaining maybe one degree a year.

Surgery is only recommended when the curve is more than 40-50 degrees, bracing has not halted it, and the patient is still growing.

Alternative treatments such as physical therapy, electrical stimulation, or chiropractic don't work.

If someone says your child has this, learn about it, involve the child, and provide a lot of encouragement.

Usually it will not interfere with normal childhood.

Wednesday, July 01, 2015

Please secure windows

Children climb up, explore everyplace, they are fast--and they fall out of windows.

Falls from windows cause more serious injuries than any other fall kids take.

They studied this at Loyola.

--Keep furniture away from windows--esp cribs, changing tables, or anything kids can use to climb. (My ex could climb out of his crib before he could walk.)

--Screens keep insects out--but don't keep kids in! Use a window guard (Google)--one that releases in case of fire.

--Or use window stops that only allow a 4-inch opening. (I used to put a nail in the side of the sash.)

--Keep windows locked when you can.

--Do not allow kids to play on balconies or roofs.

--If you can put chips or grass beneath windows.

This child is thinking about the window--you are not. You must think about it ahead of time.