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  • 5/20/2018 As we approach Memorial Day (remembrances to all those who gave the ultimate sacrifice), it’s time to start thinking about the dog days of summer. 

    Although I don’t see a significant number of heat-related emergencies in my office, many patients do end up in emergency departments suffering from heat exposure.

    Deaths from heat-related illness range from 300 to several thousand per year in America. The number is increasing with our warming climate and is markedly increased during heat waves. There are tens of thousands of visits each year to doctors’ offices and emergency rooms. 

    Risk factors that make one more prone to heat-related illness include being elderly, very young, or obese. Some prescription or even non-prescription drugs, particularly alcohol, cocaine, antihistamines, beta blockers, diuretics, ADD/ADHD medications and some psychiatric medications can increase the likelihood of heat illness. Workers, such as firefighters, who have to wear heavy clothing, are also at a high risk. 

    Absorbing too much heat from the environment or producing too much heat internally can lead to heat illness. The two main types of heat illness are heat exhaustion and heat stroke.
  • 5/13/2018 Readers have asked me to address more summer safety issues. It’s great to see kids and adults out on their bicycles now that the weather has warmed up (especially kids who aren’t sitting on the couch). This will undoubtedly result in more bike accidents. Some of the saddest experiences I had during my Family Medicine residency were to have to take care of kids who were brain injured as a result of a bike accident.

    In 2015, there were 818 deaths from bicycle accidents in the United States, an increase of more than 12 percent. Most of these deaths were the result of head injuries from people being hit by or running into automobiles. Bike accidents account for about half a million visits to emergency departments each year and account for more than $10 billion in health care costs.

    While most kids own bike helmets, often they tell me they don’t wear them. Parents often bring up the fact they never wore a helmet when they were kids. Most of the time, the reason is because helmets didn’t exist when they were kids.

    Helmets really do work – wearing one decreases the chance of a serious head injury by more than 50 percent and serious face and neck injuries by 33 percent. Those wearing helmets have less than a 17 percent chance of dying from a bicycle accident – a marked improvement from pre-helmet days. Deaths for persons less than 20 years old have decreased 88 percent since 1975. 
  • 5/6/2018 It’s finally getting warm outside – time to starting thinking about summer. This week, I want to briefly review some sun and water safety tips.

    Most people enjoy a good day in the sun. Whether it’s lounging by the water or working outdoors, we all get our fair share of sun every summer. Everyone knows you can get a burn if you’re out in the sun too long. However, many people don’t realize that you can still get a burn in the shade or on a cloudy day. Ultraviolet rays come in two forms: UVA and UVB. UVA accelerates aging of the skin, while both UVA and UVB can cause skin cancer.

    Sunscreen lotions work by absorbing the UV rays before they penetrate into your skin and cause damage. They can be effective, but only if used properly. Dermatologists will all tell you it’s safer to use physical blocking agents like widely available sun-protective clothing and wide-brimmed hats.

    Sunscreens are rated using the “SPF” scale. Don’t bother with lotions with an SPF below 15. An SPF of 15 theoretically allows you to stay in the sun 15 times longer before you burn. However, the effectiveness does not last near that long since the lotion usually wears off from sweating, swimming, or friction.
  • 4/29/2018 The summer sports season will start soon as will gardening and other outdoor chores. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal injuries busy. I want to give everyone some pointers in how to take care of the inevitable sprains and strains of summer.

    It’s interesting to me how many people come to my office after suffering an injury and don’t have any idea how to do some initial first aid. It’s extremely important to treat injuries immediately to prevent additional damage and disability.

    When a musculoskeletal structure is injured, a biochemical chain reaction is triggered to attempt to heal the injury. Injured cells release various messengers that start the process, but this also results in pain and swelling. The intent of this inflammation is to get the person to rest the injured area so it can heal. However, for an athlete or anyone trying to get back to play or work as soon as possible, this can prolong the time it takes to get back to normal function.

    The goal of orthopedic and sports medicine is to promote healing of an injury, but to also speed up the recovery process. The best way to do this is to prevent or slow the normal inflammatory chain reaction. It’s very simple really. The only memory aid you have to recall when you are injured is the word “RICE.”
  • HAMILTON HEALTH - The Season of Sneezing
    4/23/2018 

    It’s once again time to run my annual column on allergies. Many of our readers are probably already cursing the annual return of allergy symptoms. The pollen levels in Indiana are already ramping up as spring (hopefully) arrives for good.

    Allergies are a major problem for many people. When allergy sufferers are asked about their quality of life, they generally rate allergies as more bothersome than heart disease and sometimes even cancer. There are many causes of allergies, but I want to focus on the seasonal type.

    Seasonal allergies are caused by pollen. Pollen actually contains a plant’s male DNA; it is analogous to sperm in animals. The goal of any biologic organism is to spread its genes as far and wide as possible. Pollen is the perfect vehicle to accomplish this task.

    There are two main categories of pollen – anemophilous (wind-loving) and entomophilous (insect-loving). Anemophilous pollen is very lightweight, which allows it to move great distances, particularly on windy days. In fact, engineers have used the geometric shapes of some of these pollen grains to design golf ball dimples to help the balls fly farther.

  • 4/16/2018 I’ve received a request to write about thyroid gland problems. Thyroid problems are common in a family medicine setting. For those who don’t know what the thyroid gland is or does, keep reading.

    The thyroid is an endocrine gland found in the front part of the neck below and to the sides of the larynx or Adam’s apple. Endocrine glands make hormones that are secreted into the bloodstream. The hormones then travel around the body and interact with cells in different tissues, like tiny fingers that flip switches on cells to tell them to perform particular functions.

    The primary job of the thyroid gland is to control metabolism (energy use) in our cells. It does this by producing two hormones, T4 (thyroxine) and T3 (triiodothyronin). Both of these hormones contain iodine which is why iodine is so important in our diets.

    Our cells have hormone receptors on their cell membranes that act as sensors to constantly monitor body functions and tweak them to maintain “homeostasis,” a balanced internal environment. Biochemical systems that maintain homeostasis are extremely elegant. Some work like a furnace thermostat that turns the furnace on or off based on the temperature in the room. Instead of using wires and electricity to communicate, the body uses the circulatory system and hormones as chemical messengers.
  • 4/8/2018 Snoring can certainly be annoying, but it doesn't always indicate a serious medical problem. This week, however, I do want to focus on a harmful condition that can be associated with snoring – sleep apnea.

    Sleep apnea is a condition where people have pauses in their breathing while sleeping. Most people have pauses to some degree, but people with sleep apnea have much longer pauses, sometimes lasting up to 30 seconds. These long pauses cause the level of oxygen in the blood to drop and carbon dioxide to rise. These changes can be very hard on the body, especially the heart and lungs.

    There are two main types of sleep apnea – central and obstructive. Central sleep apnea is a problem with how the brainstem sends signals to the breathing muscles. It is not a very common cause of sleep apnea in adults; obstructive sleep apnea (OSA) is seen much more often. 

    Obstructive sleep apnea is caused by any type of obstruction to the flow of air in and out of the lungs. This usually occurs in the back of the throat when excess or loose tissue collapses into the throat when the throat muscles relax during sleep. This is why OSA is much more common in obese individuals – they have a lot of extra tissue in their throats.
  • 4/1/2018 I’m running through my list of suggested topics from readers, and this one goes out to a reader from Sheridan. It’s a common problem, but one of those topics that doesn’t usually come up in casual conversation - constipation.

    There are three common times in a person’s life when constipation can become a problem. The first is during early childhood, the second when a person has decreased activity for some reason, and the last is during the elder years. Each one has different causes.

    First, I have to deliver yet another lesson in basic anatomy and physiology. When we eat, food travels through the following structures: mouth, esophagus, stomach, small intestine and, finally, the large intestine. This journey is facilitated by peristalsis, a process where involuntary muscles in the wall of the digestive tract contract to move food from north to south.
  • 3/25/2018 

    Last week, I tried to explain the very complex non-Hodgkin lymphomas (NHL). This week, I want to cover Hodgkin’s lymphoma, more commonly known as Hodgkin’s Disease (HD). It gets its eponymous name from Dr. Thomas Hodgkin, who first described it in 1832.

    Hodgkin’s is a potentially curable malignant lymphoma and carries a much better prognosis than non-Hodgkin lymphomas. It is a very specific type of lymphoma that is defined by its microscopic appearance and by specific proteins that are found on the cell membranes of the tumor cells.

    The estimate for 2017 was that there would be 8,260 new cases of Hodgkin’s Disease (4,650 men and 3,610 women) and 1,070 deaths (630 men and 440 women). It is more common in whites and slightly more common in men, except in childhood where 85 percent of the cases are found in boys.

  • 3/19/2018 

    One of my patients asked me recently what lymphoma is. I must admit my knowledge of the subject is limited; it’s a medical condition I’ve tended to avoid because of its complex and changing nature. It can, however, be a very interesting disease and a type of cancer that is illustrative of where cancer treatment in general is heading in the years to come.

    “Lymphoma” is a broad term used to describe a large number of “lymphoid neoplasms.” A neoplasm is an abnormal growth of cells that can be benign (not usually dangerous to one’s health) or malignant (cancerous). Lymphoid neoplasms are composed of cells found in the lymph system. This system is responsible for filtering out and killing foreign things in our bodies, especially infectious agents.

    The lymph system contains two types of specialized cells that can kill these foreign invaders either directly (T cells) or indirectly (B cells). B cells produce antibodies that bind to the germs to help remove them from the body. It is these B and T cells that multiply out of control resulting in lymphomas.

     
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