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  • 10/22/2019 “All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.” - Hippocrates
    Few things benefit the body more than maintaining physical fitness. While doctors routinely recommend exercise for younger patients, we’re realizing how important it is for our older patients as well. Regular exercise, even in one’s senior years, can still reduce your risk of a number of health conditions, particularly heart attacks, strokes, and falls. It also may be one of the few things to slow the onset of dementia.
    Most communities are blessed to have many options available for exercise, especially programs that are supervised. I prefer these activities because a trained professional typically leads the group. This person can make recommendations to get the most out of a program in the safest way possible.
    Why is regular exercise so important for seniors? You may have noticed that as our bodies age a number of physiologic changes occur. We lose muscle mass and tone that leads to weakness and problems with balance. Flexibility becomes an issue (the most common cause of night time leg cramps). Our bones become weaker from a lack of weight-bearing activity. Balance problems and weak bones can lead to falls and fractures. Our hearts and lungs can get out of shape, resulting in reduced stamina and difficulty breathing with activity. This can lead to a reduced level of confidence & independence.
  • 10/8/2019 The title of this column, a quote from comedian W.C. Fields, refers to his penchant for drinking alcohol. So what do alcohol and W.C. Fields have to do with my topic of rosacea? Read on. 
    Rosacea is a common skin condition usually found on the face, which can be a great source of consternation. It is a disease with various clinical signs. These can include redness/flushing, coarse skin, and bumps and pustules resembling acne. It may also present with visible superficial blood vessels called telangiectasias. 
  • 10/1/2019 I’ve had a number of requests to re-run my column on shingles. I think the increased interest has been brought on by the television ads for the Shingrix® vaccine to help prevent shingles. These ads are quite accurate and compelling. I’ve had quite a few patients who have recently been suffering from this malady, two quite severely.
  • 8/26/2019 The joy of summer sports and yard work has resulted in a number of patients coming to see me complaining of sore shoulders, elbows, hips and knees. Many of these folks have been suffering from bursitis. Most of you have probably heard the term, but what is it? 
    Any time a medical term ends in the suffix “itis,” it indicates inflammation of the tissue or organ involved. In this case, bursitis is an inflammation of a bursa (pleural bursae or bursas). Bursa is Latin for purse, a very good descriptor of what it looks like – a small sac made of connective tissue. 
    A bursa is lined by a synovial membrane that secretes fluid into the sac. This turns the bursa in to a little pillow filled with a slippery liquid that helps cushion structures around it, while allowing them to glide more easily over each other. You can have fun with the kids (or yourself) by making your own model of a bursa. Put a little water in a small balloon and put an object like a book on top of it and roll it around on the table to get an idea of how bursas work. 
    Our bodies contain many bursas. The ones that cause the most problems are found in the shoulder, elbow, hip, and knee. These joints are fairly complex and have many bones, tendons and ligaments that intersect and move over each other. Without the aid of bursas, these structures would rub together, causing a lot of pain as well as wear and tear.
  • 8/21/2019 I continue to be amazed when I ask women what the number one killer of women is, the majority respond, “breast cancer.” While breast cancer is the number one cancer killer of women, and is estimated to have claimed about 40,000 women last year, it is not the biggest threat women face. It’s estimated that ten times that many died of heart disease last year.
    Cardiovascular disease is arguably the most important women’s health issue, and is largely preventable. How can women be so unaware that they have a one in 31 chance of dying from breast cancer but a much higher one in three chance of dying from heart disease? Could it be that breast cancer gets so much more coverage in mainstream and social media? Is breast cancer generally more frightening & potentially disfiguring? Is heart disease just plain boring to talk about?
  • 8/8/2019 I saw a young athlete last week who complained of shin pain. He had been upping his running mileage in preparation for the cross country season. The pain was due to a stress fracture. It is estimated that between 5 and 30 percent of athletes develop a stress fracture each year. Briefhaupt first described the condition in 1855 when examining military recruits, another group that frequently suffers this injury. 
    Everyone is familiar with bone fractures, especially those that result from acute trauma. These fractures are usually easy for an untrained person to see on an X-ray where the bone looks like a broken stick. Stress fractures, however, can be much more difficult to diagnose. 
    Stress fractures, as the name implies, result from repeated stress on the bone. This repetitive microtrauma causes disruption of the microscopic structure of the bone over time that eventually exceeds the bone’s ability to heal itself. A tiny crack subsequently develops in the bone that may or may not be obvious on an X-ray. Think of bending a piece of metal over and over; eventually it weakens and breaks.
    Stress fractures typically occur in bones that are prone to repetitive stress based on particular sports. The fractures can involve any bone, but the most common locations and their associated sports include the leg, hip and foot (runners & jumpers), the spine (gymnasts, divers & volleyball players), arms (throwers), and ribs (rowers). The forces experienced by bones in the feet and legs can be up to twelve times a person’s weight. Stress fractures are one of the five most common injuries in runners and account for up to half of injuries in soldiers.
  • 7/30/2019 Kidney stones are a topic near and dear to my heart as I’ve had the distinct pleasure of having four of them. Stones are also known as calculi, from the Latin for pebble. They can form and stay in the kidneys (renal calculi or nephrolithiasis) or move down the ureters, the tubes connecting the kidneys to the bladder (ureteral calculi or urolithiasis). Stones may also be found in the bladder.
    The ureters are very small tubes that contain smooth muscle cells. These cells contract involuntarily to help move the urine from the kidneys to the bladder. When a stone is too large to pass down the ureter, it can partially or completely block the flow of urine, causing pressure to build up. This pressure, along with contractions of the muscles in the ureter, causes deep, severe, unrelenting pain known as ureteral colic. Stones may also cause blood in the urine.
    The peak onset of kidney stones is in the third and fourth decades. It is rare after age 60. Men have about a 12 percent lifetime chance of developing a kidney stone while women have a seven percent chance. Interestingly, stones are more common in the Southeastern United States. The chance of developing a recurrence of stones is 14 percent at one year, 35 percent at five years, and 52 percent at ten years.
    Stones form when the urine becomes supersaturated. This means that minerals and compounds in the urine become so concentrated that they start to form crystals. These eventually grow to form stones. Maintaining adequate fluid intake to keep the urine diluted is therefore very important in reducing the risk of stone formation. Other types of stones may be formed by infection in the kidneys. 
  • 7/10/2019 Barbecue season is in full swing and it’s a good time to review food safety. Food-borne illness is something that almost all of us have experienced at some point in our lives.
    Food-borne illness is defined as more than two people having a similar illness with evidence of food as the source. The overall rate of these illnesses has gone down drastically in the last century with improvements in food handling and sanitation. However, we still hear about illness outbreaks.
    There are approximately 76 million cases of food-related illness in the United States each year. There are also about 325,000 hospitalizations and 5,000 deaths. Underdeveloped countries, as a group, experience about one billion cases annually and four to six million deaths.
    The Centers for Disease Control estimates that 97 percent of all cases of food-borne illness come from improper food handling. Most of these (79 percent) are from commercial establishments, while the other 21 percent originate in the home.
  • 6/4/2019 Summer is just around the corner which means I’ll start to see patients complaining of “swimmer’s ear.” Doctors tend to see more of this malady in hot, humid weather, but it can also be brought on by other conditions as well.
    The medical term for swimmer’s ear is otitis externa, indicating inflammation of the external ear. This is in contrast to the more common otitis media, or infection of the middle ear (the air filled cavity just behind the ear drum).
    The number of people who suffer from swimmer’s ear is about four per 1,000 per year, or about three to five percent of the population. It afflicts males and females in equal numbers and tends to present between seven and twelve years of age, though older people can certainly be afflicted.
    The wax (cerumen) that everyone is always trying to get out of their ears is actually there to protect the external ear canal. There exists a delicate balance of too much or too little cerumen. If there is not enough present, the ear canal can dry out, crack and develop infection. If there is too much, the ear canal can become too moist. This leads to swelling and breakdown of the skin lining the ear canal.
  • 5/20/2019 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 2017, there were 783 deaths from bicycle accidents in the United States, a decrease of about 7 percent from the previous year. 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 over $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 that they never wore a helmet when they were kids. Most of the time, the reason is because helmets did not exist when they were kids.
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Tuesday, October 22, 2019

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