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  • 12/10/2018 My patient Jim asked me to re-run my column about warts. They are very common—it’s estimated that up to 12 percent of people worldwide have had warts and that 10 to 20 percent of school-aged children have them at any given time.
    Warts are caused by a group of viruses called human papilloma viruses (HPV). When people hear HPV they often think of genital warts that are caused by particular strains of HPV virus, some of which have been associated with cervical, mouth and throat cancers. There are over 100 known types of HPV, all of which share the characteristic of being able to infect skin cells.
  • 12/3/2018 An adult patient asked me to write about night terrors. While night terrors can be seen in adults, they are much more common in children. It’s hypothesized that this has something to do with brain development in these children. 
    Night terrors are a subclass of sleep patterns called parasomnias (para-, meaning abnormal, and -somnia meaning sleep). Rather than focus specifically on adults, I’d also like to talk a bit about kids. People who exhibit parasomnias often have family members who suffer from them as well. Virtually all of these conditions go away with time.
    Parasomnias are a category of sleep disorders defined by abnormal and unnatural movements, behaviors, emotions, perception, and dreams.
  • 11/26/2018 My partners and I are starting to notice an uptick in patients walking in to hospitals and imaging centers to have heart and lung CT screening tests, usually after seeing them advertised by the facilities doing the testing. The results often show up in the patients’ primary care providers’ inboxes without any prior knowledge that their patients had the examination(s). The scans typically have out-of-pocket costs in the $49 to $99 range and are not covered by insurance. They are promoted to identify early heart disease and/or lung cancer. 
    Unfortunately, many of these scans are done inappropriately, and without a prior discussion of their utility and limitations. There are definite indications for the tests, but it’s also important to know the risks including false positives (seeing things on the scans that have no medical significance, yet cause a great deal of angst for patients), false negatives (not seeing something that is actually there), as well as exposure to radiation.
  • 11/19/2018 The cold weather is finally arriving and it’s time to prepare for the flu. Most people us the term “flu” in a very generic sense, meaning anything from cold symptoms to having a case of vomiting and diarrhea. The “flu” in this column refers to respiratory influenza. Since 2010, the number of deaths from influenza has ranged from 12,000 to 79,000. Hospitalizations have been between 140,000 and 960,000 and total cases between 9.3 and 49 million.
    Influenza is caused by viruses with Type A and Type B causing the majority of infections. Type B typically does not cause severe disease, whereas Type A can be lethal, particularly in the young, elderly, and those who have compromised immune systems. 
    Type A virus can be broken down further into different subtypes or “serotypes” based on which proteins are found on the surface of the virus.
  • 11/14/2018 A patient whose mother is having hearing difficulties asked me to write about the best way to choose someone to fit hearing aids. I’d like to begin with some background on hearing.
    It goes without saying that hearing is one of our most important senses. It is critical for our quality of life as well as for safety and social interaction. There are an estimated 30 million Americans who have some degree of hearing loss, 65 percent of whom are younger than 65 years of age. It’s very concerning that one in 14 younger adults and one in 20 adolescents have measurable hearing loss.  Since 1971, the number of Americans over three years old with hearing disorders has doubled.
  • 10/29/2018 This week I want to address a specific variant of a condition that I’ve been seeing a fair amount of lately – dizziness. Primary Care doctors in the U.S. see about six million patients a year with dizziness. 
    Dizziness means different things to different people and can be a symptom of many different medical conditions. People usually describe being dizzy when they either feel faint or lightheaded or when they feel like their environment is spinning. This latter sensation is called vertigo, from the Latin vertere meaning, “to turn.” 
    I want to touch on the most common cause of vertigo, known as benign paroxysmal positional vertigo or BPPV. Benign means the condition is not dangerous, paroxysmal indicates it occurs in a recurring pattern for short periods of time, and positional refers to the vertigo being brought on by changes in position. 
  • 10/22/2018 This week I’d like to write about a problem that costs taxpayers billions of dollars each year – Medicare fraud and abuse.  Medicare paid out $702 billion in payments for services and medications in 2017, accounting for 15% of the federal budget.  The Office of Management and Budget (OMB) reports that 4.5% of those payments were “improper,” meaning the services were not necessary, did not meet Medicare guidelines, or were downright fraudulent (a slight decrease from 2016).
    Medicare fraud refers to individuals or companies who obtain payments from Medicare under false or illegal pretenses. The OMB has been making a concerted effort to limit Medicare fraud, but Medicare is an easy target since it is such a complex program. It’s like playing the lottery for those who are intent on defrauding the government, but with a much higher chance of a payoff.
  • 9/10/2018 I’ve had requests to re-run my column on shingles. I think the increased interest has been brought on by the television ads for the vaccine to help prevent shingles, which are quite accurate and compelling. I’ve had quite a few patients who have recently been suffering from this malady, two quite severely.
    Shingles is caused by the Varicella-zoster virus (VZV). The virus is also known as chickenpox virus, varicella virus, and zoster virus. It is a member of the herpes virus family, of which eight strains are known to infect humans. 
    The biology of herpes viruses is very interesting. They infect humans through the skin and mucus membranes that line body openings.  The initial or “primary” infection results shortly after exposure to the virus. This usually causes itching and redness of the skin followed by development of small fluid-filled blisters known as vesicles. Some readers may have seen chicken pox, though it is becoming a very rare disease since the advent of the childhood vaccination to help prevent the disease.
  • 8/27/2018 The arrival of warm weather each year means we have to start worrying more about Lyme Disease. Most people are aware of the association between tick bites and Lyme disease, but few know exactly what Lyme disease is or what causes it. Indiana has seen an increasing number of confirmed cases of Lyme disease, particularly since 2013. The most recent statistics from 2016 showed 127 confirmed cases in Indiana.
    Lyme disease received its name in the late 1970s when a number of children around Lyme, Connecticut developed arthritis. The actual disease has been described since the early 1900s. It is mostly found in New England as well as Wisconsin and Minnesota. When a case does occur in Indiana, the news spreads rapidly, sometimes inciting panic. Most infections (85 percent) are seen in the spring and summer with the remainder in the fall. 
    Ticks do not actually cause the disease, though they do carry the organism that does cause it, the spirochete Borrelia burgdorferi. Spirochetes are bacteria that have a spiral shape. Another common misconception is that any tick can spread B. burgdorferi infection, when in fact only Ixodes (deer) ticks carry the organism. The accompanying photo shows a deer tick on a fingernail – they are very small.
    The B. burgdorferi organism, during its various life stages, mainly infects field mice and white tailed deer. Humans are innocent bystanders when we wander into deer habitat. The ticks lie in wait on the tips of grasses and shrubs and crawl onto us as we brush by. They then crawl about until they find a nice tender spot where they attach and begin to feed.
  • 8/19/2018 Health care at the end of life has been a popular discussion topic over the last few years. It has come up for discussion as we continue to search for ways to deliver compassionate, more cost effective care. Excellent books such as Dr. Atul Gwande’s book, Being Mortal: Medicine and What Matters in the End, have also popularized the topic.
    As a family physician, I see it as my professional duty to discuss end of life planning and care with my patients. In fact, when appropriate, I would consider it negligent to not hold these discussions. 
    To put this discussion in financial perspective, about 30 percent of Medicare expenditures are paid out in the final six months of Medicare recipients’ lives. This equates to about $6 billion a year. This would be money well spent if it went to improving health or quality of life, but most of it does not.
    However, this should not be a simple dollars and cents discussion. Determining a patient’s wishes regarding end of life treatment is both sensible and humane. Forcing patients to have treatments to keep them alive against their stated wishes is irrational and degrading.
    I suppose I have served on numerous “death panels.” I am guilty of having guided my patients and their families to help them recognize the importance of advance planning as well as carrying out those plans when the time came. It can be heart-wrenching for patients, families and their doctors. Allowing someone to die with dignity is aptly described in the modern Hippocratic Oath: “I will keep them [the sick] from harm and injustice.”
    To help patients put their wishes on paper, I want to briefly describe the advance directives that are available in the State of Indiana. Everyone should have one or more of these documents when they feel the time is appropriate. I like to start the discussion when my patients turn 50 or even younger, particularly if they have other chronic diseases.
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Monday, December 10, 2018

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