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  • 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.
  • 8/16/2018 I recently had to remove some toenails. Why on earth would someone want that done? Because they were infected with fungus. The medical term for a fungal infection of the toenails or fingernails is onychomycosis (OM).
    This condition is generally more of a nuisance than a real health threat. However, infected nails can become quite enlarged and painful. Diabetics and people who have poor immune function need to be concerned about OM. Infected nails in these folks can lead to inflammation of the skin around the nails and entry of skin bacteria that can lead to serious skin and even bone infections.
    Most people visit their doctors for OM because of the ugly nails. It is the most common nail disorder in adults and affects up to 13 percent of North Americans. It is 30 times more common in adults than children.
    OM is caused by three types of fungi. The vast majority of these infections are caused by fungi that invade and feed on hair, skin and nails. These organisms are called dermatophytes and account for 90 percent of OM. Trichophyton rubrum (70 percent) and Trichophyton mentagropytes (20 percent) are the most common dermatophytes.
    Yeasts and molds cause the remaining cases. It’s often difficult to tell what organism is causing the infection without doing a culture in the lab which is usually recommended prior to starting treatment.
  • HAMILTON HEALTH - Leaflets Three…Let It Be!
    8/4/2018 

    We’ve had pretty good weather so far this summer, allowing many of our readers to commune with nature.

    This has resulted in a lot more rashes showing up in my office. Most of this contact dermatitis was likely caused by poison ivy, one of three plants in Indiana in the genus Toxicodendron. This genus also includes poison sumac, and occasionally poison oak.

    The physical appearance of the poison ivy plant is highly variable, though it always has leaves in sets of three (see illustration). A memory aid from my days as a Boy Scout lets me recall what it looks like – “leaflets three let it be, berries white a poisonous sight.”

    The white berries can sometimes be seen in wintertime. The plant is small and low to the ground when young. As it grows, it can be found in various sizes all the way up to thick vines attached by small red roots to trees or other structures.

    The rash of poison ivy, like most contact rashes, results from the reaction of the immune system to a foreign compound on the skin. The compound binds to skin cells, is recognized by the immune system, and attacked. 

  • 7/29/2018 

    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. It also allows these structures to glide more easily over each other.

    Here’s a fun activity for the kids; make your own bursa by putting just a little water in a small balloon.

  • 7/22/2018 

    I continue to be amazed when I ask women what the No. 1 killer of women is.

    The majority respond, “breast cancer.”

    While breast cancer is the No. 1 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 10 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 and potentially disfiguring? Is heart disease just plain boring to talk about?

  • 7/15/2018 

    I saw a young athlete two weeks ago who complained of shin pain.

    He had been upping his running mileage; the pain was due to a stress fracture. It is estimated that between five and 30 percent of athletes and military recruits develop a stress fracture each year. Briefhaupt first described the condition in 1855 when examining military recruits.

    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 – the bone looks like a broken stick. Stress fractures, however, can be much more difficult to diagnose.

    Stress fractures 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.

  • 7/8/2018 

    Kidney stones are a topic near and dear to my heart as I’ve had the distinct pleasure of passing 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.

  • 7/1/2018 

    This week I want to tackle the subject of generic vs. name brand medications.

    There are a number of reasons this topic is important. First of all, medications in general are becoming prohibitively expensive for many patients. Insurance companies are also pressuring patients and physicians to prescribe generics whenever possible to reduce health care costs (not necessarily a bad thing, but certainly a pain in the rump at times).

    I receive many questions about generics in the office. People want to know why every medication doesn’t have a generic substitute and if not, how long will it be until one is available. They also want to know if they are safe and effective.

    First, let me describe what generic and name brand drugs are. Generic drugs are chemical compounds that either never received patent protection or the patent on the name brand drug has expired. In contrast, name brand drugs are protected by a patent, meaning no other companies can produce or sell that particular drug.

     
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Thursday, October 18, 2018

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