How do I prepare for the flu season?

The Center for Disease Control and Prevention recommends an annual vaccine for everyone 6 months old and up.  This is by far the most important step in preparing for the flu season.  Every year an epidemic occurs, and several thousand people die from the Influenza virus. 

The Influenza virus vaccine contains the 3 most common strains for the year.  Although many different strains can occur, the most common found strains are covered in the annual vaccine.  So it is still possible to get a “flu” if you have been vaccinated.  You cannot get the flu from the vaccine itself since the viral particles are dead.  However, the sense of illness you may get from the vaccine is your immune system just doing its job by revving up your body’s inflammation and immunity chemicals. 

This year’s vaccine is the same as last year containing the H1N1, the H3N2, and the B/Brisbane 2008 like virus.  If you remember, 2008 was a very high mortality year for the flu.  The 2008 flu had a several thousand person mortality in Europe and Asia alone just in the first 2 weeks of the season.  Approximately 1,000 people died each week from the flu.

The other things you can do of course is to use antibacterial wash or lotion often.  Do not go to the hospital if you are sick with flulike symptoms.  If you are sick go to the ER for a flu screen. 

Vitamin C can lessen the symptoms of the flu, as well as Echinacea.  Drink plenty of fluids, rest, and if needed take an antiinflammatory drug to reduce fever and achiness.

Good luck this season.  Stay healthy!

What does the Future of Medicine hold for us?

This is an interesting question, especially with how much technology is rapidly innovating.  With the increasing use of voice recognition as evidenced with use in Apple's Iphone, doctors and nurses will not have to manually input information into the computer system.  Within ten years, each office will have software that can take what nurses and doctors say, transmit into dictated orders and exam findings, and automatically send orders out to pharmacies, radiology, and lab departments.  Streamlining the registration, evaluation, and management of patients will allow for a much smoother experience for patients in the primary care realm.

Within 20-50 years, Medicine and technology may converge into a realm where patients don't even need to be seen by the physician anymore.  Imagine, as a diabetic, the 3 month follow up is due.  You wake up, go to your home medical port site, which will scan you with a laser and ultrasound, detecting the vital signs, the cell count, the liver function, hemoglobin A1c, and any other test required.  The laser can provide a 3 dimensional image of the body like a CT scan without radiation, or like an MRI.  Of course, if a face to face is desired, the patient can do so via videoconferencing.  Even if the good ole fashion face to face is required, the option is still there.  But as energy demands change, and the US finds ways to cut costs, patients will find that driving to the doctors' office maybe an energy waste.

That information is then transmitted to the Medical Home, where the patient's physician is monitoring several screens.  The physician of the near future will be able to treat more than 10,000 patients per year, averaging around 50 patients per day.  Further into the future, a physician can treat over 100 patients in a day with technology that streamlines information to his office.  The screens will have voice recognition and sensors that will be able to automatically detect abnormalities for the physician.  Prescriptions will automatically be filled via voice activation from the physician not into local pharmacies, but rather into Medication box depots, which after identifying the patients' retina and finger will dispense the medication.  These depots will be spread around such as regular pharmacies nowadays.

It may be hard to believe, but the technology for all these possibilities already exist.  Surgeons are using robots to do intricate surgery, and one day may not need to be in the actual surgery suite, or even in the same hospital.  The possibilities are endless.  I just hope that physicians and nurses never are replaced by robots.

At-Risk Drinking –Who is at Risk?

The holidays are upon us and it is time for festivities and families.  Sometimes mixed in will include egg nog, orange juice and champagne, wine and beer.  From a medical standpoint, caution should be practiced if alcohol can start to interfere with your health. 

Liver damage, high blood pressure, increased risk of heart attacks and strokes, and diabetes can result from a long history of high intake of alcohol.  So the question is, “What is too much?”

Both the National Institutes of Health, and the National Institute of Alcohol Abuse, and Alcoholism (NIAAA) have definitions for what constitutes “at risk drinking.”  From a medical standpoint, a drink is 14 grams of pure alcohol which is 1.5 oz of liquor, 5 oz of wine, or 12 oz of beer. 

At risk drinking is more than 14 drinks a week for men or more than 2 drinks a day.  For women more than 7 drinks per week and more than one per day. 

At-risk drinking doesn’t necessarily cause health problems, but chronic and daily at-risk drinking can start to damage the organs. 

If you think you have a problem check out www.niaaa.nih.gov

Some questions to ask yourself if you feel you may be at-risk include:

1. Have you felt the need to cut down on your drinking?
2. Have you ever felt annoyed when people criticize your drinking?
3. Have you ever felt guilty about drinking?
4. Do you need to drink in the morning for an eye-opener?

Answering yes to 2 or more questions should point you in the direction to seek medical help.  If you have any questions please email runsinthewynd@gmail.com

What causes Canker Sores?

I remember when braces rubbing the inside of my mouth caused those small painful craterlike ulcers.  They usually can occur by themselves or in patches of up to 10 ulcers in the inside of your mouth.  They do not segregate as they can occur on your tongue, inside your cheeks or on your gumline. 

Usually yellow with red borders, they can sometimes look slightly pale gray.  They can appear without warning, but often sensations of burning preceed where ulcers eventually appear.

Increased stress, trauma, hereditary, and immune system compromise can all cause canker sores, also known as aphthous ulcers.  Although we don't know for certain what can cause them, they are thought to be caused by deficiencies in some vitamins like iron, folic acid, and B12.  The most common link we often blame is high levels of stress, although there is no scientific proof.  Recent studies point to food allergies as a possible cause, but the proof is limited.

Doctors can treat canker sores with a variety of medications.  Clobetasol gel, lidocaine gel, hydrogen peroxide or glycerin mouthwashes, diphenhydramine gels, or antibiotics can be used. 

Alternative therapy includes home remedies containing mouth rinsing with hydrogen peroxide (2oz) with water (2oz) and 1 tsp each of salt and baking soda.  Milk of magnesia mouthwashes help.  Chlorhexidine, a pain reliever, is sometimes in mouthwashes that help.  Using tea bags to cover the ulcer can relieve pain secondary to the tannins in the tea leaves.  Over the counter salves containing glycerin and peroxide also can help.

If you have severe pain that doesn't go away you can go see a doctor.  If they remain after 14 days, a serious medical condition may exist, or if persistent multiple ulcers remain, go to a doctor immediately.  Hope all this helps and Happy Holidays!

Question: What are Probiotics? And do they really work?

The normal flora in our colon and intestines are very important.  Breaking down food particles for the gut wall to absorb minerals, vitamins, and molecules are just a fraction of what they do.  So when we knock these buggers out with antibiotics to cure a certain infection, we need to replenish the gut.

Probiotics promote proper intestinal environment by aiding in digestion and absorption of food nutrients.  They also my reduce some of the enzymes that have been implicated in formations of carcinogens in the colon.

People who have chronic gastrointestinal problems, peptic ulcer disease, irritable bowel, and diarrhea would benefit from supplements.  Also if recurrent vaginal yeast infections or urinary tract infections are present, you can supplement for up to 2-3 doses.

The correct dosing depends on the amount of live organisms.  Usually 1-10 billion organisms divided into 3-4 doses is fine for most people. 

Also remember that alcohol and antibiotics have negative impact on probiotics.  The probiotics that are used the most include Lactobacillus spp, and Bifidobacterium bifidum.

Until next time, be well and stay healthy!

Question: Every winter I get cold or flu like symptoms. Is there something I can do or take to minimize this?

Did you see the commercial on Psoriasis that has these little robots picking up little red specks from a conveyor belt and placing them up on a wall above them thereby making the psoriasis rash worse?

It is interesting to note that while some people think that those little bots are bad guys, they are actually chemicals our immune system releases in times of stress, and disease.  Some people probably think, “Kill the bots!”

The human body has a miraculous way of dealing with illness.  The Immune system stands ready 24 hours a day to fight anything and everything.  It has the power to unleash all these chemicals, but the side effects of the chemicals sometimes make us feel bad.  Fevers are caused by chemicals released from our immune system to “pasteurize” our blood and kill bad guys.  Symptoms some people experience include sinus drainage, congestion, ear pain and pressure, facial pain, and sore throat.

While these symptoms are annoying, they can be controlled.  There is an over the counter medication for nearly every symptom we have.  To prevent bad colds during the winter, I recommend 5 OTC products: Probiotics, Garlic, Vitamins A, C, and D, and Echinacea. 

Probiotics such as Lactinex, Acidophilus, Align, and Bifantis all have several million cells per tab and can be taken to prevent and treat diarrhea, gastroenteritis, irritable bowel syndrome, indigestion, and flatulence (what some know as “gas.”)

Garlic comes in tab form OTC, or in natural cloves.  You can take the tab daily or mix it in sugar water with 1 part crushed root with 10 parts water.  Do not take with Coumadin or oral anticoagulants. 

Vitamin A comes in 5,000 IU for men and 4,000 IU for women.  Vitamin A increases resistance to infections.

Vitamin C RDA is 60mg for adults. 500mg to 1000mg are safe daily intake, even though no research over past 20 years shows that those doses do not prevent colds.  However, Vitamin C is essential for healthy neutrophils, a key infection fighter in our immune system.

Vitamin D is our super ubiquitous vitamin we talked about in an earlier article, and 2000 IU daily is recommended for healthy immune systems.  In addition to aiding our immune system to fight colds, it also can reverse certain cancers like myeloid leukemia.

Two tsp of Echinacea in a cup of water three times daily is recommended to reduce the duration of a cold.  You can take an Echinacea tab daily to try to prevent colds.

I recommend this strategy for the winter months.  Of course, if you have symptoms longer than 4 days, any worsening of your colds, or concerns, no improvement with OTCs, or fever greater than 100.4 degrees you must come in to the ER or see your doctor and get appropriate treatment.

Thanks for all your great questions, keep them coming at runsinthewynd@gmail.com

Bone Health in 5 Steps

The older we get, the weaker our bones get.  It is natural when we have more bone breakdown cells than bone making cells.  However, we can slow that process down with a few steps.  Whether you do or don’t have Osteoporosis, you can benefit from these 5 steps. 

1.  Have your doctor rule out any other cause of bone weakness.  Check the blood: did the cell count point to any malignancy?  Did the calcium level point to hyperparathyroid?  Is the thyroid normal?  Do I have celiac disease?  Ruling out secondary causes is crucial.

2.  Exercise daily.   Weight bearing exercise such as walking gets the bone thinking that it needs to build more bone.  My patients know my motto, “walk til you drop.”  It doesn’t mean to walk until you fall over.  It just means have a daily routine that includes walking for exercise.  The more you sit on a chair, or lay in bed, the weaker you get.  The weaker you get, the bones get weaker and weaker. It is a vicious cycle that ends up with a fall to the floor.

3.  Get adequate Vitamin D supplementation.  Vitamin D RDA is 600 IU which is absurd.  The studies point out that a much higher dose is needed to get the adequate levels of 50 and above on the lab test.  I take a MVI and Vitamin D3 2000 IU daily.  In adults, it is safe to take up to 10,000 IU daily.  Some patients need a prescription for up to 50,000 IU daily.

4.  Get adequate Calcium supplementation of 1000mg daily.  Some specialists say that might be too much, and 600 to 800 is adequate.  In some situations a person might be prone to develop kidney stones—that person should consult with their doctor for further management. 

5.  Eliminate vices such as smoking and excessive alcohol consumption.  Leaching the bone of its nutrients, these vices do not segregate.  Not only does smoking cessation help your bones, it does your whole body a favor too. 

Until next week, enjoy the wonderful weather and the changing season.  

Memoirs of a Deaf Physician part 2

The most asked question I receive regarding my hearing is, "How long have you been hearing impaired?"  This is soon followed by, "What caused your hearing impairment?"  These are always good questions, and the many repeated questions I have answered have continued to be the same:  "I was born with it," and "I think it was probably genetic." 

The truth is I don't know what caused my sensorineural hearing loss.  I know that it was discovered after a year and a half of my mom and dad testing me with all these different techniques such as clapping behind my back, asking me a question and see if I would answer, and whispering at me. 

When I asked my mom how she discovered that maybe she knew I had a hearing problem, was when she found herself writing in my baby book all these abnormal sounding names for common terms like, "fruck," for "truck," or "bees" for "these."  My dad told me he knew I had a problem when he would whisper to me and see me move my lips like he did without sound.  Quite an impressive deduction I felt when he told me that.  I never would have thought that. 

The fact that my youngest sister has the exact same problem led me to believe that it was a genetic trait.  My mom's continued remarks about her possibly having German measles could not have caused a sensorineural hearing loss.  German measles cause a much more serious issue - complete deafness. 

My hearing loss is moderate range, about 40% hearing loss of high decibels, which effectively eliminates most high decibel sounds, like "t, c, s, e, f, h, i, l, x, and z."  These syllables are completely missed by me when spoken directly to me while I can lip read.  

I wear hearing aides now that enable me to hear about 80%.  I still miss many important syllables.  Making up for it by repeating what I thought was said helps tremendously.  I learned how to lip read at an early age.   Concentrating on some one's lips is very important for me.  I connect sounds from lip reading simply from years of experience.  I've learned that when I see the tongue against the upper teeth, that a high decibel sound will be made, like "the," for the actual word, or "lah" for the "L" sound.

I can rarely hear in a group setting or with background noise.  However, in the clinic one - on - one, my strengths can overcome by allowing me to hear and read lips to the fullest affect.  I have been fortunate to develop this strength to serve the public.

The reason I want to serve the public developed by a much longer route than expected however.  I wasn't born with the desire to become a physician.  I learned the hard, much hard way that becoming a physician would be a culmination in my journey to self fulfillment. 

The desire started with a need for a second job.  While working for a grocery store as a customer service clerk, I began working for a nursing home.  I helped people get up from bed, bathe, feed, move, change diapers, and essentially full care of an individual.  Then I noticed that these super efficient super confident people who handed out medications and were writing down things all day seemed happier.  They turned out to be nurses, so I wanted to be a nurse.

The rest is history as they say.  I was a nurse for about 3 to 4 years before I knew I wanted to be a doctor.  That story will be clarified in my book.  In the meantime, stay healthy and live well.

Justus Peters MD

Memoirs of a Deaf Physician part 1

I have decided to leave a legacy for my children.  A memoir for them and others with similar interests in the obstacles one faces in my shoes.  I have started a book called, A Walk in My Moccasins, Memoirs of a Deaf Physician.  I hope the stories are interesting to those with hearing disabilities or those who just want some heartwarming stories of events that have shaped my life to become what it is. 

Starting a book is no easy chore.  I work over 60 hours a week, take care of patients both in the hospital and in the clinic.  I see nursing home and rehab patients.  To pay off medical school, I work in the ER and urgent care part time.  So in the midst of all the medicine I practice, I find myself reminiscing about my past, and seeing how my patience has developed.  I notice how the empathy developed, how I could easily share feelings with a patient.  Developing the desire to serve the public was a long arduous journey, and I can say that many many mistakes were made and many lucky chances I received to get here. 

Writing is a personal passion I had when I first saw dad reading his books all the time.  His constant reading and his depth of knowledge captivated my young mind, and allowed me to discover more knowledge through reading and writing.  My writing has developed since college when I was held back as a freshman on English 101.  It takes time, and practice.  It was a hurdle, like the many hurdles we all faced to get where we are in life. 

I hope you all enjoy some of these small portions from the book that is still currently being written.  Right now I have about 19,800 words with a goal of 50,000 words by the end of the year.  Wish me luck.  I hope you all stay safe and healthy. ;)

The Ins and Outs of Indigestion

I remember succinctly during my Intern year training, developing a severe burning epigastric pain that radiated up my chest.  I doubt it had anything to do with stress, but rather the awesome breakfast Carne Asada burritos.  For all those great breakfasts, I paid dearly by taking Nexium for the next 2 years.

Indigestion, or dyspepsia (our medical term) can be caused by several reasons.  Improper stomach emptying may increase acid buildup.  Sometimes OTC pain meds such as Advil or Motrin, and Tylenol can cause it. 

Some people get ulcers in their stomach or intestines from H. Pylori (Helicobacter Pylori).  An infection from this bacteria can cause indigestion.  This is one of the bacteria that can actually cause gastric carcinoma.

Sometimes indigestion can be a sign of something serious like gallstones, or rarely, cancer.  Be on the look out for other signs of serious illness like: weight loss, anemia, loss of appetite, trouble swallowing, frequent vomiting, and indigestion symptoms that begin after age of 55.  Schedule an appointment asap if any of these symptoms appear.

We know what causes indigestion, now what do we do about it?  First off, you should stop taking OTC pain meds.  Drink less alcohol, quit smoking, and changing diet may help.  Fatty fried foods relax the lower esophageal sphincter which is the muscle that closes off the stomach acid from irritating your esophagus.   Try to avoid foods that make symptoms worse, like the wonderful Carne asada burritos I devoured, or spicy foods.  Indigestion can be worse if you are stressed or depressed.  Doctors can help you find healthy ways to cope with stress or talk to you about treating depression.

If you have pain or burning, doctors may recommend medicine such as ranitidine, or omeprazole.  Omeprazole is a proton pump inhibitor (PPI) which is really too strong to be treating acid reflux.  I tell patients, it’s like killing a fly with a shotgun.  Recently a new disease has emerged secondary to chronic use of PPIs.  It is called Gastric Rebound disease. 

A little acid is good, to kill all the bacteria, viruses, and parasites we swallow with our food.  But when our stomach is not making acid, it produces more and more acid producing cells.  So when you take away your meds, the acid overflows and worsens any reflux symptoms.  A proper weaning protocol is essential to getting completely off PPIs and using them only as needed. 

There are other meds that may help if you feel bloated or full.  If you have a bacterial infection you may need antibiotics.  Schedule an appointment if you feel any symptoms that are not going away.  Thanks again for all the questions!  Be safe and healthy!

This Year's Measles' Outbreaks -- A Surprise?

The Centers for Disease Control and Prevention released an advisory update on Measles last week.  There have been 12 outbreaks since the beginning of the year in the US totaling to about 150 cases of Measles.

Measles, considered eliminated in 2000 thanks to high 2 dose measles vaccine coverage is making a comeback.  Measles is a virus that can cause pneumonia, encephalitis (infection of the brain tissues), and death.  It remains endemic in other countries without strict vaccine laws.  Larger outbreaks are occurring in Europe, Africa, and Asia.

Of the 156 cases, 82 were unvaccinated, but 11 had received 2 MMR doses (measles-mumps-rubella vaccine).  So that means that even though you have been vaccinated, if your titer for immunity is low, you can still get the infection. 

Measles is an acute illness transmitted by coughing and sneezing.  It can remain on surfaces and in the air up to 2 hours after leaving an infected person.  The CDC recommends that all patients are up to date on their MMR vaccines and other vaccines.  Those traveling abroad, and older than 6 months should receive vaccine.  Infants aged 6-11 months should receive 1 dose of MMR before departure.  Children aged 12 months or older should have documentation of 2 doses of MMR separated by at least 28 days.

Teenagers and adults without evidence of measles immunity should have documented of 2 appropriately spaced doses of MMR vaccine.  If you know anyone with a fever and a rash lasting 3 days or more, with temperatures of 101 degrees Fahrenheit or higher, with symptoms of coughing, sore throat or redness in their throat, and conjunctivitis (inflammation of the pink area inside the eyelids), get to a clinic right away.  All cases should be isolated and reported to local health departments.

Protecting Your Children from Cyber Bullying: A Parent's New Mission

The news stories never change.  A bright young person takes their own life after suffering from cyber bullying.  These kids are ranging from middle school on up into high school and even college.  What is there to do?  As social media becomes the trade of the future, parents and teachers need to be aware and assist the children as they mature into responsible adults.

One of the keys to protecting children is to improve communication.  A child will tell a trusted adult what is happening in their life.  If parents are aware of any cyber bullying, the school administrators need to be informed.

Secondly, advising children through the maturing years on their self worth and building confidence goes a long way.  Cyber bullying targets children who seem weak, and sometimes feel like they have no self worth.  Let children know not to let anyone take away their self worth.

Thirdly, getting away from social media for awhile can be seen as therapeutic.  With everything on Facebook or MySpace nowadays, people find their “number of friends” to equal their importance.  Taking a break away from what is torturing you can do wonders.

If your child is involved in Facebook, parents need to be on the site as well and monitor what is going on.  Being involved in all activities is the number one powerful message children understand in the relationship and it won’t be broken.  Read all text messages and talk to your kids constantly.

Helping your children through play acting is helpful.  Teaching children to be assertive is key.  If someone is bullying them, teach them to say, “I don’t appreciate that, and if you keep doing it, I will call the police and report you to the police department.”  If kids keep internalizing the emotional and psychological abuse in cyber bullying, then it will explode in the worst way.

Question "How do I know I am in an abusive relationship?"

Abuse comes in many forms and is not always physical.  Sometimes, simple emotional abuse can cause feelings of insecurity or fear.  Not having access to finances, or the car, or the ability to be free in your home is a form of controlling behaviors.  Sexual abuse includes forced sexual activity or rape which can have devastating effects on your psyche.  Verbal abuse can include repeated name calling or threats. 

An abusive relationship is a crime, and you should not feel that it is your fault.  Self blame for abuse is detrimental for not just your psychological health, but also for your physical health.  It is quite common -- about 1/4 women and 1/9 men are abused in their relationships.  Please talk with anyone that you trust, friends, preachers, nurses, or doctors, and keep all your important papers close by in case you need to leave in a hurry.  Have a plan for a place to go and call the police at any time you feel you are in danger.

Question: What is the difference between moles and melanoma?

Moles can come in all different ways.  Some are brown, tan or even flesh covered.  Most are usually less than the size of a pencil eraser.  An ordinary mole can be present at birth and remain the same size, and color for many years. 

Melanomas are often larger than moles.  While common moles are less than 1/4^th an inch, a melanoma can be larger.  Common moles usually are the same color throughout, while melanomas have several colors or an irregular pattern.

Normal moles are usually round or oval with no border irregularity.  Melanomas do not have even borders and may be notched.  Melanomas are asymmetrical which means one half is different than the other half. 

Melanomas usually occur in people who have a higher number of moles, both irregular and larger.  If a family member has melanoma, there is higher risk for others in the family as well.

Lifestyle choices also contribute to potential melanoma development.  Frequent sun exposure, multiple sunburns at an early age, having fair skin, easily freckling, or having red or blonde hair can be a predisposition for risk of melanoma.

Be aware of any mole that changes, or a sore that doesn't heal.  Look closely at the borders of all moles and see if any of the pigment is spreading from the border into surrounding skin.  Be aware of any changes in sensation which may include itching, tenderness, or pain at a mole site.  Look for changes in the surface of a mole, if it oozes or bleeds.  Also look out for a mole that stands out differently than the other moles on your body. 

If anything looks or feels different come by the office and get a biopsy.  Pathology reports in about 7-10 days. 

Thanks for the questions.  Keep them coming. 

Chronic Neck Pain Recommendations

Everyone has heard the story - someone in family has history of injury to the neck, whether whiplash in an auto accident, or leading an active lifestyle in sports.  They do fine for awhile on Tylenol and they have no more pain in their neck.  Then after a few years, they have increasing pain and numbness either in their arms or hands.

Neurological symptoms with neck pain require imaging studies, The American College of Radiology reports.  Magnetic Resonance Imaging (MRI) is useful in diagnosing disk herniations, where the disk between the vertebrae bulges into either the spinal canal or into the nerves that come off the spinal cord.  MRI is useful in finding tumors, ligament damage, and fractures.

The ACR recommends a 5 view x-ray series of the cervical spine in anyone with chronic neck pain of any age, with or without history of trauma, with history of cancer, or with history of neck surgery in the past.

The ACR reports that if the 5 view x-ray is normal, and there are not neurological findings, no further imaging is required.

Of course, if there is any metal in the body, such as pacemaker, or bladder stimulator, MRI is not recommended.  Some people have severe claustrophobia, and therefore MRI is not recommended.

If you have chronic neck pain, make an appointment to see your doctor to get adequate evaluations.  Thanks for questions and keep them coming!  runsinthewynd@gmail.com

Health Alert: E. Coli Infection and what to look for

The recent outbreak that claimed the lives of 9 people, and caused Hemolytic Uremic Syndrome (symptoms associated with kidney failure) in over 400 people in Germany has apparently spread to the US.  On May 31, 3 Americans who recently traveled from Hamburg have been reported with Shiga Toxin E. Coli infestation.

E. Coli normally resides in our colon.  The problem is when some strains of E. Coli develop the Shiga toxin.  This toxin has a virulent ability to create havoc on the immune system. 

Some symptoms can include severe stomach cramps and diarrhea (often bloody) with vomiting.  If there is a fever, it is low grade.  Most of the time it is self limiting and lasts only 5-7 days, however some unfortunately develop Hemolytic Uremic Syndrome (HUS) about a week after the diarrhea starts.

HUS is a syndrome of 3 classic symptoms: anemia (low blood levels), renal damage, and thrombocytopenia (low platelets).  The anemia is caused by the spleen chomping on the blood cells causing abnormal shapes what we call “schistocytes and helmet cells.”

If you know of anyone who develops these symptoms, go to nearest ER, and get stool studies.  Antibiotics are not recommended until full diagnostic studies can be done.  Sometimes antibiotics and increase risk of developing the HUS.  Labs will report positive stool cultures to the state health departments.

More information can be obtained from the CDC.  Any questions for article please submit to runsinthewynd@gmail.com

Question: Can physical therapy treat knee pain?

Being a proponent of physical therapy, I believe it can help reduce symptoms, improve mobility and function and strength of most if not all joint pains. 

The key is strengthening the muscular groups both above and below the joint.  For the knee, a physical therapist will exercise those muscle groups.  Usually therapy will last 3 times a week for up to 6 weeks. 

The American Physical Therapy Association has many suggestions and guidelines for many different types of injuries on their website for the public at www.moveforwardpt.com 

Physical therapists can aid you in improving symptoms of pain with use of ultrasound technology as well.  They are always helpful and only want you to have a complete recovery.  Of course, in the process of your therapy, you may feel otherwise.  Their job is to exercise you, and get those muscles improved.  If you stop moving, you lose muscle mass, and therefore function.  In fact, laying in bed all day has considerable impact on muscle mass.  Like they always say, “use it or lose it.” 

My favorite knee pain exercise involves actually the hip and waist muscle groups.  Knee extension puts increased pressure on the joint, so my favorite is to keep the knee straight while standing, and just raise your leg up 90 degrees or parallel to the floor.  Doing 3 sets of 10 to 15 reps strengthens the quadriceps, or the muscles in your thigh. 

You can do this exercise for many knee problems and even hip problems like iliotibial band syndrome.  Whatever the painful condition, please consider adding physical therapy to improve your symptoms.  Contact your doctor for any issues you may have.

Thanks for the emails.  Be safe and healthy!  Questions can go to runsinthewynd@gmail.com

Skin Care 101

I know there are so many products on the shelves for skin care.  It is frustrating to see that each product is unique.  You can hydrate, soothe, relax, de-stress, or de-age your skin.  They have different smells, different flavors, different solutions, ointments, creams.  

But to make it easier to deal with I have some simple solutions to the most basic of skin issues.  The first is hydration.  Some people have skin that is fragile, dry and dehydrated.  You can tell someone is slightly dehydrated by the skin “turgor.”  Skin turgor is a sign we use based on how elastic the skin is.  If you can pinch your skin and it stays in that pinched form for a long time, we say you have poor turgor.  Or if your skin stands on its own after moving it a certain way, it has poor turgor.  Normal skin should go back to normal after being pinched. 

Moisturizing your skin is the first step to strengthening it.  A nighttime moisturizer is usually all you need, but if you have skin that stands up by itself or has “poor turgor,” then you should probably use it twice a day. 

My favorite moisturizer is Aquaphor ointment.  It may seem thick at first, but if you warm it up, it goes a lot easier on the skin.  It doesn’t have those smell good aromas, and is not greasy like Vaseline.  It is perfect and makes a nice complexion to your skin.  This is a very good step to take for improving your skin.  More to come, in the meantime stay healthy!

Want to Feel Better?

I am sure most of you all have been following Christine Morgan and her great nutrition information.  One of the most important things about nutrition is that the diet alone can significantly reduce most if not all chronic diseases!  I know we don’t walk around with shirts that say, “ I want Diabetes and Heart disease!” or “Give me Strokes and Cancers.” Go for those nutrient-dense foods such as almonds, blueberries, olive oil, and just about any brightly colored fruit and vegetables.

I remember in medical school one of the professors remarked that the oldest people in the world live in Southeast Asia.  What did we learn?  They eat less.  They are all small.  My professor said, “We could live forever starving, or we could die early eating to our delight.”  If we could count calories, we will make big strides in our dieting.  I tell patients to try to knock off 200 to 500 calories a day of their normal intake.  This will help with 1-2 lbs of weight loss a week--a far safer weight loss that won’t bounce back in weight gain.  If you can, try eating until you are sufficient, but not full.

I tell all my patients to walk 30 minutes a day.  We know that the moment we stop all activity, our joints get stiff and painful.  If you cannot walk secondary to obesity or excessive pain, try walking back and forth in a pool.  This takes all the pressure off your joints and body, and still provides great exercise.

I am amazed that most people don’t know what the SPF means.  To simplify, it means how many minutes of protection it has.  So an SPF of 30, should be re-applied every 30 minutes.  An SPF of 50, every 50 minutes should be re-applied.  Good skin feels better.  My favorite moisturizer is Aquaphor by far, but simple products like exfoliators and skin polish can add improvement to the skin. 

A recent NPR show had some great wisdom about sleep.  Daylight revs up our energy by increasing our wakefulness, so to increase sleep hygiene, make sure the environment is dark, and inviting, peaceful and still.  That means no television in the room.  It is also well understood that the same ingredient in apples that curb our appetite, called leptin, is produced in our bodies when we sleep.  What a coincidence.  Sleeping 7-9 hours a night will decrease heart attacks and diabetes’ risks.

Tons of information is available on feeling better, and feeling younger.  Time doesn’t revolve around us, we are servants of time.  Therefore, enjoy life to its fullest, be safe, and live healthy.

What are these bumps?

What are hives and what causes them?

Hives are itchy bumps on the skin that can be in different shapes and sizes.  We call hives, “urticaria.”  Hives can occur within a few minutes and can take several hours to fade away.

The severity of hives varies, for some people, hives occurs every day.  Others may have hives for only a few days to a few weeks.  Naturally, sensitive people who have hyper immune systems develop hives, especially those with hay fever or asthma.

There are many causes, mostly foods, airborne allergens, medicines, or infections.  It is difficult to pinpoint how one gets hives.  I remember developing hives after eating bananas.  After awhile, bananas didn’t affect me except cause a little itch on the roof of my mouth. 

It is unusual but also heat or cold, even pressure can elicit an allergic response that creates hives.  The distribution of the rash can give you a clue.  If hives occurs only in both lower legs, maybe socks or pants can be the culprit.

If the symptoms are too unbearable, try antihistamines over-the-counter.  Try to stay away from drying agents like calamine lotion.  There is nothing lotiony (is this a word?) about it.  Stick to Aquaphor ointment to keep your skin moist.  Like I said, moist skin doesn’t itch, but dry skin does.  Apply twice daily.  If you have moist skin, and are taking an antihistamine, and still have suffrage, start on some over-the-counter steroid cream. 

If all else fails, and you are itching so bad that your dog or cat is worried about you, call your doctor and let them know what all you have tried.  We would be more than happy to alleviate your suffering.  Until next time, be safe and healthy!

Emotional Trauma and Inflammatory Bowel connection

When a person experiences an event that causes stress such as a loved one dying, witness to violence, victim of abuse, the trauma has a direct physiological effect on the body.  In addition to having an impairment of our cognition, our gastro-intestinal (GI) system takes a large hit.  With any trauma, we are more susceptible to gastric ulcers, more susceptible to inflammatory bowel disease.  A large amount of emotional trauma in childhood has been studied and directly linked to IBS, or inflammatory bowel syndrome.

Studies show that the severity of symptoms are directly related to the severity of the trauma.  Therefore, if we experienced a significant traumatic event, our GI system will have worse symptoms. 

Post-traumatic growth is a new psychological ideal where we observe how people learn to cope with certain issues, learn new insights, and acquire new strengths.  As time goes on, we change hopefully for the better.

Appropriate Blood pressure checks

When you check your blood pressure at work, at the grocery store, Wal-Mart, pharmacy, or anywhere in the public area, be aware that it is probably not going to be your normal blood pressure.  All of those places constitute a slight increase in your stress levels. 

When I have a patient monitor their blood pressures, i want them in their favorite chair in their favorite room.  Both feet must be on the floor.  Relax for 5 minutes, breathe nice and deep through the abdomen.  Take 3 blood pressures one minute apart, and average them out. 

The blood pressures will change every second.  So an average is a good way to estimate your normal range.  Pick a time, preferably before dinner, not within 30 minutes of eating or drinking anything to do your blood pressure.  You don't have to check it every time you get stressed and feel panicky.  In fact, a small squirt of Adrenaline in your body when you are stressed is normal.  If a bear was chasing you, you would need a high blood pressure to be able to climb a wall or tree, right?

I want to know if your blood pressure is elevated when you are resting and relaxing.  I like the blood pressure to be between 100 to 120s systolic over 60 to 70s diastolic.  Anything higher will be Prehypertension, Stage 1 and then Stage 2 Hypertension.  See your doctor ASAP if your numbers are higher.  Until next time, be safe and healthy!

Fuel Up to Play 60

A program that encourages youth to eat healthy and stay active has been made with the National Dairy Council, NFL, and the US department of Agriculture.  The youth are encouraged to eat nutrient rich foods such as low-fat, fat free dairy, fruits, veggies, and whole grains.  They are also encouraged to be active and play at least 60 minutes every day.  This sounds like a promising program.  Harkening to days of old, children ran around outside all day.  Playing hopscotch, mirps, stuck in the mud, queenio, chants, and trades made childrens' imagination soar.  While playing video games indoors can help with eye to hand coordination, research doesn't show that it improves cognitive function like outdoor exercise.  Indoor games do not improve strong academic performance either. 

On the website http://www.fueluptoplay60.com/ students can take the pledge, learn from other students, track physical activity and healthy eating behaviors, and earn rewards.  I think I am going to approach our local school district and see if we can get this implemented.  Doing so at your own school district can make a difference!  Until next time, be safe and healthy!

Coenzyme Q-10 for Angina?

Angina can be a dangerous symptom.  When someone complains of chest pain, abdominal pain, right or left arm pain, we need to rule out heart issues.  These symptoms occur when your heart isn't getting enough oxygen.  Conventional medications doctors use to protect the heart include coronary artery dilators, like nitrates or calcium channel blockers.  We can also use beta blockers to relax the heart muscle so that the need for more oxygen is diminished. 

Alternative ways to assist your heart is to supplement coenzyme Q10 which is depleted in heart disease patients.  L-carnitine and magnesium also can be supplemented to improve energy metabolism. 

You can do easy home remedies to help as well like tilting the head of bed up 3-4 inches to decrease work load on the heart.  An Aspirin a day can seriously save your life.  If you have a heavy meal, spend a longer time than usual up to an hour to eat it.  It is known that exertion after eating can cause heart attacks.  Stop smoking as this greatly exacerbates angina.  Stop birth control pills as they can cause clots. 

If you have angina you should be seen in the ER immediately, and worked up by a Cardiologist.  Hope this helps.  Be safe and healthy.

Prone to clots?

You may have heard a story like this.  Totally normal person with no history of any medical problems suddenly develops a painful swelling reddened leg or arm.  Or a normal person without history of any medical problems suddenly has a stroke?  Or how about a totally normal person without history of any medical problems suddenly dropped dead?  These can seem extreme but in the medical field, we see these things occur.

Blood is meant to circulate throughout your body.  When the blood circulation slows down or stops, it can form clots.  Clots that travel can stop the blood flow in your brain, in your heart or extremities creating major symptoms.  Some people have genetic predisposition to having clots.  For instance, a mutation in certain genes, such as Factor V Leiden, can predispose one to have clots all the time. 

Preventing clots from forming is a common strategy whenever one is admitted to a hospital.  Avoid long periods of inactivity while on a long trip, during illness, or after surgery.  Walk around every couple hours.  Exercise your legs when you are sitting down at a desk.  If you smoke, quit, because smoke damages blood vessels and therefore increase the risk of blood clot.  Go to your doctor and see if you have any risk factors for blood clot or a family history.  It's a move that may save your life.  Until next time, Be Safe and Healthy!

Med School Memory 2

My favorite class by far was Gross Anatomy.  Our teacher was a big bear of a man but gentle as a cub.  He had black hair with specks of gray with a matching moustache.  I really had to strain to listen to him because he spoke in a hushed tone.  He always had a twinkle in his eye, as if talking about anatomy excited him.  He had a permanent smile even while he talked.  His lectures were long and boring but his demeanor and gentility made him a favorite. 

Each year the students at Creighton University School of Medicine have a memorial service for all the people we studied from in Gross Anatomy.  As a tribute of respect for both the people we studied, and to the family members, we have a touching ceremony to honor them appropriately.  We get to name each of our bodies.  We gave our lady the name "Ethel."  She was a small fragile 80 plus year old lady who was perfect for dissection.  She had the smallest amount of fat tissue of all the bodies.  Each day we dissected more and marvelled at how lucky we were to have such a fine specimen to learn from.  I met a good guy who was part of my team of 4 medical students.  We will call him, "Chad."  He was a like a California surfer boy.  Easy going, laid back, slightly longer hair, and easy smile who could play the guitar.  He and I really enjoyed Anatomy and we stayed late after classes and came in early on some days to go over what could possibly be on the test. 

My scrubs always smelled like formaldehyde.  I can still smell it if i think about it.  It permeated my car, and made dates miserable.  I didn't care.  I was in Heaven. 

Treating Sleep Apnea

While the treatment of choice is a positive airway pressure device (PAP), other alternative therapies exist as well.  Using different body positions during sleep can help.  Using more pillows to keep your head elevated can open up the airway.  Some oral appliances can help but only if there is very mild sleep apnea. 

PAP therapy provides a constant flow of air into the lungs which helps you breathe freely.  I personally have tried a PAP machine to see how it affects sleep.  I have no problems with it.  It has a comfortable head gear, nose piece.  The benefits include improved energy and lower blood pressure.  Some who have sleep apnea and excessive daytime sleepiness will feel energized with better attentiveness. 

I hope all who understand the risks of sleep apnea and the assistance we have available for you.  I firmly believe the PAP machines are life savers. 

New Vitamin D recommendations

Every multivitamin I have picked up, i look at the recommended daily allowance (RDA) for certain minerals and vitamins.  The most important one that I pay attention to is the one that has the most research.  The most researched vitamin nowadays is Vitamin D.  The daily recommendations says to take 600 IUs daily, which amounts to less than 25 nanograms of Vitamin D.  The experts are saying Vitamin D intake should be around 2000-4000 IUs daily!  I tell all my patients to take a multivitamin AND Vitamin D3 supplement 2000IUs daily.  That will get them in between those requirements.  Taking a Vitamin D3 supplement will not get your levels up high right away.  It takes about 6 months to a year to actually feel any effects from adequate vitamin D intake. 

So be patient, and continue your vitamin D intake at 2000IUs daily, and pray that your energy improves, your heart improves, your bones and muscles improve.  That is all for now.  See ya'll later.

Sleep Apnea increases morbidity and mortality

Do you have excessive daytime sleepiness?  Do you snore loudly?  Do you gasp or choke during sleep?  Do you feel groggy and have morning headaches?  Do you feel depressed and irritable during the day?  Are you obese or a large neck?  All of these questions reflect increased risk for sleep apnea.  When your heart doesn't get the oxygen it needs, high blood pressure results.  Chronic high blood pressure creates irregular heart beats, increases risk of heart attack and stroke. 

The excessive daytime sleepiness complaint may seem benign to many people.  But daytime accidents or work related accidents can be related to sleepiness.  Talk with your doctor if you have any of these symptoms, and if a sleep disorder is diagnosed, you will probably do a sleep study.  This is where you go to a sleep lab and they will do their best to make you have a good night's sleep.  While you are sleeping we can monitor your heart beat, your sleep stage, your oxygen saturation.  We will be able to tell if you have true sleep apnea.   We will talk about treatment tomorrow.

Med School Memory Part 1

Studying in medical school was especially difficult for me.  Although I sat in front of the class, I still missed a lot of what was said.  Having a note service helped, but still some things were missed.  Therefore, I spent extra time reading.  Getting up at 0400 hours was not unusual.  I would go for a run in the morning, and then hit the books.  My support system evolved around my closest friends.  But none of them usually got up early with me.  I would read for an hour, sipping a Red Bull, or local convenience store coffee.  Taking multiple small breaks so I would not fall asleep was essential.  Then came the lectures.  They started at 0800 and seemed to go on forever.  Breaks were lifelines of emotional oxygen.  At lunch, I would break out my peanut butter and jelly sandwich and go to town.  Sometimes I would try to take a power nap during lunch.  Another 3 to 4 hours of afternoon lecture, and then we were free. 

I saved money by checking out my text books from the library.  I had to read and re read chapters right there in the library.  I would use Kaplan study seminars on video tape to get ready for USMLE Step 1, or 2.  After studying I would probably go to the gym and work out.  Staying sane meant physical exertion and activity.  I enjoyed intramural sports like flag football or basketball.  In the evening, I would try to relax and that was when my roommate Eddie would be studying.  Thinking back, I thought the medical school years were the best of my life.  However, I am wrong, because these are the best years.  The circle of life.

The Hippocratic oath part 3

The study of Medicine allows us to utilize pharmaceuticals.  We trust our knowledge of the pathophysiology of the human body to determine which drugs are safe, and which ones are not.  We trust our knowledge to benefit patients and not harm them.  We studied the physiology of medicines and their effects on the body, and therefore feel confident when we prescribe them.  The 3rd part of the Hippocratic oath says:

"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

Our healthcare system has now evolved to include many different therapies that assist patients back to health.  Physical therapy improves strength, flexibility, and range of motion.  Occupational therapy improves activities of daily living.  In home care, senior services improve the lives of senior citizens.  New medicines improve different aspects of our illnesses.  Chiropractic medicine improves alignment and pain.  The healthcare system is massive and impressive.  As a physician, I have promised to utilize regimens to improve my patients' lives.  I am happy to be a social servant.  It is not just a job.  It is a calling.

Allergies

Our immune system is amazing -- it continues to evolve as we age.  It builds immunity and develops allergies all through our lives.  What our immune system thinks is foreign is something we cannot control.  We sneeze, itch, drain, cough, and feel miserable without having a say.  It just seems unfair!  If we feel miserable enough, we go to the doctor or the pharmacy for relief, and go on our merry way.

The main bad guy is called, "histamine."  He's mean!  It is released on our skin, in our airways and in our gastrointestinal tract.  When we have an "allergy," one or all of those systems are reactive.  We may have a hyper-response on our skin that causes itching.  We may have nasal congestion, itchy eyes, and ears, sneezing and sore throat or even asthma if the allergy response affects our airways.  And we may have abdominal cramps, diarrhea, inflammatory bowel, colitis, if it affects our gastrointestinal tract. 

Hopefully, our reactions are minimal, and controlled with little or no medication.  But if we have severe enough allergies, than we should get help.  If you have questions you can email me at runsinthewynd@gmail.com  or tweet at @askjustusmd .

"Are you sure you can hear well enough to be a nurse?" I remember the question as if it was yesterday.  Before medical school, I was a nurse.  I remember school and walking the halls of the School of Nursing in Bacone College in Muskogee, Oklahoma.  It seemed like it was never going to end.  The mornings would never end, the lectures continued without end.  I obviously had a sleep disorder because I fell asleep almost during every lecture.  It was embarassing because I was in the front row! 

I had to be up close to the professors because I have a hearing impairment.  I wear hearing aids every day.  I was born with sensorineural hearing loss, as was my baby sister.  We both wear hearing aides. 

The question haunts me because it sounded discriminatory.  At the time, I obviously was naive and innocent, and nothing should stop me from becoming a caregiver.  I didn't answer it truthfully.  I said, "of course!" and went my way, but deep inside, I needed help.  I bought super strong hearing aides and a super strong electronic stethoscope, and thus began my journey to become a caregiver for the sick.  It has been the best journey in my life.

The Hippocratic Oath part 2

The teachers pave the many trails of education.  Directly proportional to the time they spend teaching is the success of the student.  Most teachers I hope still believe in what they do.  When I read the 2^nd paragraph, to understand it clearly, I understand more importantly the value of the Art of Medicine.   During the years of medical school, internship, and residency, I respected those who taught me.  They have given me their time and energy, and thus invested in me trust for the common people. 

Considered an art long ago, now an advanced science, Medicine has now become so ubiquitous as to be a part of government intervention.  The United States government now invests nearly 4 billion dollars into Cancer research alone.  The medical community is truly blessed to be able to research newer ways to assist in treating patients.  None of this would be possible without our many professors of medicine.  Hippocrates saw this as an art however, back in the ancient times.  The second paragraph divulges into the arena of those who taught the art. 

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

Nowadays in med school we are taught all of the science of medicine.  We learn the mundane details down to the chemical reaction between the molecules in all physiological pathways.  We learn the various organic structures in pharmacology.  But we forget sometimes about the Art of Medicine. 

Hippocrates reasons that the bonds of our fellow colleagues include an understanding of what Medicine really is.  While the scientific method wasn’t constructed until way after Hippocrates wrote his treatise, the basis of most science started with an Art.  Early astrologers painted stars before they realized that a mathematical construct could predict when stars would be in certain points in the sky.  Early inventors practiced many voluminous drawings of possible technology prior to creation of the machinations detailed by scientific knowledge.

I remember watching a German film in med school Ethics Class, "I Accuse! (Ich klage an!).”  In this movie, a woman with multiple sclerosis asks her husband, a doctor, to permanently relieve her of her suffering. He agrees to give her a lethal injection of morphine. At his trial he argues that he committed an act of mercy, not murder. He is acquitted. 

Medicine in some countries practice assisted suicide, and we learned that ethics and law dictate a lot of what we are able to do with our patients.  I remember the patient actors and actresses who play acted their disease process and we were graded on how well we listened, how our diction sounded, and how much compassion we showed.  It was good practice, and I just now remember that it was part of the art of medicine. 

Teaching Ethics in Medicine, the principle of beneficence, self autonomy.  Directly corresponding to a Constitutional right to life liberty and pursuit of happiness, medical ethics opened our eyes.

The professors themselves were varied in style in personalities, and color.  I learned a lot from few and a little from a lot, but I always respected them as the expert.  I depended on every word they said.  Having a hearing impairment required me to pay very close attention at the front of the class.  That attention I paid in lectures is the same attention I pay to my patients.  I am intending to help someone, so I need to be listening intently. 

Now practicing medicine has allowed me to teach others, my patients, my nurses, assistants, and anyone who is willing to follow the wonderful education of medical knowledge.  I hope to help set a good standard for others to follow.

The Hippocratic Oath part 1

On the wall in my office sits a large framed art piece.  Ronda, my mother-in-law, drew and painted a beautiful rendition of Old English style writing, with large colorful drawings of different anatomical structures, including the vertebral spinal column, pelvis, a shoulder girdle, and an intrauterine fetus.  She had burned the edges of the page to give it an “aged” look.  As I began to read, I remember taking this oath both on the first day of medical school and on graduation day.  That was nearly 5 years ago.  The first paragraph says:

“I swear by Apollo, the Physician, Asclepius, Hygieia and Panacea and all the gods as well as goddesses, to keep according to my ability and my judgment, the following Oath and agreement:”

I wondered long ago who and what those entities were.  Why did these names have a place in our oath?  What was the reason that we have Greek traditions in this society?  How is modern medicine evolving?  Ancient practitioners believed in many different entities.  Medicine men of the Native American Tribes believed in Mother Earth.  Mayan practitioners believed in the Vision Serpent.  The Greeks and Romans impressed upon us in many ways.  We still have a Senate, and architecture all over the U.S. replicating Doric, Ionic, and Corinthian structures of old. 

Before Christianity was spread to the Greeks and Romans, the gods and goddesses were worshipped as those who could take away disease as well as cause them.  The goddess Febris, could cause fevers and cure it.  The Hindi goddess, Sittala, did the same.  Apollo was bringer and reliever of plagues as depicted in the Iliad.  The goddess Hygieia, the daughter of Asclepius, was the guardian of health or disease prevention, and Panacea, the goddess of healing. 

I remember reciting these words but not knowing what they exactly meant at the time of entering medical school, and then having an idea of how it related to the modern practice of medicine when I graduated.  It was revolutionary when it was written over 2500 years ago.  Prior to this time, doctors and magicians were practitioners of the same science.  William Osler wrote in “Evolution of Medicine,” that magicians and sorcerers were the only ones to cure disease, while doctors treated symptoms.   

Medicine in the past was an assortment of concoctions, potions, poultices, fumigations and the like.  We still have that today.  We still have spirituality that existed prior to Christianity and worshipped many different gods, where today we have religion based from many important figures, including Jesus Christ, Mohammed, Siddharthama Gautama Buddha, and the first Brahmins of Hinduism.  While centuries have passed and sorcerers and magicians and physicians practiced different traditions, we still practice new ones today.  Today, many Americans swear on the Bible an oath to tell the truth the whole truth and nothing but the truth so help me God, in a court of law.  Also, in America we have freedom to practice any religion, thus different oaths. 

The Hippocratic Oath, as the first of its kind to separate humanistic medicine and the practice of the inhumane, was and is fundamental for all physicians to remember.  It is an oath worth repeating and remembering.  We are trusted professionals, and we serve the public, the common people, because we care.  We swore to that.

Cramping, Intermittent Diarrhea and Abdominal Pain: What am I?

These three symptoms are included in a wide variety of illnesses, but the most common is possibly an inflammatory bowel disease, or irritable bowel syndrome.  If these symptoms occurred after a cold, it could be a viral gastroenteritis.

When someone has inflammatory bowel disease (IBD), parts of their GI tract will “flare up,” and cause many symptoms such as irregular stools, bloody diarrhea, and abdominal cramping.

I have noticed also, some patients will develop fatigue, malaise, a low grade fever or night sweats.  Joint pains have been associated with IBD.  But usually the first symptom is fever.  Fever is simply your immune system working overtime to get ride of an infection or inflammation.

If you have emotional stress, or history of emotional, psychological or sexual abuse, or dietary indiscretions, you may have recurrences of IBD. 

If you have these symptoms and also complain of pain around the anus, you may have Crohn’s disease.  Crohn's Disease is an autoimmune disease where the immune systems attacks the colon.  Weight loss is seen more in Crohn’s disease because the colon doesn’t absorb digested foods as well.
 
It can take years for someone to be diagnosed with IBD.  If you or a family member complains of recurrent abdominal pain, fevers, and diarrhea, please come in to see your doctor.   

Feeling tired all the time? What is Chronic Fatigue Syndrome?

Fatigue is feeling down with little energy.  The loss of the “get up and go,” is a common complaint.  The problem that doctors have is we don’t have a test for fatigue.

Fatigue is a symptom that a person expresses to us.  We can’t get a lab test for it.  We can’t image a portion of the body for it.  Doctors are scientists and we work with facts that are scientifically validated.  So we are at a loss sometimes when one complains of fatigue.

Chronic Fatigue Syndrome (CFS for short) has been called many names in the past including “Myalgic Encephalomyelitis,” and “post-viral fatigue syndrome.” 

The newest data and updates on it support a few facts that we know about it including that it tends to occur after a viral illness, tends to last longer than 6 months, and includes symptoms such as: mild fever, recurrent sore throat, painful lymph nodes, muscle weakness and muscle pain.

The reason we call it a syndrome is because there is a number of symptoms that occur in CFS.  In addition to the above symptoms, one could have migrating joint pain or stiffness, recurrent headaches, sleep disturbances, and even neurological deficits like forgetfulness, and confusion.

CFS is debilitating and depressing because people who feel tired all the time will get depressed. 

When a physician evaluates you for CFS, they will check your blood pressure because most times low blood pressure is found.  Also a slight temperature or fast heart rate could be found.  

We would then check labs including ruling out Lyme disease, lymphoma, leukemia, HIV, and thyroid disorders.

Treating CFS is also a difficult thing to do for doctors.  Mostly rest, moderate activity, no exercise, and if any infectious etiology is found, then antibiotics can be used.  If the etiology is truly viral, there is no treatment. 

Vitamins and supplements have not been found to be effective, but Coenzyme Q 10, and vitamin
B 12 may lessen symptoms.

An herbalist may prescribe Astragalus Ten Formula which combines Asian ginseng, licorice, and astragalus in powder or tablet form.  However as all with many chronic illnesses, one has to accurately get a diagnosis to get adequate treatment.

Thanks for all the questions and comments.  Have a great day and let me know if you have any questions.

runsinthewynd@gmail.com