iPosted It...Medicine

Patient Education Sites

Patient Education
Reminder about two helpful sites...

MEDLINEplus
No advertisements. National Institute of Health presents reviews of topics and links to resources (clinical trials, etc).

Ten-year heart risk calculator
Clarifies risks when considering lipid management. Also links to other ATP III (Adult Treatment Panel III) Guidelines.

imatinib (Gleevec) and hair color

Glee back? Imatinib and hair color.
Peter Ruehlman points out that in France nine people with grey hair had "re-pigmentation" within five months on imatinib (Gleevec). No word on how often this happens, or the color you get. NEJM 2002;347:446 (August 8) Correspondence.

Trucks and accidents

Truck Tire Blow Out & Accidents
Yesterday morning I was first car behind an 18-wheel flatbed truck. Seems to me I was thinking about safe distance. All I can tell you was the explosion was a bomb. Debris flying towards my windshield. I pulled to the right, and down the magically provided exit ramp. No other cars. No collision.

Got back on I-75. The truck was pulled over. Could see no flat tires. My guess is a tire exploded. (No police report). Amazing sound; instant storm of debris. Not a unique scenario. Many serious accidents over the years? Beautiful day for me. Lucky.

Translating World Health

Talking World Health
In the office a woman from Dakar, Senegal did her best with English. I did my best with French. Taking the medical history, when we lost each other Google translator came in handy. Law requires access to translation. Unclear to me how often this is fulfilled.

Imatinib (Gleevac) Mechanism

Imatinib (Gleevec)--Why do cells die?
Peter Ruehlman treated a man with CML (Chronic Myelogenous Leukemia). After years of elevated counts, fatigue, depression and containment with interferon, imatinib was tried. Counts normalized. (The gentleman subsequently has died of a myocardial infarction.)

Dr. Ruehlman describes another CML patient who has been cleared of chromosomal evidence of disease with imatinib. How does a drug that blocks tyrosine kinase eliminate malignant cells? Does it have other effects beyond inhibition of the phosphorylation?

Answer?...Interfering with glucose metabolism may lead to cell death.

Cryptosporidium Scotland

Acute diarrhea, Scotland. 'Nae Kentucky or Milwaukee.
Scotland faces cryptosporidium (a consideration in our earlier discussion of diarrhea).

Aortic Root Abscess

Aortic Root Abscess
Back to this unfortunate problem confronted earlier last month. For helpful review, see Brecker SJ, Pepper JR, Eykyn SJ. Aortic root abscess. Heart 1999 Sep;82(3):260-2. [Image Copyright 2002, WebPath]

Soda and Obesity

Soda Pop
Man in the office claimed to drink ten 2-liter bottles of soda per day. (Wife confirmed this. I am still skeptical). He rarely comes to the office, but he drops by this week, a year later. His weight a year ago was 385. Now it is 340 pounds. "You remember our conversation?" he asked. He had stopped drinking sugar drinks...that's all.

Another recent example, same deal, this time a cab driver. Hot days. Lots of sweetened soda. By avoiding soda over six months he had lost 20 pounds. He reminded me of our talk. (In both cases there could, of course, be another cause of weight loss, we will see. I will confirm exact weight loss in each case.)

These are adults. Last year a Lancet article drew attention to the problem in children. Now people and groups with contrary concerns cite personal liberty (right to personal beverage choice) and shoddy evidence. Drink up.

Drug Shortages

Drug Shortages
"No lasix?"
Next week: "Where's the solumedrol?"
...Medication shortages happen. To keep up on which and why, the FDA helps.

Monofilament testing

Feet
Can monofilament testing help us (patient & doctor) prevent foot injury and ulceration in diabetes?

Weblogs in Medicine
Jacob Rieder uses Family Medicine Notes to help teach. His weblog serves as an example; he provided a jump start for me. Kind recognition appreciated.

Cincinnati Radiation History & Ethics

Medical Ethics & Radiation Research
US District Court Judge Sandra Beckwith summarizes the history & ethics of Defense Department whole body radiation research in Cincinnati, 1959-1972. Her 1995 decision eloquently discusses autonomy, liberty, and informed consent.

GI Bleeding & BUN

GI Blood and BUN
Does a rise in BUN rise distinguish upper from lower GI bleeding? (Physiologically is the rise in BUN due to catabolism of blood in the gut or simply under perfused kidneys?) This study found a specificity of only 27% and sensitivity of 90%. (Even less reliable in older patients, or with renal & liver diseases.)

Crack in America

Drugs, Neighborhoods and People
To follow-up on our Friday Clinton Hills conversation, the Physician Leadership on National Drug Policy (PLNDP) teaches about substance abuse, public health, and policy.

The book we talked about is Crack in America--essays by physicians, pharmacologists, sociologists and others. Gives sense of recurrent binges and prevalent patterns of use. Has clear opinions on policy.

Our July 2002 Team

Care Givers
Our July 2002 Internal Medicine Team at Good Samaritan Hospital moves on. A good team of people.

Who's who...
Backrow...Chris Bode, Jeff Schlaudecker, Rob Stevens, Lisha Fieler, Chuck Herfel
Front...May Mbah, Marco Callirgos, Carl Gandola

PMR

One Painful Shoulder and Edema in PMR
The review article that Jeff brought in says that while shoulder pain is usually symmetric in polymyalgia rheumatica (PMR), it can begin as unilateral (as in our patient).

We also had talked about edema and its causes in our patient, uncertain if this could be associated with PMR. Yes, edema "of the dorsum of the hands and wrists, as well as of the ankles and tops of the feet" can be a distal manifestation of PMR.

A Physician's Personal Experience
...A letter to the editor reflecting on the concept of condolence letters.

Antibiotics and COPD?
Antibiotics can help in exacerbations--discussed in this excellent review. (Doxycycline effective).

But antibiotics for cough in an otherwise healthy person in your office is a different story. Same for chickens. (This link asks for a password to register for free access).

Physician assisted suicide

Tonight Hemlock Society, Assisted Suicide
Tonight (Tuesday July 23) 7:00 at the Vernon Manor Hotel Cindy Kerkoff, President of Hemlock Society of Ohio will speak. "The mission of Hemlock of Ohio is to maximize the options for a dignified death, including voluntary physician aid in dying for mentally competent, terminally ill adults who request it, in the context of legal safeguards."

The Supreme Court in 1997 found "no constitutional right to die with the help of a physician, and upheld state bans on assisted suicide." Legal issues, broader issues, and media coverage can be readily found on the web.

Rhabdomyolysis CPK and Cuff Test

Rhabdomyolysis, CPK and cuff test
Good review article raises several metabolic conditions that might explain our gentleman's heat/exercise intolerance. Still need information on forearm cuff test and on range of CPK's found in rhabdomyolysis.

Good Sam Library Requests?
Need something from our library? Try email, library@trihealth.com

PMR & Prednisone Duration

How Long Prednisone in Polymyalgia Rheumatica (PMR)?
This review suggests "between one third and one half of patients can stop steroids after two years."

Friday at Clinton Hills
Here are directions.

Palliative Care non-pain symptoms

To Find Quiz
To find the quiz on management of non-pain symptoms click Quiz in the Navigator (the list of items to the left). ...Might help us this coming week.

SOAP notes. BATHE people.

SOAP notes. BATHE people.
We know about SOAP notes. But do we BATHE the patient?