You must really like me, because I got tagged by three people last night.
Thanks Kirsten, Mimi, and Irene. I'll start working on these soon...
HRT, or hormone replacement therapy, has traditionally referred to estrogen replacement therapy in women going through menopause. As you have probably heard, estrogen has fallen out of favor for menopausal symptoms because of estrogen's association with blood clots, stroke, and breast cancer.
Now, testosterone is now taking a hit, according to a study from the Mayo Clinic (ABC). What were the important clinical questions that they wanted to answer: In 150 people over 60 years old, does testosterone replacement therapy slow the aging process and does testosterone replacement increase libido?
At the end of two years, the hormone-taking men and women did have increased levels of sex hormones in their blood compared with those who had received fake pills or fake patches. But these hormone increases didn't make the volunteers any younger, as the supplement industry often promises.Uh, I'm thinking that this is really interesting to know, but maybe I don't want to know how they conducted this study. It's kind of like TMI, or too much information. I can kind of just see a bunch of Alfred Kinsey wannabes flying around the Mayo Clinic with clipboards and questionnaires. Kind of amusing to think about actually."We found no difference in quality of life, including sex drive," said Dr. Sree Nair, lead author and professor of medicine at the Mayo Clinic.
One of the most common questions I get is about side effects of medications. Don't get me wrong, this is a good question to ask, especially if you're not familiar with the medication that is being prescribed.
In today's Journal of the American Medical Association, there is a study which estimates approximately 700000 medication complications each year (Chicago Tribune). I know what you're thinking, "Yeah, it's that Food and Drug Administration again. They're working for the drug companies. They just push all medicines through and don't care about side effects."
It's true that, in the study, the most common classes of medicines that sent people to the ER for treatments were insulin for diabetes and blood thinners like coumadin. But, the problem was not with the prescription medicine itself, but with interactions with other medicines, specifically over the counter pills and herbal supplements.
Dr. David Soria, chairman of the emergency department at Florida's Wellington Regional Medical Center, said patients should tell their doctors about drugs they have been prescribed by others, as well as over-the-counter drugs they take, such as aspirin and herbal remedies.I'm not placing blame here, just re-emphasizing the fact that good patient-physician communication is essential for good medical care. I realize, especially for older people, who may see a lot of doctors, to try to remember who prescribed what and why. (Just a plug for the job of a good primary care physician.)Soria said older patients seem to be taking more herbals because they're easy to get and there is heavy marketing of products that patients think will help to keep their minds sharp or give them more energy.
"Patients don't typically tell us what herbal medications they're on because they don't consider it a drug. They think it's a vitamin," Soria said.
Some studies have found that herbal products, including ginseng and gingko, can cause bleeding, and that others, such as St. John's wort and kava, can react negatively with other medications. St. John's wort also can interact with Plavix, a blood thinner, and cause bleeding.
But monitoring them can be a problem because few studies have been done on the herbals, and because there can be inconsistencies in the batches coming from different manufacturers, Soria said.
Herbal supplements are marketed as "safe" because they're natural. And, this may be the case when used by themselves. In addition, over the counter medications are safe when used correctly. Problems occur when people take prescription medicines, OTC meds, and herbal supplements. Interactions among all these chemicals could be a problem - thus the 700k medication complications each year. So, be careful out there!
One of the questions I got today during my talk had to do with seafood. I was mentioning omega-3 fatty acids and that they can have a beneficial effect on a person's cholesterol. "I thought that fish was bad for you," someone asked me, and they heard that there were a lot of contaminants in seafood. The Institute of Medicine, in a new report, tries to clarify the confusion (CNN).
"The benefits of cardiovascular health from eating seafood, including farm fish, far outweigh the risk of cancer from environmental contaminants," said Dr. William Hogarth of the National Oceanic and Atmospheric Administration, the group that commissioned the report.The environmental contaminants they're talking about include mercury, dioxins, and PCBs. The study found that the levels of these substances were so low in seafood, that there is no danger in consuming it, even a potential cardiac benefit.
The committee members say they aren't sure why fish reduces the risk of heart disease. It could be a direct effect of the omega-3s, or it could simply be that it is lower in saturated fats than other meats, and by adding more fish to the diet, individuals are eating less of the fattier meats.I do not live close to the ocean. So, one of the many things I look forward to is having fresh seafood when on vacation. Finally, a news story about food that has nothing to do with spinach, ecoli, carrot juice, botulism, recalls, or any of that bad stuff. Order up some broiled salmon and veggies for me tonight. Yum!
Grand Rounds 3.4 is up and rolling over at Emergiblog. Kim, the Queen of Carnivals, has what seems like a HUGE number of links over there today. Grab a BIG cup-o-joe and enjoy! Next week's host is listed as Health Care Law Blog.
Can't get enough of blog carnivals? I know Kim can't because she's hosting Change of Shift: A Nursing Blog Carnival in just two days. How does she do that? Sheesh!
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I just got back from my talk about cholesterol at the hospital. Thanks to all of you who gave suggestions on what I should say. I definitely used your comments as I prepared this talk. The audience was the cardiac support group. We have a small cardiopulmonary rehab center at the hospital, and the support group makes up the patients in this program.
Tough crowd, let me tell you. Don't get me wrong, not mean or anything like that. They were very well informed and had a lot of good questions about diet, exercise, and medications. I've done these talks before and the most questions are usually about medications.
Before leaving, the staff gave me a bag of caramel corn as a thank you for speaking. Following my earlier post today, the first thought that came to my mind was, "Whom can I re-gift this to?" HA!
So, I walk in my office yesterday and I see an envelope. I open it and it's a card that says, "Happy Boss's Day!" I didn't even know it was boss's day (check out Michael C for more comments on this). Who made up this "holiday" anyway? Probably the same people that made up Sweetest Day. I have an entire rant on fabricated "holidays," but I'll leave that for another time.
Anyway, inside the greeting card I see a gift card to one of our local restaurants. "Gee, that's nice," I think to myself. Then on the back of the gift card I see a little mark in the corner. It looks vaguely familiar to me. I think for a few minutes, and I figure it out. I'm the one who made that mark a few months ago when I bought this gift card on behalf of the docs here. These gift cards were given to the staff for another fabricated holiday.
Actually, I thought it was kind of funny. I walked into the nurse station and one of the staff members say, "Do you like your card?" I snickered and said, "This is a re-gift isn't it?" I never saw staff members scatter out of the room so fast.
I first heard the term re-gift on an episode of Seinfeld. All of you have done this before, I'm sure. It's when you receive a gift that you particularly don't want. And, instead of returning it or throwing it away, you give it to someone else.
Re-gifting is more common than you think. Cnn.Com reports a study which polled about 1500 Americans. More than half of the people polled said that they re-gifted in the past. In addition, a whopping 78% of respondents said it was acceptable to re-gift.
Nancy Wong, a spokeswoman for Harris Interactive, said she was surprised by the number of people who admitted to re-gifting.I'm going to come clean and say, yes, I've done this before. The problem is accidentally re-gifting back to the same person, and getting caught. This has happened to me before when I give a gift, and that person says, "Didn't I give this to you last year?" So, that's why I wasn't upset when I got the card yesterday. Any funny re-gifting stories out there?"It's not something I've thought about and when I saw that nearly half had done it -- 52 percent have re-gifted and or would re-gift -- it's quite a significant number," Wong told Reuters.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License.
Did you know that someone is making money off of your blog without your permission? I've been doing my own research on this, and I'm really upset about it. I'll refer you to Moof's description of the situation (Part 1 - especially the comments, Part 2, Part 3), as she is the first I heard about this. Mimi also has a descrpition on her blog. I also refer you to Lorelle.
Bitacle.org is the villain here. They are stealing your posts (the full text, pictures, etc from your post), slapping ads at the top and collecting the cash. Want to see an example? Click here.
Are you on bitacle? Check for yourself. Make sure you search under the "aggregates" tab to try to find your own blog. What can you do? Read about it more at Stop Bitacle. They have a button to put on your blog.
As you can see, I've but a couple of buttons at the top of this post. Bitacle doesn't see the sidebar, so if you decide to get a button, make sure you place it in the post itself to be effective. I'm toying with the idea of putting the buttons at the top of each post for the time being. That would be a significant blog change for me.
I just found another way to possibly fight back. It's from Plain Jane Mom; it's creative, and it's funny. If it works out, then I won't have to put those buttons at the top of each post. Check it out the great tip here.
In other blog related news, I'm going to moderate comments now. (I've talked about comments before, click here to read more.) I never wanted to do this, but I'm starting to get a lot of spam comments - the price of fame, I guess *smile*. So, if you don't see your comments popping up right away, that's why. (Parlancheq, thanks for asking)
Finally, I've decided to cut down the number of posts on the front page. (I've also talked about this before, click here.) I'm right around the 150 total posts range, and I've seen people have blogger problems when the front page gets a high number of posts. Want to read my previous posts? I invite you to check out the archive section in my sidebar. I'm really tired. Long weekend working, ugh...
Update: The bitacle link for this post is here. None of my top graphics are there. I tried Plain Jane Mom's suggestion but unfortunately it didn't show up as on hers - bummer, that would have been funny. Just wanted to update all of you.
I know I said I was taking a blog break, but hey, I'm Dr. A and I'm a blogaholic. Plus, I just had to share this short story with you. So, I'm on call. And, you know what that means: busy, busy, busy, tired, etc.
Usually after finishing rounds at the hospital, I stop at the office to try to catch up on some paperwork there. It's windy and cool here today, so I wanted to get inside quickly. So, I turn the key of the door and slip in.
The next thing I usually do is put my code into the security system keypad. I missed by one number and accidentally hit enter. Then, I panicked. For what felt like hours, although it was only less than a minute, I frantically tried to correct my error.
The alarm went off inside the office. I'm the only one here, so I kept working to try to enter the right code. I hear the phone ringing. It's the alarm system company. I tried to explain the problem, and seemed to solve the situation.
Relaxed, I walk down to my office and try to find a chart. Suddenly, I hear sirens get closer to the office. We're located right next to the hospital, so I figured it was an ambulance coming to the emergency room.
When I saw the police car rushing into our parking lot, my feeling of embarrassment grew. I went outside and saw that it was an officer who has done security for our soccer games in the past.
"Doc," he said smiling, "Forgot your code again, huh?" "No," I replied, "I missed one number and all this happened." "On call again, are ya?" "Yup."
Thought you would get a kick out of this. I'm sure some of you out there in blogland have done something funny and embarrassing like this before. What's your story?
Drug Denial: Early diagnosis and treatment of Alzheimer's Disease (AD) has been shown to slow progression of the disease. You'd think that everyone would want early treatment, right? Well, apparently not in the UK.
An article from Times Online reports that their National Institute for Health and Clinical Excellence (Nice) is denying medications like Aricept and Exelon to early stage and late stage patients.
Neil Hunt, the chief executive of the Alzheimer’s Society, said: "This blatant cost-cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke.I've talked about government interference with health care delivery before, so I won't belabor the point here. Suffice to say that from a disease treatment standpoint, I hope that Nice reconsiders its decision.
Ineffective Drugs: AD has limited drug treatment as it is. More advanced stages of AD are particularly difficult. Symptoms here include agitation, aggression, hallucinations, and delusions. Although no medications have FDA approval to treat the agitation symptoms of advanced stage AD, many docs have used psychiatric medications to try to control the symptoms.
An article from the LA Times reports a study conducted by the National Institute of Mental Health using two psychiatric meds commonly used to try to alleviate symptoms (Zyprexa, Seroquel).
Depending on the drug, 37% to 50% of patients discontinued their pills because they weren't working, and up to 24% stopped taking them because of side effects such as drowsiness, weight gain and confusion. All told, 82% of patients quit their drugs.In my experience, I've found similar poor results in my assisted living and nursing home patients. I'm going to keep trying meds like Zyprexa and Seroquel, because there is very little else out on the market right now to treat advanced AD. Hopefully, there will be other treatment options in the future.
THC Treatment: The chemical name is delta-9-tetrahydrocannabinol. It is also called THC. If you don't already know, this is the active ingredent in marijuana. Some already use this to control side effects of cancer and AIDS treatments.
An article from The Age reports that the Scripps Research Institute in California performed a study which found that THC helps to decrease the formation of the protein plaques which cause AD.
THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, the researchers reported in the journal Molecular Pharmaceutics.I'm just imagining how they actually performed the study. "Dude, my memory is so much better." "Dude, I'm hungry, pass the potato chips." "Dude, pass the controller. It's my turn for the XBox." "No, it's my turn." "No, it's my turn."
Finally, am I advocating citizens of the UK to smoke pot since they have no access to prescription AD drugs? No, of course not. But, from a cost standpoint, pot is less expensive than Aricept or Exelon (at least that's what I've been told -- HA!) Maybe something for them to consider...
I'm on call this weekend, and I'm feeling a little blog burnout. So, I'm taking a few days off. Back next week some time. See you soon.
It's no secret that I'm a news junkie. You can plainly see this from my blog. In addition to my patient rounds, I do my blog rounds and news rounds. I became really upset when I read this article from the Washington Post called, "Doctors Slow to Adopt E-Records for Patients."
About one in four doctors use some form of electronic health records, suggesting that a technology frequently billed as a way to improve the quality and efficiency of care has yet to win widespread acceptance, according to a study released yesterday.As these type of articles in the media go, the following paragraphs build the case why an electronic record is a good idea -- it "collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically." In addition, they "improve patient care, reduce errors, curb unnecessary tests and cut paperwork."
Yes, I get it. Even though I am one of the 75% of docs who do not use electronic health records (yet), I agree with everything that has been said above. I think all docs agree that going electronic is the future of medicine.
So, what's the hold up? Why isn't everyone using it now? There are two main hangups, in my opinion. The first one is covered later in the Post article, and it is who will have access to this electronic infomation? Also along these lines is who owns the information inside the computer?
"The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records," said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. "They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians."For example, if I'm talking with a patient and entering information into a laptop, and this information is stored on the hospital server three streets away from my office, who has access to this information - besides me? How comfortable would you be if I told you your medical data is on a hospital server and possibly backed up on an offsite server, while now, your information is in my paper chart under lock and key in my office? Just something to think about.
The BIG reason docs have not jumped on board is plain and simple -- COST! This is something that is never talked about in the lay press. The federal government has made a goal of most Americans on an electronic health record by 2014. Like a lot of other things from the federal government, this is an unfunded mandate.
Even for a small office like ours, the cost can be between 50-100 thousand dollars. But, hey docs can afford that, right, because I see them driving their expensive cars and have their expensive houses?
Medicare is a govenment program which is health insurance for people over 65 years old. As you all know, the number of Medicare patients is rising very day, because as a nation, we're growing older. Many physician offices depend on Medicare for a good portion of their income. In 2007, Medicare is slated to be cut by 5% unless Congress intervenes by the end of the year.
This cut will hugely effect docs across the country. Just as an example, here's an article from the Concord Monitor.
The New Hampshire Medical Society estimates that the cut will cost the typical family practice $20,000 next year, which could force some doctors to stop accepting new Medicare patients.So, bottom line, I totally agree that the electronic health record is the wave of te future, and all docs will eventually get on board. What the press neglects to cover is the real story of why this is not happening now. I know I'll continue to read articles like the one today in the Post, and I'll continue to get upset. But, here is the real story of why so few use electronic records now.The association and its counterparts across the country have until December to persuade Congress to stop the cut. Lawmakers have, in years past, heeded similar requests, but local doctors remain worried.
"Primary-care doctors are really mom-and-pop shops," said Dr. Gerard Hevern of Suncook Family Health Center. "Most of us do it because we love it . . . but we do it on a shoestring. When you begin to erode that margin, it really impacts in ways that are profound."
Addendum: Dinah from Shrink Rap has some additional thoughts and some great comments in her post entitled "For The Record." Check it out! Also, thanks to all of you reading via Grand Rounds this week. I invite you to check out the rest of my blog.