tag:blogger.com,1999:blog-55490904176529891592024-03-19T06:35:58.471-05:00David Fisher, MD, MPHYour source for the latest health news <br> and common sense medical opinionDavid Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.comBlogger61125tag:blogger.com,1999:blog-5549090417652989159.post-61901528938400812009-12-20T23:07:00.000-06:002009-12-20T23:07:18.596-06:00This Week's Health Headlines<a href="http://diabetes.webmd.com/news/20091214/coffee-tea-may-stall-diabetes">Drinking Coffee or Tea May Reduce Risk for Diabetes</a><br />
<a href="http://www.webmd.com/breast-cancer/news/20091215/spices-may-prevent-breast-cancer">Black Pepper and Curry: Two Great Tastes that... Fight Breast Cancer?</a><br />
<a href="http://www.medpagetoday.com/PrimaryCare/Geriatrics/17603">Volunteering Keeps Older Minds Sharp</a><br />
<a href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/17569">FDA Panel Makes Major Change in Cholesterol Drug Recommendations</a><br />
<a href="http://www.medpagetoday.com/PrimaryCare/AlternativeMedicine/17590">Meeting Spiritual Needs Improves Quality of Life for Dying Patients</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-41557769708418501542009-12-13T21:43:00.000-06:002009-12-13T21:43:55.124-06:00This Week's Health Headlines<a href="http://www.webmd.com/migraines-headaches/news/20091208/high-flow-oxygen-treats-cluster-headaches">Relief for Sufferers of Cluster Headaches</a><br />
<a href="http://www.sciencedaily.com/releases/2009/12/091210000845.htm">Study: Most Hospitalized Patients Don't Know Their Medicines</a><br />
<a href="http://www.medpagetoday.com/MeetingCoverage/ASHHematology/17413">Study: Doctors Leave Gaps When Talking to Patients About Their Cancer</a><br />
<a href="http://www.foxnews.com/story/0,2933,579900,00.html">Discovery Could Lead to Pill That Makes Curly Hair Straight</a><br />
<a href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/17434">Kissing a Frog Won't Get You a Prince, But It Could Get You Sick</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-35758724320365228572009-12-06T15:51:00.000-06:002009-12-06T15:51:31.213-06:00This Week's Health Headlines<a href="http://www.webmd.com/cold-and-flu/news/20091204/cdc-few-serious-reactions-after-swine-flu-vaccine">CDC: H1N1 Vaccine Has Proven Safe So Far</a><br />
<a href="http://www.foxnews.com/story/0,2933,578296,00.html">French Scientists Create Human Skin Using Adult Stem Cells</a><br />
<a href="http://www.abcnews.go.com/Health/13-embryonic-stem-cell-lines-released-research/story?id=9227723">NIH Opens Federal Funding for Embryonic Stem Cells in Spite of Ethical Concerns</a><br />
<u><span style="color: purple;"><a href="http://www.abcnews.go.com/Politics/slim-fast-recalls-millions-shakes-diet-drinks/story?id=9251524">Slim-Fast Recalls All Products Due to Non-Lethal Toxin</a></span></u><br />
<u><span style="color: purple;"><a href="http://www.medpagetoday.com/PrimaryCare/Obesity/17319">Weight Loss Eases Sleep Apnea in Obese Men</a></span></u><br />
<a href="http://www.foxnews.com/story/0,2933,578300,00.html">Study Says Loneliness is Contagious</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-53122004213102273492009-12-06T14:41:00.002-06:002009-12-06T16:53:14.941-06:00Oregon state registry for end-of-life wishes: a good idea?Oregon recently <a href="http://ow.ly/IDvX">launched a state registry</a> for patients who sign a form known as <a href="http://www.polst.org/">POLST</a> (Physician Order for Life-Sustaining Treatment). This transferable order set allows patients to give specific instructions on the treatments they would or would not want in certain situations. For example, a patient may opt for or against resuscitation for cardiac arrest, for or against IV antibiotics, or whether or not to place a feeding tube in different scenarios. The POLST orders go beyond most states' DNR (do not resuscitate) orders, which only apply in the event of cardiac arrest. POLST allows a patients to direct their care even when they have become to ill to express their wishes.<br />
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One of the biggest problems with advance directives is that emergency crews or hospital staff cannot locate the documents in a crisis, the time when the expressed wishes are most crucial. Unless medical personnel have a verbal or written directive from the patient, we are obligated to perform certain procedures like intubation and mechanical ventilation, which many terminally ill patients do not want. POLST tries to ensure that wishes are honored, but even in states where POLST has been implemented, relying on a paper form has its risks. This program in Oregon would allow medical personnel with a password to instantly access the POLST record electronically, even if the paper document cannot be found. Many times I have encountered situations when a patient was in a crisis, unable to speak, and we could not locate the advance directive or power of attorney. Too often the patient had something done that went against his or her expressed wishes, simply because those expressions were not available when needed.<br />
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I understand concerns that people may have about an electronic record of private and personally held wishes that can be used to direct medical care. I believe that this system would give more control to patients, not less. If you take the time to document your wishes, shouldn't they be available to health care personnel in a time of crisis? The registry is purely voluntary; Oregon residents are not required to participate. There is no coersion to choose one option over another; patients may direct care however they see fit, even to request all available treatments or procedures be given under any circumstance. While I do not agree with Oregon's policy on legalized physician-assisted suicide, I believe that a voluntary electronic registry of patient wishes is a helpful addition to the health care system, and I hope that more states adopt such a program.<br />
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As I have said <a href="http://doctordavidfisher.blogspot.com/2009/08/advance-care-planning-101-its-easy-and.html">before</a>, the best way to ensure that your wishes are honored is to name a Power of Attorney for Health Care. Read more <a href="http://doctordavidfisher.blogspot.com/2009/08/advance-care-planning-101-its-easy-and.html">here</a>.<br />
</span>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-75515329575331478322009-11-30T00:34:00.000-06:002009-11-30T00:34:21.942-06:00This Week's Health Headlines<a href="http://www.reuters.com/article/healthNews/idUSTRE5AO2LC20091125">Exercise makes you hungry, but it also makes you feel full</a><br />
<a href="http://www.foxnews.com/story/0,2933,577209,00.html"></a><a href="http://www.medpagetoday.com/Neurology/MultipleSclerosis/17203">New theory on multiple sclerosis stirs excitement</a><br />
<a href="http://www.webmd.com/cold-and-flu/news/20091125/worrisome-spike-in-bacterial-infections-with-h1n1-flu">H1N1 flu leads to spike in pneumonia, and new vaccine recommendations</a><br />
<a href="http://www.medpagetoday.com/Cardiology/Prevention/17179">How much salt should you cut out to cut your stroke and heart risk?</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5AP35920091126">Depression may increase risk of leaky bladder in women</a><br />
<a href="http://www.foxnews.com/story/0,2933,577209,00.html">US diabetes cases to double, costs triple by 2034</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-16552086665696378542009-11-26T01:28:00.002-06:002009-12-06T16:53:37.936-06:00Engage with Gravy, then Engage With GraceI have blogged before about the importance of <a href="http://doctordavidfisher.blogspot.com/2009/08/advance-care-planning-101-its-easy-and.html">sharing your end-of-life wishes</a> with someone you trust. Thanksgiving is the perfect time to have that conversation as you gather with family. The fine folks at <a href="http://www.engagewithgrace.org/">Engage with Grace</a> have put together a slide of 5 questions that will make this process easier.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNeJWRVK8IoKGGAAtRvz2WS9DoEFm73HvG_y-Tn3kkTcN35Rf0vLXlc-5Aox-Ts67UW8vCjl7WhyckdCA8mC0Kkk_IXBq9h3gbynHsFXOtaVCOyngtfLsbIqJcsQ4-SZsaOlOtTDgV3OU/s1600/theoneslide.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNeJWRVK8IoKGGAAtRvz2WS9DoEFm73HvG_y-Tn3kkTcN35Rf0vLXlc-5Aox-Ts67UW8vCjl7WhyckdCA8mC0Kkk_IXBq9h3gbynHsFXOtaVCOyngtfLsbIqJcsQ4-SZsaOlOtTDgV3OU/s320/theoneslide.jpg" yr="true" /></a><br />
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If you have the gizzards to bring up these questions at the Thanksgiving dinner table, you deserve the Myles Standish Award for Bravery. Even so, I find that once the ice is broken, these conversations can be quite cathartic, and you and your family will feel like you accomplished something important at Thanksgiving besides overloading on poultry and dozing off into a tryptophan-induced haze. So, after you engage with gravy, Engage with Grace this holiday. You can thank me later.<br />
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...would love to hear your comments on how it goes...David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-19011949234975990552009-11-23T12:40:00.000-06:002009-11-23T12:40:16.176-06:00This Week's Health Headlines<a href="http://www.abcnews.go.com/Health/w_SleepNews/study-shows-memories-enhanced-sleep/story?id=9127524">Learning while sleeping: Not so crazy after all?</a><br />
<a href="http://www.foxnews.com/story/0,2933,575928,00.html">Low-carb or high carb? Both diets seem to help</a><br />
<a href="http://www.medpagetoday.com/ProductAlert/Prescriptions/17147">Diet drug linked to increased strokes and heart attacks</a><br />
<a href="http://www.medpagetoday.com/Endocrinology/Diabetes/17131">Doctors say low pay for diabetes care shortchanges patients</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5AJ4RK20091120">Swine flu infections dropping, but more to come?</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5AJ4J820091120">Certain foods proven to reduce colon cancer risk</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-49251164673885846112009-11-22T00:44:00.002-06:002009-11-22T00:45:38.825-06:00The "Million Med March"<div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVpkwWwsT-GDoPD8AsFCupDvFbrYw-pHM05hbwsE6Xzz6CiehJvDrGXGYlT-wS9lJMFk4Y9g472hplpCcdD7DlX0ljQiD2wIJgWjdhf9-UymAC2NM8brz3dIw1iNMQKUfZ7IvWPy119M8/s1600/IMG_1037.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVpkwWwsT-GDoPD8AsFCupDvFbrYw-pHM05hbwsE6Xzz6CiehJvDrGXGYlT-wS9lJMFk4Y9g472hplpCcdD7DlX0ljQiD2wIJgWjdhf9-UymAC2NM8brz3dIw1iNMQKUfZ7IvWPy119M8/s320/IMG_1037.JPG" yr="true" /></a>Today I attended the <a href="http://millionmedmarch.com/">Million Med March</a> held in cities across the US and here in Chicago. It was sponsored by <a href="http://docs4patientcare.org/">Docs 4 Patient Care</a>, a grassroots organization of physicians, healthcare professionals, and concerned citizens who want to reform health care while preserving the integrity of the patient-physician relationships we enjoy in this country. I didn't know much about the group before today. There weren't exactly 1 million doctors at Chicago's rally today- maybe 200-300. Even so, there were some important messages. Here is a summary of what was said, and my reflections on the event.<br />
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<div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: left;"><em>1. We are blessed to live in a country where the exchange of ideas is protected by law.</em><br />
</div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: left;">It was a privilege to gather with like-minded people today and express my views on an issue that I care about. Few nations on earth protect, and even encourage, free and peaceful assembly to promote a cause. The police who were present were not there to break up our meeting, or even monitor what we were saying, but to protect our right to assemble. I'm not a big "rally" guy, but I appreciated the chance to participate today with no risk to my personal safety, my job security, or my family's well-being. <br />
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<em>2. Doctors are bad protestors/activists.</em><br />
Today's rally lacked the energy that I have experienced at other public events. It was not because the doctors present do not believe strongly in sensible health care reform. I think most physicians, in an effort to provide their patients with the best, evidence-based medical care, get used to just falling in line with the latest recommendations and "standard of care." Protests do not come naturally. That, combined with the even-tempered personalities often found in physicians, makes us bad activists. We are not a "rah-rah" crowd.<br />
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Most of the doctors I talk to are not in favor of the current health care bill. Most of them also feel there is not much they can do to impact the health care reform efforts in Congress. Part of that is due to the fact that very few doctors were actually invited to participate in the process. The American Medical Association (AMA) supports the bill, but it represents less than 30% of doctors. (Many AMA members are newly graduated physicians who have not taken time to cancel the free membership they received as a medical student.) Another reason doctors don't feel we can have an impact is that, for whatever reason, we tend not to rally together. Perhaps it is the self-sufficiency we learned in medical school and residency training. It may be that we are too busy to ask each other to participate in an event seen as an "extra" thing. The laws prohibiting physicians from forming a union also prevent us from uniting around a cause. I am proud of those physicians who attended today. As one physician and speaker put it, "I wasn't going to come today because I have a busy practice, a family, and few minutes to spare, but then I realized, that is why I needed to come today, because health care reform is going to affect all of those things."<br />
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<em>3. The introduction of a public option will lead to government-run health care.</em><br />
Even if this is not the stated intention, offering a government-subsidized health insurance plan to all will eventually destroy private health insurance as we know it. The argument for the "public option" says that health insurance companies need a competitor to "keep them honest" and the government needs to provide this competition to prevent abuse. Sounds great, but since when did the US government compete with its own people? One enters a competition for one reason: to win. That means that the clandestine goal of the government-run plan is to make private insurance companies into losers. Since a government plan does not have to remain profitable to stay in existence, it will play by different rules. Since its inception in the 1960's, Medicare has operated at a $37 trillion loss, yet it is bigger than ever. No private company can "compete" against a beauracracy that bulletproof.<br />
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<em>4. The "opt-out" provision in the Senate bill is a sham.</em><br />
To create the impression that the public option is not being forced upon us, the Senate included language that will allow individual states to opt out of offering the public option. What is not publicized is the fact that states who opt out will still pay the same taxes as states who opt in. They will incur the same costs but no benefits. It's doubtful that any states will opt out of the plan, since they cannot opt out of the cost.<br />
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<em>5. Estimates of the bill's costs are grossly underestimated.</em><br />
You have probably seen the CBO estimates of a $849 billion price tag for the current health reform bill. The CBO numbers are based on a ten-year projection. Since the changes to the health care system are slated to take place in 2013, the estimates only include 6-7 years of costs, but they include 10 years of increased taxes that will start immediately. In other words, three of those ten years are income-only years for the program, with no costs. Let's say you move into a house in June and paying six months of mortgage payments of $1000 each. Would you then assume that, since you paid $6000 for your mortgage this year, that you would pay $6000 again next year, and your payments would only be $500/month? Of course not, because you failed to take the entire year into account, but that is essentially the way the CBO is projecting the costs of this health care plan.<br />
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Plenty more was talked about today, and I encourage you to read as much as you can and get as involved as you can. To learn more about today's event, visit <a href="http://www.docs4patientscare.org/">Docs 4 Patient Care</a>.<br />
</span>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-35960584728612795542009-11-16T09:32:00.000-06:002009-11-16T09:32:11.823-06:00This Week's Health Headlines<a href="http://abcnews.go.com/Health/WellnessNews/frequent-neti-pot-sinus-infections/Story?id=9054035&page=2">Frequent Neti pot use could cause sinus infections</a><br />
<a href="http://www.rush.edu/webapps/MEDREL/servlet/NewsRelease?id=1315">Reduced muscle strength associated with Alzheimer's disease risk</a><br />
<a href="http://www.msnbc.msn.com/id/33795216/ns/health-cold_and_flu">Get instant diagnosis by coughing into your... cell phone?</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5A954C20091110">ER waits worsening, especially for those in a true emergency</a><br />
<a href="http://www.foxnews.com/story/0,2933,575267,00.html">Are chemicals in plastics making boys more feminine?</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-8167183109323697112009-11-14T22:18:00.003-06:002009-11-15T17:53:47.377-06:00Nonpartisan Agency says House Bill will reduce Senior CareIn June, I wrote about <a href="http://doctordavidfisher.blogspot.com/2009/06/where-president-obama-is-wrong-about.html">why the proposed health care reforms will end up reducing benefits for seniors</a>. This week, a major nonpartisan agency agreed. Today's Washington Post has a story about the report from the Centers for Medicare and Medicaid Services. It reads:<br />
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<em>"The report... found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether."</em><br />
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Read the full article <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/11/14/AR2009111402597.html">here</a>.<br />
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Good intentions do not always equal good results. Congress needs to consider the unintended consequences of asking our health care system to do more with less. As the Post article explains, the weakest and most infirm could still end up out in the cold. We need different solutions to the problems with our health care system than the ones currently being proposed in Congress. The <a href="http://rules-republicans.house.gov/Media/PDF/RepublicanAlternative3962_9.pdf">bill offered by the Republicans</a>, while not perfect, offers more common sense solutions, like giving incentives to individual States for reducing their numbers of uninsured, increasing tax benefits related to Health Savings Accounts, and at least addressing problems with medical liability. Before the Senate votes on health care reform, let your Senators know that the current proposals are a bad prescription for America.David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-31308578645211220182009-11-10T23:45:00.001-06:002009-11-11T22:33:32.661-06:00Dennis and Me<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKQ8ROIF6zqXEU6xLaL670c4y-s1HJ3nOzkjqHaHM-Z1r-2nyIib9RfdlLL3-GqZ764RxfdDGxdvt9ZlOQYbdigim7IyCGpwIhoJb3VMq4RHhq25Gr_044E0pO4WgA4pNHVfA_MXJSWLw/s1600-h/Dennis+and+me.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" sr="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKQ8ROIF6zqXEU6xLaL670c4y-s1HJ3nOzkjqHaHM-Z1r-2nyIib9RfdlLL3-GqZ764RxfdDGxdvt9ZlOQYbdigim7IyCGpwIhoJb3VMq4RHhq25Gr_044E0pO4WgA4pNHVfA_MXJSWLw/s200/Dennis+and+me.jpg" /></a><br />
</div>I had the chance to attend a live broadcast of The Dennis Miller Show at Navy Pier. I took it upon myself to grant him an honorary MD, since laughter heals and he is one of the best. Listen <a href="http://radiohousecalls.com/shows.php">here</a>.David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-84797381086397254682009-11-08T20:58:00.000-06:002009-11-08T20:58:18.990-06:00This Week's Health Headlines<a href="http://abcnews.go.com/Health/ConsumerNews/greenwashing-green-claims-accurate/story?id=8999483">Are "green" products really green? Not always, according to study</a><br />
<a href="http://www.medpagetoday.com/Surgery/GeneralSurgery/16840">Eating too fast contributes to weight gain</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5A45UE20091105">Breakdown of the House Health Care Bill</a><br />
<a href="http://www.cbsnews.com/stories/2009/11/05/politics/washingtonpost/main5535723.shtml?tag=cbsnewsLeadStoriesAreaMain;cbsnewsLeadStoriesHeadlines">Experts: H1N1 spread is outrunning vaccine</a><br />
<a href="http://www.medpagetoday.com/Surgery/GeneralSurgery/16840">Study: Surgeons-in-training need a work week of more than 80 hours</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-5853085062922531012009-11-02T23:00:00.000-06:002009-11-02T23:00:54.435-06:00This Week's Health Headlines<a href="http://www.cbsnews.com/stories/2009/10/30/health/main5465029.shtml">CDC: Kids' deaths from H1N1 jump to 114</a><br />
<a href="http://www.foxnews.com/story/0,2933,570538,00.html">New injection could cure snoring</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5A15AR20091102">Survey: Doctors performing Pap test too often</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5A11CI20091102">High cost of malaria medicine costs millions of lives</a><br />
<a href="http://abcnews.go.com/Health/w_ParentingResource/down-syndrome-births-drop-us-women-abort/story?id=8960803">Down syndrome births decline as more moms abort</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-5497317460757085382009-10-26T01:08:00.000-05:002009-10-26T01:08:33.226-05:00This Week's Health Headlines<a href="http://abcnews.go.com/Health/SwineFluNews/h1n1-swine-flu-emergency/story?id=8913231">President Obama declares H1N1 a national emergency</a><br />
<a href="http://www.medpagetoday.com/Orthopedics/Orthopedics/16542">Knee pain? Don't rest, exercise</a><br />
<a href="http://abcnews.go.com/Health/MindMoodNews/media-violence-sex-threaten-kids-pediatricians/Story?id=8866443&page=1">Doctor's group: media sex and violence threatens kids</a><br />
<a href="http://www.foxnews.com/story/0,2933,569326,00.html">Food labeling program halted over FDA warnings</a><br />
<a href="http://www.medpagetoday.com/Pediatrics/Vaccines/16574">Rotavirus season shortened since introduction of vaccine</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-48711100913253218272009-10-25T16:26:00.003-05:002009-10-25T19:23:28.381-05:00Natural sleep aids in pregnancyTuesday morning on <a href="http://mornings.fm/">WMBI</a> a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep. In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl. This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child). However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy. My response brought to light one of the problems in our health care system, namely, that the increasing demands of insurance companies and health care systems force doctors to rush through an office visit, and we often fall back to the old playbook of the most commonly recommended pharmaceutical solution, rather than exploring other 'natural' and behavioral remedies. I felt like I did the radio equivalent of a rushed office visit on Tuesday. Thankfully, I have the opportunity to follow up and explore those alternatives here.<br />
<span class="fullpost"><br />
Sleep patterns are clearly altered for pregnant women as they approach the birth of their baby. The expanding uterus presses on the surrounding organs, making it difficult to last the night without having to get up to empty the crowded and shrunken bladder. The sheer discomfort of the expanding abdomen, and the often corresponding back pain, make it difficult to sleep comortably, especially if the woman is used to sleeping on her stomach. I believe that the disturbed sleep can help prepare an expecting mom for motherhood. Once the baby is born, new moms are called upon to spend odd hours nursing and caring for their baby. Every new parent knows that while their newborn may sleep 18 out of 24 hours, the sleep usually comes in 90-120 minute spurts followed by 1-2 hours of wakefulness. Furthermore, newborns tend to have an opposite sleep cycle after birth, spending more time sleeping during daytime hours and more time awake at night. In a way, the woman who has to adapt to irregular sleep patterns is being trained for the physical demands of early motherhood.<br />
<br />
That being said, there are some simple ways to improve sleep during pregnancy. The basic behavioral recommendations to improve sleep still apply. Try to wake up and go to bed around the same time every day. Avoid caffeine in general, but especially in the afternoon and evening. It is important to continue to drink plenty of water during pregnancy, but try to limit your intake for 2-3 hours prior to sleep, and be sure to empty your bladder fully before bed. Many women state that sleeping on the side and placing a pillow between the legs provides additional comfort. Continuing to exercise during pregnancy is safe, and regular exercise has a positive impact on sleep.<br />
<br />
Regarding "natural" sleep aids, some are safe in pregnancy and some are not. It is important to remember that herbal and 'natural' remedies are not regulated by the FDA, so they can claim anything they want on their packaging without having to prove their claims with scientific studies. Also, the FDA does not test the products to ensure that the ingredients listed on the label are actually contained in the supplement. Some of the more popular sleep aids are below.<br />
<br />
<strong>Melatonin</strong> is a chemical that resets the body's 24-hour clock, called the Circadian rhythm. Pregnant women have naturally lower melatonin levels, and these lower levels may be important to the baby's development. Therefore, I would not recommend melatonin durnig pregnancy.<br />
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<strong>Chamomile</strong> is commonly used to make tea that is used by many as a sleep aid. Most would consider chamomile tea to be safe, but probably not the more concentrated chamomile oil. I can safely recommend chamomile tea during pregnancy.<br />
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<strong>Valerian </strong>is an herb that has a mild effect on the body and is one of the safer herbal sleep aids, however, there is conflicing evidence about whether it is safe during pregnancy. Therefore, I would play it safe and not use valerian during pregnancy.<br />
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<strong>5-HTP</strong> is a supplement used for depression that can also aid in sleep. It affects serotonin levels, and while many doctors consider serotonin-altering medications to be generally safe in pregnancy, we do not have convincing evidence that it is completely safe. Therefore, I would not recommend 5-HTP.<br />
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<strong>Kava</strong> was once a popular herbal supplement used for anxiety symptoms and insomnia. Many problems with kava have been uncovered, including its harmful effects on the liver. I do not recommend taking kava for any reason.<br />
<br />
<strong>Tryptophan </strong>is not available as a supplement but is present in turkey, cheese, nuts, beans, eggs, and milk. High levels have induced fetal tumors in laboratory animals, so seeking out tryptophan in high doses is not advised. The amount of tryptophan in a glass of warm milk would be safe, and it may be enough to assist with falling asleep.<br />
<br />
In summary, about the only "natural" sleep aids that I recommend are warm milk or chamomile tea. Making some behavioral changes may also help with sleep during pregnancy, but in the later stages, it is probably unrealistic to maintain normal sleep patterns. If you find yourself wide awake and frustrated as your due date nears, take a moment and pray for your baby. It's a great way to prepare yourself spiritually and emotionally for the arrival of your child, while your body trains itself physically for more sleepless nights ahead.</span>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com1tag:blogger.com,1999:blog-5549090417652989159.post-28731164754354982322009-10-24T15:39:00.000-05:002009-10-24T15:39:10.071-05:00Feature on Albert Schweitzer Fellowship websiteThe fine people at the <a href="http://www.schweitzerfellowship.org/">Albert Schweitzer Fellowship</a> recently invited me to participate in their "Five Questions for a Fellow" feature on their blog <a href="http://schweitzerfellowship.wordpress.com/">Beyond Boulders</a>.<br />
<br />
Read the article <a href="http://bit.ly/1fmHex">here</a>.<br />
Read more about Albert Schweitzer <a href="http://doctordavidfisher.blogspot.com/2009/06/who-was-albert-schweitzer.html">here</a>.David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-87538284312892057782009-10-18T16:47:00.000-05:002009-10-18T16:47:39.542-05:00This Week's Health Headlines<a href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/16474">Manufacturers come up short in expected H1N1 vaccine production</a><br />
<a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm186861.htm">FDA warns H1N1 products purchased over internet could be phony</a><br />
<a href="http://med.stanford.edu/ism/2009/october/mri-back.html">More MRI scanners may lead to unnecessary back surgeries</a><br />
<a href="http://abcnews.go.com/Health/CancerPreventionAndTreatment/wireStory?id=8845159">FDA approves another vaccine for virus that causes cervical cancer</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE59H1HY20091018">More progress in the fight against breast cancer</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE59F49120091016">Pregnant women with back pain might benefit from acupuncture of the ear</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-17565840875215061802009-10-11T16:44:00.000-05:002009-10-11T16:44:23.751-05:00This Week's Health Headlines<a href="http://www.nytimes.com/2009/10/09/health/research/09virus.html">Chronic fatigue syndrome linked to a little-known virus</a><br />
<a href="http://www.medpagetoday.com/Nephrology/ESRD/16346">Exercise improves survival in chronic kidney disease</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE59756D20091009">Another big step taken in adult stem cell research</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5974O820091008">Feelings of being wronged may worsen your recovery from whiplash</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5963ZP20091007">Trying to quit smoking? Texting may help</a><br />
<a href="http://www.medpagetoday.com/Surgery/Otolaryngology/16322">Cruising in a convertible could harm your hearing</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-38187666539641252412009-10-03T22:59:00.001-05:002009-10-04T02:10:44.445-05:00The 411 on H1N1Here it is: the breakdown you've been looking for on the flu vaccines.<br />
Who should receive them?<br />
<br />
First- the <strong>regular seasonal flu vaccine</strong>, available now.<br />
You should get the flu vaccine this year.<br />
The only people who should not are infants less than 6 months, people with an egg allergy, and people with a previous reaction to the flu vaccine.<br />
<br />
Next- the <strong>H1N1 vaccine</strong>, available in the next few weeks.<br />
The following groups of people should get this vaccine:<br />
Pregnant women<br />
Children age 6 months to 18 years<br />
Caregivers for children this age<br />
Young adults 18-24<br />
Health care workers<br />
People age 25-64 with a chronic medical condition<br />
(Examples include diabetes, asthma, COPD, and autoimmune conditions)<br />
<br />
People age 65 and older are at lower risk for H1N1, so they are not recommended for the vaccine until the higher priority groups are inoculated. Sometime in December or January, people age 65 and older may be recommended to receive the H1N1 vaccine.<br />
<br />
The H1N1 vaccine will be available as a nasal spray and as a shot. Pregnant women cannot receive the nasal spray because it contains a live virus. It is safe for everyone else except those with a compromised immune system (as in HIV). Children under 10 will require 2 doses about 4 weeks apart. Everyone else will need only one dose.David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com9tag:blogger.com,1999:blog-5549090417652989159.post-50880595096312945262009-10-03T15:33:00.002-05:002009-10-03T15:51:23.738-05:00This Week's Health Headlines<a href="http://news.yahoo.com/s/afp/20091002/wl_uk_afp/healthscienceusbritainbiology;_ylt=AoWui6RKg3fmFotVZotMWsas0NUE;_ylu=X3oDMTJyOGRkbDhsBGFzc2V0A2FmcC8yMDA5MTAwMi9oZWFsdGhzY2llbmNldXNicml0YWluYmlvbG9neQRwb3MDNwRzZWMDeW5fbW9zdF9wb3B1bGFyBHNsawNzY2llbnRpc3RzZmk-">Scientists extend lifespan by blocking protein</a><br />
<a href="http://www.foxnews.com/story/0,2933,558964,00.html?loomia_ow=t0:s0:a16:g12:r1:c0.139691:b28072594:z10">Most babies born this century will live to 100</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5916GK20091002">Yoga may decrease age-related "dowager's hump"</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5915RS20091002">Yet another benefit of vitamin D- it prevents falls</a><br />
<a href="http://www.medpagetoday.com/Cardiology/Hypertension/16260">Combination of generic drugs cuts heart risk by 60%</a><br />
<a href="http://www.chicagotribune.com/news/chi-wic_01oct01,0,7958247.story">Federal WIC program finally allows use for fruits and veggies</a><br />
<a href="http://news.yahoo.com/s/nm/20090929/lf_nm_life/us_food_friends">Skinny friends could wreck your diet</a><br />
<a href="http://www.google.com/hostednews/ap/article/ALeqM5hrXJT0plz6GHuLW-RxhxKJbsqJFQD9B1U6PO0">Treating your kids to too much candy could land them in... jail?</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-36884788819917683892009-09-26T22:17:00.008-05:002009-10-03T15:40:18.788-05:00This Week's Health Headlines<a href="http://abcnews.go.com/Health/SwineFluNews/rapid-flu-test-insensitive-h1n1/story?id=8665576">Think it's swine flu? Don't go for the rapid test</a><br />
<a href="http://www.nlm.nih.gov/medlineplus/news/fullstory_89795.html">Antidepressants during pregnancy linked to heart defects in baby</a><br />
<a href="http://www.medpagetoday.com/Urology/ProstateCancer/16142">Study: No evidence to support routine PSA testing for prostate cancer</a><br />
<a href="http://www.medpagetoday.com/PrimaryCare/BackPain/16112">Fear of back pain may increase your risk for back pain</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE58O4ZS20090925">Poor math skills may worsen diabetes control</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE58N4PN20090924">Low vitamin D may be deadly for older adults</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-71115934905509889682009-09-20T14:07:00.008-05:002009-10-03T19:13:00.441-05:00This Week's Health Headlines<a href="http://www.reuters.com/article/healthNews/idUSTRE58H4EP20090918">First H1N1 vaccine in US will be a nasal spray: CDC</a><br />
<a href="http://www.msnbc.msn.com/id/32920468/ns/health-infectious_diseases/">Deadly mosquito-borne illness heading to US</a><br />
<a href="http://news.bbc.co.uk/2/hi/health/8260561.stm">Unhealthy habits could cost men 10 years of life</a><br />
<a href="http://www.medicalnewstoday.com/articles/163854.php">Steroid injection may help restore vision when eye veins are blocked</a><br />
<a href="http://www.foxnews.com/story/0,2933,552902,00.html">Daily dose of aspirin may cut colon cancer risk<br />
</a><a href="http://www.foxnews.com/story/0,2933,551402,00.html">Scientists discover cure for color blindness</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com1tag:blogger.com,1999:blog-5549090417652989159.post-74436887178253646972009-09-13T21:41:00.009-05:002009-10-03T15:43:46.966-05:00This Week's Health Headlines<a href="http://www.reuters.com/article/healthNews/idUSTRE58A3V620090911">Eating meat in middle age may help preserve later abilities</a><br />
<a href="http://www.reuters.com/article/healthNews/idUSTRE5896GD20090910">Even a little smoking increases breast cancer risk</a><br />
<a href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/15913">Docs stressed out when patient unable to communicate wishes</a><br />
<a href="http://news.bbc.co.uk/2/hi/health/8245578.stm">Sleep specialist says sharing a bed is 'bad for your health'</a><br />
<a href="http://www.medpagetoday.com/CriticalCare/Pneumonia/15869">New test can determine if you really need antibiotics</a><br />
<a href="http://abcnews.go.com/US/wireStory?id=8562204">Health reform will prompt need for many more primary care docs</a>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0tag:blogger.com,1999:blog-5549090417652989159.post-24973768701086251772009-09-12T23:05:00.005-05:002009-10-03T15:44:34.880-05:00House Calls Episode Two"House Calls" airs Sunday night at 10pm on AM 560 WIND and streams live at <a href="http://560wind.com/">560wind.com</a>. In addition to the latest health headlines, I will address the topic of H1N1 flu. My guest is <a href="http://cip.gmu.edu/biographies/bio.php?BioID=40">Donald Thompson, MD</a>, Senior Medical and Public Health Program Director in the Center for Infrastructure Protection at the George Mason University School of Law in Arlington, Virginia.<br />
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</div><div><b>Episode Two Action Steps</b>:<br />
</div><div>1) Prepare to utilize hand sanitizer liberally this flu season. Purchase some bottles for you and your family to have with you at all times.<br />
</div><div>2) Do not touch your eyes, nose, or mouth until your hands are clean.<br />
</div><div>3) Get the regular influenza vaccine, available now at your doctor's office or other locations (unless you have a contraindication like egg allergy or previous adverse reaction to the vaccine).<br />
</div><div>4) Get the H1N1 vaccine when available (likely late October-early November) if you are in one of the recommended <a href="http://www.cdc.gov/h1n1flu/vaccination/acip.htm">groups</a>:<br />
</div><div><span class="Apple-tab-span" style="white-space: pre;"></span>a) Pregnant women<br />
</div><div><span class="Apple-tab-span" style="white-space: pre;"></span>b) Household contacts and caregivers for children younger than 6 months of age<br />
</div><div><span class="Apple-tab-span" style="white-space: pre;"></span>c) Healthcare and emergency medical services personnel<br />
</div><div><span class="Apple-tab-span" style="white-space: pre;"></span>d) All people from 6 months through 24 years of age<br />
</div><div><span class="Apple-tab-span" style="white-space: pre;"></span>e) Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza (these would include asthma and other lung disorders, and conditions causing immunosuppression such as HIV or certain cancers).<br />
</div><div>5) If you get sick with fever, aches, cough, and congestion ("flu-like" symptoms) stay home and limit your exposure to people until 48 hours after your fever is gone.<br />
</div><div>6) If your fever is over 103, you are unable to eat or drink, or you are having severe vomiting or diarrhea, seek medical attention. These are risk factors for dehydration, a major cause of morbidity and mortality from the flu. You should also seek medical attention, of course, if you are having difficulty breathing.<br />
</div><div>7) Don't panic. Common sense will get us through this!<br />
</div>David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com1tag:blogger.com,1999:blog-5549090417652989159.post-1751264445903292592009-09-06T19:12:00.005-05:002009-10-03T19:08:15.784-05:00Chicago Tribune article on "End-of-Life Conversations"<a href="http://www.chicagotribune.com/news/local/chi-sun-endoflifesep06,0,6438844.story?page=1">Today's article</a> by Barbara Brotman in the Chicago Tribune gives an excellent representation of what advance care planning conversations might look like at the end-of-life. Of course, advance care planning can occur at any stage of illness, and does not always have to address things like Do-Not-Resuscitate orders or refusing other invasive measures. It could simply cover what you value when it comes to your health care, and who you want for your Power of Attorney.<br />
<br />
The article also explains more about <a href="http://www.someonetotrust.org/">Someone to Trust</a> and what we are trying to accomplish in Chicago.David Fisher, MD, MPHhttp://www.blogger.com/profile/06815008637271967993noreply@blogger.com0