Feeds:
Posts
Comments

Retirement

TerryHollebeckMD

Since a previous article concerning my relapse with multiple myeloma cancer and the effects of chemotherapy, and after much thought and soul searching, I have decided to retire from the practice of medicine.

Having just turned 70 years old and having practiced medicine for the past 43 years (28 of those years in my current practice of urgent care medicine in Scotts Valley), I think it’s time to move on.

At this time I do feel very well, all things considered. I look forward to having some more time to spend with my wife Beth and my daughter Emma, as well as to pursue other interests, such as restoring my good old ’71 Volkswagen bus.  Beth is a musician and music educator and I’m sure I’ll spend more time as her “roadie”.

Being a doctor is something that I had wanted to do since childhood, and it was an honor to follow in the footsteps of my father and grandfather. I have never regretted my decision to enter the medical field. I can’t imagine having pursued a more personally  rewarding and satisfying career.

The difficult part of this decision is that up to this very day, I have thoroughly enjoyed practicing medicine and never really thought about retiring. However,  besides the health issue, there is also the struggle with the time consuming and impersonal electronic medical record, the seemingly daily burdensome rules and regulations coming from a variety of sources, and the constant concern of  malpractice, all of which I will not miss.

But, what an honor and privilege it has been to practice medicine. I have found tremendous satisfaction in treating patients,  being able to alleviate suffering, curing illnesses of all sorts and even saving lives. I have enjoyed the one on one interaction I’ve had with patients and having the opportunity of getting to know them and appreciate them for who and what they are.

I’ve been in Scotts Valley long enough to have taken care of children who are now coming to the clinic with their own children. I’ve been saddened when people whom I have come to know have passed away but,  on the other hand, I’ve enjoyed watching families grow and witness their changing dynamics. In    the past 28 years at Scotts Valley, I figure I’ve had over 100,000 patient visits and therefore have been able to treat a significant number of people from Scotts Valley, the San Lorenzo Valley, and surrounding areas. I’ve always enjoyed walking into a local store or event and seeing the familiar face of a patient and be able to talk with them  and to see and know them outside of the medical setting.

I will miss my wonderful supporting clinic staff with whom I have spent much of my recent life and who had become like a family to me. I am also honored to have been associated with as fine a group of physicians as there could ever be, 30 of them when I first began my work with the Santa Cruz Medical clinic in 1987, and now numbering some 210 physicians with our Palo Alto Medical Foundation affiliation.

Most importantly, I want to thank each and every one of you patients who trusted me and allowed me to care for you over the years. It’s my interactions with you that I will miss the most.

However, I am not going away completely. I will continue this medical column as I have many more topics to share with you and much more to say. As I have previously mentioned, I plan to publish a book  incorporating the most interesting articles. I’m excited about continuing this work.

Since I won’t be seeing you in the clinic, I look forward to seeing you out in the community.

My very best wishes to you all and remember, life is a gift, gives thanks for each and every day.

NYResolutions

As we prepare to leave the old year behind us and greet the New Year, I would like to propose the following health related resolutions:

  1. If you smoke – quit.
  2. If you drink alcohol, do so in moderation and do not drink and drive.
  3. Develop a routine exercise program and stick with it.
  4. Improve your diet – increase fruits and vegetables and decrease fats and carbohydrates.
  5. Buckle up every time you enter your car.
  6. Don’t talk on your cell phone while driving – not only very dangerous, but now also illegal.
  7. Don’t climb ladders alone, have someone with you, (personal experience speaking).
  8. Get regular dental checkups and eye exams.
  9. If you are overweight try to lose weight, but if you can’t at least remain physically fit.
  10. Use sun screen when outside during the sunny months.
  11. Routinely exam your skin for any unusual changes.
  12. Keep your immunizations up to date including all the usual ones that babies and children receive, as well as a diphtheria-tetanus booster every ten years for adults and a yearly influenza vaccine.
  13. Have your blood pressure checked at every health care visit.
  14. Routine health maintenance screening exams to be discussed with your doctor and should include:
  • Pap test for women beginning at age 21.
  • Cholesterol level test starting at age 20.
  • Mammogram for women beginning at age 40.
  • Blood sugar test starting at age 45.
  • Colon screening (colonoscopy) beginning at age 50.
  • Prostate exam for men starting at age 50.
  1. See your doctor sooner rather than later if you have a strong family history of any significant medical problems such as cancer, heart disease, diabetes, high blood pressure etc.
  2. Avoid stress, relax, and do your best to try to enjoy your life whatever your circumstances.

ColdFluMeds

With the cold and flu season approaching, I want to repeat an article I did several years ago about what over the counter medications are available to help alleviate the miserable symptoms of the winter illnesses.  Almost all of the hundreds of products available over the counter contain at least one or a combination of the following ingredients:

  • Tylenol (acetaminophen) or Advil (ibuprofen) for aches and pains
  • Sudafed with either pseudoephedrine or phenylephrine, a decongestant
  • Guaifenesin an expectorant (thins mucus)
  • Dextromethorphan a cough suppressant
  • Antihistamines such as diphenhydramine or chlorpheniramine

We could probably get by with only five different bottles of cold medications on those pharmacy shelves, each containing one of the above medications. I think that taking these drugs individually rather than in combination is better so that one can tailor one’s symptoms to a specific medication and avoid taking something that might not be necessary.  Always read the label on the medication package to check on potential interactions with drugs you may already be taking and to know the possible side effects or warnings.

Here’s how these drugs work.  Tylenol or Advil work equally well for relieving the aches and pains of an illness as well as helping to reduce a fever. Read the directions carefully. The maximum daily dose for acetaminophen is 3000 mg. per 24 hours.

Sudafed, for those who do not have high blood pressure, may be helpful to relieve the swelling of the nasal/sinus passages and to relieve the pressure in the ears due to blocked eustachian tubes. Sudafed with the main ingredient pseudoephdrine, has changed from over the counter to behind the counter and it will need to be signed out for purchase through the pharmacist. It’s probably worth the effort. Sudafed with ingredient phenylephrine can still be purchased over the counter but may be a bit less effective than the pseudoephridine.

Guaifenesin is an expectorant which means it helps to thin out mucous in the nose and sinuses, as well as in the lungs, which makes it easier to either blow out or cough up the mucous.  Dextromethorphan is a cough suppressant which should help at least a little to lessen one’s cough. Honey has also been found to be effective in slowing down a cough. Neither of these remedies is strong enough to actually stop a cough and will not interfere with the healing process.

Antihistamines are really most useful for the symptoms of allergies like hay fever, but they may help colds by slowing down mucous production.  Perhaps they help most by their side effect of drowsiness, thereby helping one to sleep.

Another highly effective way to decongest the nose and sinuses is to perform sinus rinsing using either a netti pot or my preferred method, a Neil Med sinus rinsing kit found at most pharmacies. I have found rinsing to be highly effective to alleviate sinus symptoms and to even treat or prevent sinus infections.

In Summary:

  • For aches and pains from a cold or flu, use Tylenol or Advil.
  • For stuffy nose, sinus congestion or plugged ears use Sudafed.
  • To loosen mucous use guaifenesin such as Mucinex or Robitussin.
  • To help slow down a cough, use a medication with dextromethorphan, such as Robitussin DM or Vicks 44, or try a couple tablespoons of honey in a hot beverage.
  • Get plenty of rest and drink lots of liquids.

Closely follow the directions for proper dosage found on the medication labels.

These are some basic guidelines for choosing medications for the symptomatic relief of common cold and simple flu. I have to admit the effectiveness of these drugs is somewhat limited but worth trying. Adequate rest, liquids, and time still play a major role in recovery from these miserable conditions.

See your health care provider if you have a fever for more than 4-5 days, if you have a fever of more than 103 degrees, or if you have any significant concerns about your illness.

Medical Marijuana

Medical-Marijuana

My goal in this article is not to judge the use of marijuana as good or bad, legal or illegal or right or wrong. My intention is to provide information now available from current medical literature of its medical benefits, known side effects, and when not to use it.

Marijuana has been used for medicinal purposes for several thousand years beginning with the ancient Chinese. It was used at that time for a multitude of medical problems, from the treatment of malaria to the treatment of constipation.

Marijuana was introduced to the United States in the mid 1800s and was prescribed by physicians for its therapeutic benefits until 1937 when it was prohibited from being prescribed. Then in 1970 it was legally prohibited for anyone to even possess or use marijuana.

Because of public demand for the medical use of marijuana in California, in 1996 it became legal to use for medical purposes and soon other states followed suit.

The benefits of marijuana are attributed to its cannabinoid compounds of which some 100 have been identified. The two most researched and well known of these are tetrahydrocannabinol which is also the main component for the mind altering effects of Marijuana, and cannabidiol which causes less of a high.

Most patients smoke the dried plant for the quickest results. Marijuana’s active ingredients can also be delivered through capsules, vaporizers, liquid extracts, foods, and beverages. One major problem is that dosing can be unpredictable since the level of active ingredients varies between plants, as well as the fact that absorption of ingested forms varies among patients.

THC has also been synthesized and available in the U.S. for medical use under the generic names of dronabinol and nabilone, both of which can be prescribed by a Physician.

Although many users have found multiple health benefits from marijuana for the treatment of numerous health problems, there are really only of few that have passed scientific testing. They include:

  • Nausea, especially when caused by cancer chemotherapy and AIDS.
  • Chronic pain especially when due to neuropathy, cancer, or AIDS.
  • Glaucoma
  • Multiple sclerosis
  • Epilepsy
  • Appetite and weight loss in cancer patients.

Again, I want to emphasize that there is a myriad of other conditions that may be helped by marijuana but they, so far, are not backed up by scientific evidence. Most medical practitioners would prefer that patients first use traditional proven treatments for most health problems and to use marijuana for treatment failures.

There are known health risks to the use of marijuana including:

  • Impairment of thinking, problem solving skills, and memory.
  • Increased anxiety and panic attacks.
  • Reduced balance and coordination.
  • Increased risk of heart attacks, inflammation of heart muscle, and atrial fibrillation.
  • Possible hallucinations and withdrawal symptoms.
  • Lowering of blood glucose and blood pressure, and increased risk of bleeding.

Smoking marijuana, which is the most common method of use, has its own set of potential problems. It is associated with possible increased chronic bronchitis and lung cancer (although much less likely than smoking tobacco). A review of current literature shows agreement that the possible harm to the lungs from smoking marijuana does not endorse the safety of its use in this manner.

At this time experts recommend limiting the use of medical marijuana to adults older than 18 years of age. There are also other health related conditions where marijuana should not be used including:

  • History of schizophrenia or other psychiatric disorders.
  • Severe heart or lung disease.
  • Severe liver or kidney disease.
  • Pregnancy or planned pregnancy, and breast feeding.

Even with the possible side effects and the non uniformity of doses and strengths of its various forms, I would encourage the use of medical marijuana for the known conditions where it has been proven to be helpful. I can also accept its use in any number of conditions when more conventional treatments have failed.

As marijuana use becomes more widely legalized it should open the door to much needed research which would provide more information as to the best doses and delivery systems for medical use as well understanding the risks and benefits for all users. This information would be of great help to both physicians and patients.

Health Update 2015

TerryHollenbeckMD

As many of you know, two years ago I was diagnosed with multiple myeloma, a cancer of the plasma cells in the bone marrow. It was put into remission after 2 1/2 months of chemotherapy. It took awhile to get back to my old self again but for the past year, other than the neuropathy of my feet, I feel great. I returned to work half time last October and was happy to be “back in the saddle” again, doing the work that I love to do.

The stem cell transplant I was to have had after my first round of chemotherapy two years ago was postponed because it was thought that it could make the neuropathy worse. So I’ve been on a low dose maintenance drug and my oncologist has been following monthly blood tests to monitor the myeloma activity. After about six months the numbers were slowly creeping up but no one was too alarmed. Then it was decided to do a PET scan (a CAT scan using a radioactive dye) which I had done in late August. Surprisingly and unfortunately, it showed a lot of myeloma activity affecting many parts of my bones. In other words my myeloma has relapsed. However, unlike the first time I was diagnosed, I really feel very well and as everyone tells me, “You look great!” I’ll take that as a good sign.

Because the steroids from my first round of chemo have caused a deterioration of my hip joint, I was to have had a hip replacement last month, but that has now been postponed so that I could begin chemo right away. I have just finished my third week of chemo, still feel very well, still have my hair and my most recent blood test shows very favorable improvement already. That is music to my ears.

I’ve begun an extended leave of absence from work to deal with the new round of chemo and to keep me from exposure to sick patients. I’ll miss seeing many of you but I find myself once again as the patient and now I’ve got to take care of myself.

I will continue writing my articles and, in fact, I will have more time to do so. I’ve been encouraged by many to put my articles in a book format which I hope to do this coming year.

Thanks to all of you who have had me in your thoughts and prayers.

Tick Bites

tick bite

In Santa Cruz County, it is reported that less than five percent of the mature Western black-legged ticks and a somewhat higher percentage of the nymphal (baby) stage, carry the Lyme bacteria. Although many people worry after being bitten by a tick, the risk of acquiring an infection is quite low. In this article I’d like to discuss the tick bite and signs and symptoms of Lyme disease.

Neither the tick’s body nor its head burrows into the skin. Instead, the tick attaches by its mouthparts. An infected tick can transmit an infection only after it has been attached, taken blood from its host, and fed for 24 to 48 hours. If you find a tick on you that is unattached and non-engorged, it is unlikely to have transmitted an infection. Look carefully for the immature nymphal ticks, which are the size of a sesame seed. It helps to shower after clearing brush or walking in wild lands.

The proper method of removing a tick is to use a fine pair of tweezers and grasp the tick as close to the skin as possible. Pull it straight out, gently but firmly, without jerking or twisting. After removing the tick, wash your hands and the skin around the bite thoroughly with soap and water.

If, after removal, you see anything remaining in the skin, this represents tiny mouthparts of the tick. It is not the tick’s “head” and it cannot increase the risk of transmission of Lyme disease once the tick body is removed. If you are unable to remove the mouth parts easily, as you would a splinter, leave it alone and the skin should eventually heal. If you are concerned see your doctor.

Quite often, after an obvious tick bite, a red rash may develop at the site of the bite within the first 24 to 48 hours. A rash that develops this quickly after the bite is usually an allergic reaction to the saliva of the tick. It rarely grows beyond 2 inches, needs no treatment and disappears within a few days.

The actual Lyme’s rash, called erythema migrans, is reported to occur in up to 80 percent of infected tick bites. It is described as a red rash that is usually neither itchy nor painful. It develops a few days to a few weeks after a tick bite and is likely to be the first sign of Lyme disease. The rash most often continues to get larger over a period of time and will grow to be well over 2 inches, possibly 8 to 12 inches or more, and may last for several weeks. This rash may sometimes develop a pale appearance in the center, causing a bull’s eye shape.

Either during the time of the rash or shortly thereafter, other symptoms of Lyme disease may appear which resemble these common flu-like symptoms: fever and chills, malaise (achiness), headache, and achy joints.

The rash and/or the above flu-like symptoms may indicate early Lyme disease and you should see your doctor. When recognized during this early stage, most infections can be adequately treated.

If the above symptoms do not occur, are not recognized or are not treated properly, then one might develop late Lyme disease which can more severely affect different parts of the body such as the  joints, the nervous system, and the heart, to mention a few.

The bottom line is that whether you are aware of a recent tick bite or not, if you develop an unusual, unexplainable rash or if you develop flu-like symptoms (without respiratory symptoms), especially outside of the flu season, you should visit your doctor and discuss the possibility of Lyme disease.

Leg Cramps

leg cramps

Most of us have at one time or another had a nocturnal leg cramp. Some individuals suffer frequently from them. Almost anyone can experience cramps, but they are more common in the elderly. Although they are technically harmless, they can be quite debilitating sometimes lasting 15 minutes or more. Most cramps have no obvious underlying cause.

It is believed that cramps may be associated with dehydration, prolonged sitting or a deficiency of certain electrolytes such as magnesium, potassium or calcium. Some medications have also been implicated, including diuretics, oral contraceptives, and beta blockers. Cramps have also been related to conditions such as pregnancy, diabetes and thyroid disorders.

There is weak evidence that B complex vitamins and magnesium supplements may help to prevent cramps. Most food and natural supplements have not been found to be helpful.

What to do for a leg cramp? First try massaging the cramped muscle. Next, try flexing your feet by bringing your toes up toward your knees. Try applying either hot or cold compresses directly to the painful muscle. Lastly, if you’re not in too much pain try to get up and walk around.

Here are some suggestions for reducing the frequency of cramps:

  • Maintain adequate hydration by drinking plenty of water throughout the day. This is especially important if you’ve been working out and/or sweating.
  • Massage and stretch your calf muscles before retiring. For stretching, try standing two or three feet from a wall with one foot forward. Lean forward with forearms up against the wall, keeping rear knee straight with the rear heel flat on the floor. Hold for 20-30 seconds then switch legs and repeat.
  • Loosen or un-tuck bedcovers and sheets at foot of bed in order to give your feet plenty of room.
  • Avoid high heels as well as completely flat shoes. Wear shoes with good support.

In the past, quinine was traditionally used as a treatment for leg cramps, but due to its dangerous side effects, it is no longer recommended. In fact quinine products are no longer sold over the counter.

If you have tried all the above suggestions and still suffer from nocturnal leg cramps, see your doctor.

Follow

Get every new post delivered to your Inbox.

Join 85 other followers