Archive for December, 2013


As we prepare to begin a new year, I’d like to share with you some highlights from my columns this past year.

Upper respiratory infections:These infections which cause coughs, sore throats and congestion, are almost always caused by a virus infection and shouldn’t be treated with antibiotics. If symptoms continue to worsen, especially accompanied by a fever, see your doctor for evaluation and treatment.

Hepatitis C:Baby boomers (those born between 1945 and 1965), should be tested for hepatitis C as more than two million Americans currently are infected with this disease and many who are, are unaware of it.

Advanced directives:Sometimes referred to as “living wills,” advanced directives direct physicians as to your wishes for medical treatment if you were to be incapacitated and unable to make decisions on your own. Talk with your doctor about this important document.

Swallowing pills:If you have trouble swallowing them whole, most pills, capsules, or liquid medications, can be crushed and mixed in most any type of food. Check with your pharmacist to ensure that your particular pill or capsule can be mixed with food.

Hearing loss:If you are having problems with your hearing, make an appointment with a qualified audiologist and have a routine hearing test. Technological advances have made hearing aids an excellent option to restore hearing.

Hydration:To keep your body healthy, drink a glass of water or other low- or non-calorie beverage with each meal and between each meal, and drink water before, during, and after exercise.

Constipation:First try life style changes such as adequate liquid intake, and regular exercise. Maintain a high fiber diet to include beans, whole grains, fresh fruits and vegetables, and less dairy, red meat and processed foods.

Childhood immunizations:Immunizations are safe. Many well-controlled scientific studies have all concluded that there is no scientific or statistical relationship between immunizations and autism.

Vision disease:See your doctor immediately if you have any obvious visual change. People between the ages of 18 and 50 should have routine eye exams every two years and every year after the age of 50. Children need routine eye exams as well. Ask your child’s doctor about the frequency.

Hair loss:Losing some 50 to 100 hairs a day is considered normal. If you are experiencing what you consider to be hair loss of more than or sooner than you expect, talk to your doctor or dermatologist. Do this before spending a lot hard earned money on worthless treatments which are so frequently advertised to the public.

Nonprescription pain medication:You may choose from Tylenol, Advil, Aleve, or common aspirin to relieve most simple pain. Taken in the recommended dosage, Tylenol, which is effective and has less potential side effects, would be my first choice.

Generic drugs:With only a very few exceptions, generic drugs are equal in almost all aspects to the equivalent brand name drug and are much less expensive.

Diverticulitis:If you have worsening pain in the left lower abdomen, or no improvement of such pain for a few days, seek medical help immediately.

Have a very happy and healthy New Year!

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Many people these days who are having routine colon screening exams, are being told that they have a condition called diverticulosis which is the presence of small pockets or pouches in the wall of the large bowel found just above the rectum. Risk factors for diverticulosis include inadequate intake of dietary fiber, lack of exercise, and aging. Diverticula are found in up to 60 percent of people by age 60, and the percentage keeps climbing with age.

Most people who are told they have this condition are surprised to find out because they have not had, and probably will never have, any symptoms of the disease. However, at some point in time some 10 percent to 20 percent of those who have diverticula will develop an infection in one of these pouches which is then called diverticulitis. (The suffix “itis” means inflammation.) It has long been thought that eating popcorn, nuts, or seeds would contribute to diverticulitis by becoming trapped in a diverticula, but this has since been disproven.

Common symptoms of diverticulitis are increasing pain and tenderness in the left lower abdomen, fever, nausea, and either diarrhea or constipation. Your doctor will likely order a blood count which may show an increase in the white blood cells indicating an active infection. A CT scan of the abdomen will often confirm the diagnosis.

Most of those in the early stages of diverticulitis can be treated as an outpatient with antibiotics for up to two weeks, pain medicine as needed, and a liquid diet for a few days. In most cases this is all the treatment that is necessary. If there is no significant improvement in two to three days, or if symptoms worsen at any time, a prompt medical re-evaluation is necessary.

Potential complications of diverticulitis necessitating immediate hospitalization are:

n An infected diverticula filled with pus (called an abscess).

n Rupture of an infected diverticula spilling contents of the bowel into the abdominal cavity which can lead to a life threatening infection.

n A bowel obstruction where the bowel stops working.

At this stage, treatment will include powerful intravenous antibiotics, IV fluids with no liquids or food by mouth, and adequate pain control. Surgery may be needed on an emergency basis to remove the infected bowel, or it may be delayed and done at a later date when the infection/inflammation has calmed down.

Up to 40 percent of those who have recovered from non-complicated diverticulitis will have one or many more attacks in the future.

Some now think that recurrent diverticulitis is due to underlying inflammatory changes in the affected portion of the bowel. There is hope that an anti-inflammatory drug currently used to treat colitis may go a long way in treating recurrent diverticulitis.

If you have worsening pain in the left lower abdomen or no improvement of pain for a few days, whether or not you know you have diverticular disease, seek medical help immediately.

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“Billions wasted on pricey drugs” was the headline in the newspaper this week. Medicare claims that the program is wasting hundreds of millions of dollars because doctors continue to prescribe and patients continue to ask for pricey name brand drugs when cheaper generic drugs are available.

I agree that this is a major problem which needs to be addressed. My own medical group is working hard and with good success to change the prescribing habits of doctors to use the more reasonably priced generic drugs whenever possible.

What exactly are generic drugs? They are copies of brand name drugs which have the same dosage, side effects, intended use, risks, strength and safety of the brand name drug. In other words, the brand name drug and the generic version of it should be identical.

The generic version of a drug can be manufactured and sold once the patent on the brand name drug has expired. The generic costs much less than the brand name drug mainly because the generic manufacturers don’t have to duplicate the hundreds of millions of dollars spent on research, development and marketing conducted by the original manufacturer.

There is concern by many that generic drugs are cheaper because of a compromise in quality or effectiveness. However, the Food and Drug Administration requires that generics be as safe and effective as the brand name drug. The generic must be bioequivalent to the name brand product, which means that the amount of active ingredient is delivered to the body at the same time, and used in the body in the same way as the brand name. The generic will often be a different color, shape or flavor than the brand name and it also may have different inactive ingredients, but the active ingredients must always be the same.

There are a few classes of drugs, such as anti-seizure medications, thyroid hormone replacement, and blood thinning drugs, where it is best not to switch back and forth between generic and brand name versions. Your doctor can explain this in more detail.

Since nothing in life seems perfect, I recognize that there may be instances where a generic version of a drug just doesn’t seem to work as effectively as its brand name equivalent. This needs to be discussed with your doctor and dealt with appropriately since the number one issue in the doctor patient relationship should be: What’s best for the patient?

Patients do, for the most part, have a choice of generic versus name brand drugs, but must realize that both private and public insurance plans may not pay for the non-generic or will require a higher co-pay, thus increasing the out of pocket cost of the drug. Feel free to discuss this with your doctor and pharmacist.

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