Have you been told you have high blood pressure?

Have you been told you have high blood pressure?  If so, you are not alone.  Hypertension affects 1/3 of Americans.  High blood pressure is considered a “modifiable risk factor” for cardiovascular disease, stroke kidney failure and death.  Modifiable means that we can CHANGE it.  Unlike gender and age that are NOT modifiable.

Treatment of high blood pressure decreased all-cause mortality.  This means it is worth your while to be aware of your blood pressure and to bring it down if it’s high.

Are there symptoms of high blood pressure?  There can be.  But, you may feel fine and it is high enough to require medication.  If you have symptoms you may feel

  • headache,
  • lightheadedness,
  • nausea,
  • short of breath,
  • heart palpitations,
  • bloody nose or
  • anxiety.

What should you tell your doctor if your blood pressure is high?

  • Tell them if you were prescribed medication for high blood pressure in the past AND if you take it as prescribed.  (Up to 65% of patients on antihypertensive medication do not take it as prescribed).
  • Any new medications (they may alter blood pressure or interact with your blood pressure medications?
  • Any other drugs like cocaine (we are not the cops nor your mother, please tell us what you take)?
  • Any history of heart problems or kidney disease or diabetes or sleep apnea?

How should you take your blood pressure?

  • Get an appropriately-sized automated electric arm cuff.
  • Sit in a chair with legs uncrossed for five minutes before the measurement.
  • The arm in the BP cuff should be resting comfortably on a table at the same height as your heart.
  • Take your blood pressure at home or at the pharmacy and write these down.  Many patients ONLY have high blood pressure at the doctor’s office. This is called “white coat hypertension” even if we are not wearing a white coat.

Most important advice: Take your medication as prescribed.  Follow up with your physician as she asks.  High blood pressure is a MODIFIABLE risk-factor, take care of it.

Posted in blood pressure, Diabetes, General Medicine- Adults, heart, Uncategorized | Tagged , , , , , , ,

When is a sore throat something worse?

When is a sore throat something worse?  A peritonsillar abscess is a deep infection of the head and neck.  THIS is the something worse I am talking about.  The diagnosis is made by clinical presentation and examination by your physician.

  • What are the symptoms?
    • fever,
    • drooling,
    • one-sided ear pain,
    • sore throat,
    • difficulty swallowing,
    • foul-smelling breather if
    • difficulty opening your mouth and
    • a muffled/”hot potato” voice.
  • What is the treatment?  Drainage.  Yes, this means that a needle or a scalpel will be used to open the abscess (pus pocket). And, antibiotics will be given.  You may need intravenous fluids if you have been so uncomfortable that you have not been able to drink.  You may also need pain medicine.
  • Why did you get this?  It is thought that peritonsilar abscesses begin as exudative tonsillitis (a sore throat with pus) and then progressed to a superficial skin infection of the throat (“cellulitis”), and then the infection of the cellulitis grows and forms a pus pocket.  I like to say that the bacteria came together and “had a party.”  Our job as the doctor is to break up that party and help you to heal.
  • Do you need to spend the night in the hospital?  Probably not.  If your doctor is concerned about airway compromise, extension of the infection into deep neck tissues, or if after abscess drainage you feel worse… then you may spend the night in the hospital.
Posted in General Medicine- Adults, infections, oral health, Uncategorized | Tagged , , , , , , , ,

Interesting facts about laceration closure (stitches)…

Laceration-closure interesting facts…

  • Non-infected wounds (caused by clean objects) can be stitched up to 18 hours after the injury.
  • Head wounds can be st
    itched up to 24 hours after the injury.
  • Using potable (drinking) water instead of sterile saline to irrigate the wound has not shown to increase the risk of infection.  So, clean it out!
  • If your doctor wears non sterile gloves to stitch you up, that’s fine.  There is no increase risk of infection when a laceration is sewn up with a doctor wearing non sterile gloves versus sterile gloves.
  • You may need a tetanus booster.  So, keep a record of your last one.
  • Depending on where the laceration is, a different thickness and type of suture will be used, a different laceration-closure technique will be done, and a variable timing of suture removal scheduled.

The next time you see your primary-care doctor, ask them if you have a laceration can you call their office and will they work you in?!  I love to sew up lacerations in the office.  Of course, depending on the location and complexity, you may need to see a plastic surgeon.  But, call your primary care physician first.  It has the potential to be  a win-win situation: the patient may not need to pay a large co-pay for the emergency department and I love to sew!

Posted in Dermatology, General Medicine- Adults, Uncategorized | Tagged , , , , , , , ,

How does your doctor spend her workday?

How does your doctor spend their workday?  There is actually an even split between office visits (read this: patient-care visits) and the “paperwork” that goes along with it.  As a residency faculty who teaches new doctors, I have long told them that a doctor touches 200 items a day that are about patients, but not with patients.  This includes laboratory results, consultant notes, and medication refills.

The study, published in April 2017 Health Affairs indicates that in an average day, a physician spends 3.08 hours face-to-face with patients and 3.17 hours with the computer one-on-one.

I am well-known by my patients to refill their medication (at their office visit) until their medical condition dictates that I should see them in the office for a follow-up.  My hope is that the patient has the medication they need and that their hassles at the pharmacy (obtaining their medication) are less.  And, for my workflow, it means that my patients are cared for and that I may get home on time by taking care of everything at their office visit and not after-hours with the computer.  That sounds like a win-win to me.

Our medical system is becoming more and more bogged down with computer documentation.  When I began in medicine 26 years ago life was so different… I’m doing my best to keep up with the changing times.

Please be patient with your physician.



Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , ,

Do you really need a pelvic exam during your next well visit?

Maybe not.   The American Academy of Family Physicians released an update April 25, 2017 stating that when screening non-pregnant  women without any gynecological or abdominal symptoms, no pelvic exam needs to be done.   Actually, in the age of quantifying research into helpful (an “A” recommendation), the pelvic exam in this subset of patients gets a “D” recommendation, meaning it is not suggested.

This does not mean that a pap should not be done at the suggested frequency.  A “pelvic exam” refers to the part of the exam when your physician puts two fingers inside your vagina and one hand on top of your abdomen.  This is meant to reveal an enlarged uterus or ovaries (normally the size of almonds) or to locate the source of abdominal pain.  The pelvic exam is known to be a low-yield physical exam test in patients without symptoms.

The pelvic exam is used when the patient is concerned about pelvic inflammatory disease from a sexually transmitted infection or when there is abdominal pain or bloating.  The harms of pelvic exam in asymptomatic patients are thought to be fear, anxiety, embarrassment, pain and discomfort, and possibly unnecessary intraabdominal surgeries.

At routine well women exam visits family physicians have many issues to address with their patients (medications, vaccines, current complaints) and prioriztizing  screening tests that have proven benefit is important to maximize this time together.

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Prostate cancer screening guidelines updated

flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

Are you concerned about prostate cancer?  The USPSTF (The United States Preventive Services Task Force) has updated their recommendation on screening for prostate cancer.

Men aged 55 to 69 years should talk to their physician about the potential benefits and harms of getting a blood test called PSA, prostate-specific antigen.  The benefits are that if the lab is abnormal, that cancer may be found.  The harms are that the lab may be abnormal, and the patient may undergo painful prostatic biopsies and or tumor resection with resultant incontinence and impotence.

The patient can help the physician decide whether the patient needs this laboratory test.

The USPSTF recommends AGAINST PSA-based screening for prostate cancer in men 70 years and older.

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , ,

Considering adding cannabis to your medical prescriptions?



Considering adding cannabis to your “medical” prescriptions?  Rethink your choice.  A recent study of TWENTY MILLION patients shows a 26% increased risk of stroke and a 10% increased risk of heart failure.  The study analyzed data of patients aged 18 to 55 and found that even if they control every other factor (“using multivariate regression analysis”), patients who use cannabis are significantly more likely to experience

heart failure, stroke, coronary artery disease (this can lead to heart attacks), sudden cardiac arrest, and atrial fibrillation.  Also, cannabis users are more likely to report high blood pressure, tobacco use, alcohol use, and obesity.

It is postulated that using cannabis may rev up cannabinoid receptor type 1 and may increase atherogenesis (when blood vessels become lined with plaque)

Now that cannabis is legal in 28 states (plus Washington DC), there’s a need to be more knowledgeable of the risks (and benefits?!) of cannabis.  More research is pending…

I hope this helps you make more informed decisions about your healthcare.

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