What do your nails say about your health?!

What do your nails say about your health?!  Nails can be a window into your overall health.  Read on….

Green nail syndrome.  This  may be caused by excessive copper in the body or an infection called Pseudomonas aeruginosa infection of the nail bed.

  • Copper poisoning is rare.  It can be caused by cooking food in uncoated cooper cookware or drinking water with a high copper content.
  • More commonly a Pseudomonas aerouginosa infection of the nail can occur, especially if you have chronically wet hands.  Treatment for this is topical gentamicin or oral or topical cipro.  Keep your hands dry!


Yellow nail syndrome.  This is usually from primary lymphedema or chronic lung problems.  The nails can look thickened, excessively curved and yellow.  Toenails are more often affected than fingernails.  Yellow nails may be a sign of a shortened lifespan (usually due to respiratory infection).  It is unknown why lung diseases may cause yellow nails.

White superficial onychomycosis.  These are white patches of fungus that invade the superficial layer of the nail plate.  It looks like white powdery substance attached to the top of the nail.  More likely to affect children than adults.  Treatment includes application or topical antifungals or taking antifungal pills by mouth.

Runner’s toe.  This occurs on the big or second toe due to repetitive trauma to the toenails against a shoe while running.  may show a dark red or black discoloration beneath the toenail.  This will resolve over time.  Buy properly fitted footwear to help prevent injury of the toenails on the end of the shoe.

Melanoma of the nail.  The acral-lentiginous melanoma is a type of melanoma that occurs on the fingers, toes, palms, soles and nail bed.  This is most often on the thumb and the big toe and occurs most in those 40 to 70 years of age.  If you have a dark spot under your nail, ask your doctor if this needs a biopsy7733108000_54821ed346_oflickr.com/photos/toxic_vanity/7733108000

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How is the flu hitting your region? Nevada is in the RED!

How is the flu hitting your region?

Nevada is in the RED!  (See the attached USA flu map of influenza-like activity for the week ending January 13, 2018)


What can you do?  Get the flu vaccine.  Stay home if you have a fever (No, do not go to the store or to work).  Wash your hands often.  Get the flu vaccine.

The Centers for Disease Control is our physician-go-to organization for infections and vaccine-related information.  Please read on for additional accurate information…




Posted in General Medicine- Adults, infections, infections, Pediatrics, pregnancy, Uncategorized, Vaccines, Vaccines | Tagged , , , , , , , , , , , , ,

What may be the future of primary care? And, why? How can this help you?

What may be the future of primary care? And, why? How can this help you?

Here’s a great 5 minute video on Direct Primary Care. It may cost you LESS than insurance premiums plus your co-pays.

Consider it. There are Direct Primary Care offices all around the country. These are fascinating times we live in. Innovative. Direct-to-the-people-care. Take the (enormously-profitable) insurance companies out of the middle.

Posted in Uncategorized

Sleep. Are you a good sleeper?

Sleep.  Are you a good sleeper?

Sleep Quality.   It’s a predictor of overall physical and mental health and overall vitality.  The National Sleep Foundation made a consensus statements.  I’ll summarize them…

How long should it take you to fall asleep?  Less than 15 minutes is appropriate.  If it takes you 45 to 60 minutes to fall asleep, it’s taking too long.

How many awakenings are important?  In all age groups one or fewer awakenings per night indicates good sleep quality.  In older adults, 2 awakenings per night is considered good sleep quality.  If you are awake for more than 50 minutes at a time, that is considered a component of poor sleep quality.

What is sleep architecture?   This is measured in terms of sleep cycles and patterns.  The sleep cycle begins with the transition from being awake to non-REM sleep (from stage N1 to N2 to N3) and then to REM sleep.   In adults, when REM sleep is between 21 to 30% of sleep time this indicates good sleep quality.

Should you take naps?   Yes, if you are a child.  Otherwise, 1 or fewer naps per day, lasting 20 minutes or shorter may still constitute good sleep quality.

It is know that a sleep study in a lab may not reflect normal sleep patterns at home.

What else can change sleep patterns and quality?!

  • ingesting or withdrawing from drugs,
  • major depression,
  • obstructive sleep apnea,
  • restless legs.

I hope this helps.

infant car seat

flickr.com/photos /lessel/ 2729066

Posted in Brain, General Medicine- Adults, Pediatrics, sleep disorders, Uncategorized | Tagged , , , , , , , , , , ,

“Pajama time” finishing clinic notes? How does your doctor finish their day?

“Pajama time” finishing clinic notes? How does your doctor finish their day?

The New England Journal of medicine ran an interesting article. Attached is a graph of how doctors finish their day. It’s absurd. I urge my kids (and every medical student I meet) that they should practice typing games online. Its fun, but also may allow you to get-home-on-time AND be mentally present for your family. This is true for ANY field.

I type 110 words a minute so my “pajama time” is usually not spent looking at my work’s electronic health record (EHR). I did have a young patient once remark that I’d have made a great secretary… I agreed with him.

Here’s that short and enlightening article of how much time is spent on EHRs and how the system can be changed. EHRs are causing physician burnout. It’s tedious patient care meant to justify billing to insurance companies. Doctors are retiring or changing fields (away from patient care) in droves. Beware patients… this really does affect you.


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Are you un- or underinsured or without a SSN in Northern Nevada? We have free medical clinics!


Northern Nevadans who are uninsured, underinsured or without a social security number can receive free medical care at upcoming free University of Nevada, Reno School of Medicine Student Outreach Clinics in January and February 2018. UNR Med offers the clinics in a continuing effort to assist the region’s medically uninsured with needed healthcare services.

Click on the following link for more details!


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Pancreatic cancer is an uncommon and deadly cancer

stock  Letter C_IMG_7879

flickr.com/ photos/ lynnfriedman/ 8703242835

Pancreatic cancer is an uncommon AND deadly cancer.  It is the 12th most common cause of cancer in the US and usually diagnosed at an advanced stage.  Only 3% of stage III patients are alive at 5 years.  Pancreatic cancer rarely affects those less than 45 years of age. There are both non-hereditary risk factors and hereditary (family-linked) risk factors.

  • Nonhereditary risk factors for pancreatic cancer–
    • Occurs more often in men,
    • African Americans,
    • patients with a chronic pancreatitis,
    • diabetes,
    • cigarette smokers,
    • obesity and
    • physical inactivity.
  • Hereditary risk factors
    • Those with a non-O blood type,
    • someone with a first-degree relative with pancreatic cancer, and
    • risk increases with each additional first-degree relative with pancreatic cancer, hereditary breast and ovarian cancer syndromes (like BRCA gene carriers, hereditary nonpolyposis colon cancer, atypical mole and melanoma syndrome, and Peutz-Jeghers).

Screening for pancreatic cancer.  Bad news…. There’s no effective screening for asymptomatic people or those at normal risk.  The US Preventive Services Task Force recommends against routine screening.  The International Cancer of the Pancreas Screening Consortium recommends that patients at increased risk of pancreatic cancer may have an endoscopic ultrasound or magnetic resonance cholangiopancreatography.  Although there is no consensus on when or how often this screening should be done.

What may bring you in to the doctor if you have pancreatic cancer?

  • Nonspecific abdominal pain,
  • weight loss, and/or
  • jaundice.

There may also be enlargement of the liver, anorexia (meaning loss of appeteite), nausea, vomiting and diarrhea.

Presenting signs and symptoms relate to the tumor location.

  • 70% of pancreatic cancers are at the head of the pancreas.  The symptoms that are associated with this location are weight loss, dark-colored urine and jaundice.
  • 30% of pancreatic cancers are in the body or the tail of the pancreas and this may cause abdominal pain, weight loss, and loss of appetite.

How is pancreatic cancer diagnosed?

First off, your doctor should do a thorough medical history and physical exam.  There are no blood markers to reveal pancreatic cancer.  Imaging studies are depending on patient presentation and may include an abdominal ultrasound or CT scan.

Treatment.  First the cancer needs to be “staged.”  This is to decide if the cancer is resectable as the only curative strategy is surgical removal of the cancer.  Tumor markers are not useful from a diagnostic perspective, but cancer antigen 19-9 (CA 19-9) is useful in determining the prognosis.

If the tumor is unresectable, palliative care is the only option.  If the patient has chemotherapy, a clinical trial should be affiliated with the treatment.  Some chemotherapy regimens have been shown to prolong life by several months.

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