ACL tears can sideline an athlete or crush an Olympic dream. It’s a common knee injury affecting nearly twice as many women than men. Dr. Cedric Ortiguera, a Mayo Clinic orthopedic surgeon and sports medicine specialist, says 150,000‒200,000 ACL injuries occur each year in the U.S., and that number is growing as more children become involved in competitive sports year-round. The good news is that surgery can help get some athletes get back in the game.
Monthly Archives: July 2021
DR. C’S JOURNAL: A WORD ABOUT DREAM THEORIES
Dreams are very egalitarian. I really believe that one person knows just about as much about dreams as another person, since almost all of us do a lot of it, and no two theories about dreaming are the same. However, I would like to give you some of what I have learned from my own dreams and readings about them. In addition, I have included a reference that discusses Scientific dreams studies in some detail.
When I was about 14 years of age, and burning up with a desire to learn more about medicine, I bought the only “medical” book I could find in Grass Valley, California: The interpretation of dreams, by Sigmund Freud. I vividly remember being amazed at how Freud could figure out the symbolisms in the dream case studies he published. The interpretations were not at all clear to me, even after I was told the answer, and chewed on them a bit. I subsequently read the opinion that a lot of them were made up. The essence of Freuds theory of dreams is that they were wish fulfillments, which is patently not always true.
REM sleep was linked to dreams in 1953, a couple of years before I graduated from medical school. For years, dreams were studied in a unitary context of REM sleep, and in the opinion of some, this has slowed down progress on the knowledge of dreams immeasurably. We now know that dreams are not always linked to REM sleep. Dreaming can be neurologically interrupted, while REM sleep goes on. REM sleep can be eliminated while dreaming goes on.
So we go back to the starting block; what are dreams?
The Ancients put a lot of stock in dreams, such as Joseph’s dreams predicting a seven-year drought, which earned him a place on the pharaohs Staff. Martin Luther thought they were the work of the devil. My son Michael thinks they are a good thing, since when you dream you are sleeping, and sleep is a wonderful restorative.
My own theory is that they are random fragments of experience which are ordered and supplemented to form a story. These random fragments can either be from recent experiences, perhaps being consolidated in memory, or old experiences that are being pruned as unnecessary. These snippets are then aggregated under the influence of mood neurochemicals, and flow out in the dream narrative.
Sensations coming in from the environment can play a role. I will always remember the story of a sleep study patient, who was slapped on the back of his neck by a wet towel. He awakened immediately, and vividly remembered a dream about the French Revolution, in which he was guillotined. I read that dreams take 5 or10 minutes of time to develop, however.
I dream almost every night, and most are forgotten rapidly. Some have enough detail and meaning for me too mull over before I get up. Some of my more common dreams are of flying, or getting lost. The pleasant dreams are definitely in the majority. Only rarely, a sinister one will wake me up.
The following reference details about 50 of the most common dreams that people experience. Much other pertinent information is contained. What is your theory on the causes and meaning of dreams? You probably have as good an idea as anybody else.
—Dr. C
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #44: SYPHILIS (STD)
Syphilis is a venereal disease, or STD, that is unusual, unique in many ways. First of all, it is one of the few major diseases to have originated in the Americas, the New World, and carried back to Europe most likely by Columbus; Popularized by “guns germs and steel”, the infectious disease traffic was almost all the other way, most famously smallpox which decimated the Native Americans.
A second unusual characteristic is that it’s treatment(penicillin) is known, cheap, easy, and yet Syphillis infects millions of people yearly, most commonly to be sure in the developing world, but also large numbers in America where is helped by AIDS, and spread by men having sex with men.
A third unusual characteristic is that syphilis can mimic practically any disease. There are three stages. The first stage is a painless ulcer, usually on the genitals. After a few weeks, the second stage develops, showing a widespread rash and other symptoms. After a few more months, problems develop in the heart, brain, or growths ( gummas) in many other areas .
When I was in medical school we used to go to an old peoples home to listen for aortic regurgitation, and observe the neurologic symptoms of syphilis patients. Syphilis is still a cause of aortic insufficiency, if untreated.
Treponema pallidum, The causative agent, is also unusual. It has a very small geome, and has many missing cellular mechanisms, making it dependent upon Homo sapiens, it’s only known Reservoir. The fragile but very active organism will die in a few hours outside of its human host. Like it’s confederate,AIDS, The infection can easily spread from mother to child with devastating consequences. It is one of the major diseases for which pregnant mothers are tested.
Syphilis is one of the best arguments for being monogamous. If this can’t be, remember that syphilis is easily treatable, and that you should report any unusual illnesses to your doctor.
—Dr. C
RESEARCH: ‘THE SCIENCE OF HEALTHY AGING’ (SCRIPPS)
Although growing older comes with a number of major life changes, science can help inform the things we do in the here in and now to forestall the most serious features of the aging self, promoting healthspan and not just lifespan.
- Build Muscle – Muscle mass is one the best predictors of health and longevity. Muscle tissue is known to release its own chemicals called myokines, which can have benefits that span cognition, immunity and anti-cancer activity. By performing regular, resistance-based exercise that prioritizes strength, we can delay the loss of bone density and risk of physical injuries.
- Vitamin D – Commonly known as the sunshine vitamin, vitamin D is in fact a critical hormone that helps maintain healthy bones, boost our immune system and improve our cardiovascular function. With age, the production of vitamin D in the skin can become less efficient, so if we don’t spend enough time outdoors, our risk of vitamin D deficiency may increase.
- Neurodegenerative Diseases – One of the most unsettling aspects of aging is the potential for neurodegenerative disease. These conditions are increasingly prevalent in those with diabetes, suggesting that the brain’s blood flow and energy supply may be compromised. Research indicates that regular physical exercise, a healthy whole foods diet and staying intellectually active could at least slow the rate of decline.
- Mindfulness – As we get older, major arteries can become thicker and less flexible, leading to increased blood pressure and undue strain on the heart. A regular mindfulness practice such as yoga or meditation has been shown to stem the release of stress hormones like cortisol and adrenaline. By freeing us from this “fight-or-flight” state, this habit can improve blood flow and reduce the risk of heart attack and stroke.
- Stay Social – As social animals, maintaining a strong sense of community and close personal relationships into old age are underestimated contributors to longevity. While social isolation in seniors can result in significant physical and mental decline, research suggests that close loved ones offer important emotional support and behavioral modifications that can overcome periods of high stress.
- Metabolism – “My metabolism is slowing down!” That’s what we often hear, as the aging body becomes less effective at using energy, placing us at risk of obesity and type 2 diabetes. By maintaining our muscle mass and reducing sugar consumption, we can support hormonal health, preserve our metabolism and keep our vitality into those advanced years. As scientists continue to find ways to extend our lives, paying attention to these keys to healthy aging can help increase the quality of those extra years.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #43: CELIAC DISEASE
Celiac disease – I know of no disease more rare that is a fixation for more people. Practically everything I see in the processed food area advertises itself as being gluten free, yet celiac disease affects about only one in 100 people. Even the dogs that I see on my walk are claimed by their owner to be on a gluten restricted diet.
Celiac disease-it’s hard to imagine a more complicated and variable disease. Although Coeliac Disease runs in families with HLA-DQ2 and HLA-DQ8, having these markers is not alone sufficient to cause Coeliac Disease. Eating gluten is not even sufficient, but requires an enzymatic change via tTG2 to make gluten fire up the immune system. Testing for an antibody to tTG2 is one of the better tests for celiac disease, and a drug that blocks tTG2 has recently proven helpful as a treatment for celiac disease.
CD often starts in young children, but the disease can begin at any age. Although gastrointestinal symptoms such as diarrhea or constipation, bloating, and bulky, oily stools are typical, even clear-cut cases may have no recognized symptoms at all. In other cases almost any organ can be involved, or the symptoms can be non-specific such as Weight loss, anemia and fatigue.
it is estimated that only about 10% of people with celiac disease are ever proven to have the diagnosis. It Is massively under diagnosed in spite of permeating the popular lore.
A lot of people place themselves on a gluten-free diet and claim to feel better, but being on a gluten-free diet makes the diagnosis difficult to make; if celiac disease is seriously suspected, the doctor will place the patient on a gluten-containing diet which allows the tests, such as anti-t-TG2, or villous atrophy of the small bowel to become positive.
Among people who actually have real, valid, proven celiac disease, who have every reason to want to restrict gluten to improve their Disease, 40% of them have great difficulty in adhering to the necessarily draconian gluten free diet.
Even the doctors can have a blind eye to celiac disease, since it is quite rare. A good friend of mine with chronic bloating went to a gastroenterologist who declared her free of disease, without having ruled out celiac disease. One would think that a gastroenterologist would be tuned in to coeliac disease, given the prominence of gastrointestinal symptoms and pathology.
The patient should be her own advocate.
—Dr. C
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DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (JULY 17)
A weekly podcast on the latest medical, science and telehealth news.
DR. C’S JOURNAL: CAUSES & SYMTPOMS OF INSOMNIA
Sleep has many functions, among which are clearing the body of toxins and consolidating memory. The exact amount we need is determined by age, and genetics among another things. From what I’ve read, eight hours is required, plus or minus an hour.
That being said, there are a few among us who are super sleepers. Going back in history this probably included Mozart and Thomas Edison: They could live healthy, productive lives with as few as three or four hours of sleep. Genetic mutations, including changes to the Orexin Gene receptor account for true super-sleepers.
Familial fatal insomnia is a genetic disease operating through prion proteins, and does not illuminate the problem of insomnia. In most people there are two major forces which determine the onset of sleep, the circadian rhythm, and sleep pressure.
The TIMING of the sleep varies from morning larks to night owls. These shifts in the circadian rhythm is also genetic, involving many genes, including PER and CRY. Diurnal rhythm can apparently be changed, But with difficulty.
The sleep pressure is caused by the gradual daily accumulation of adenosine in the system, apparently resulting from the stripping away of the phosphate groups from the energy currency, ATP. This can be assuaged by caffeine containing drinks, such as tea or coffee. Caffeine temporally blocks the effect of adenosine, but when it wears off, you usually go right back to your fatigue state.
INSOMNIA occurs when you do not get as much sleep as you need, and are tired in the daytime. This is a major problem for a lot of people.
Insomnia has many causes. Stress will cause an increase in Cortisone in the bloodstream which interferes with sleep. Caffeinated drinks nicotine and other stimulants can cause you to have difficulty falling asleep, and alcohol will help you fall asleep but will often result in awakening in the middle of the night when the alcohol is metabolized.
Depression, Parkinson’s, chronic pain, gastroesophageal reflux and any other medical conditions can interfere with sleep. Sleep apnea, often associated with overweight and heavy snoring, is a special problem that sometimes needs the help of a sleep specialist.
Some poor habits such as reading in bed, doing work in bed, eating at bedtime, and heavy exercise just before bed can also be a problem.
A regular routine of Preparing for sleep, such as brushing and flossing and taking a warm shower are also helpful; you can get more details by looking up “sleep hygiene”.
A lot of people take a nap, but this can cause some difficulty in going to sleep. Among things you can do to prevent insomnia include living an active life, making your bedroom comfortable for sleep, and using your bedroom ONLY for sex and sleep.
Please refer to the accompanying Mayo clinic article for more organized information.
—Dr. C.
Mayo Clinic articlehttps://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
VIEWS: IS U.S. HEALTHCARE SYSTEM BROKEN? (HARVARD)
Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.
Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.
The cost is enormous
- High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
- Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.
Access is uneven
- Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
- Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
- Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.
Dr. C Commentary:
Please refer to the DWWR Posting on “concierge doctors” for my rant on the current healthcare system, which I will not repeat.
The truth is more nuanced. All countries are having trouble of one sort or another with their healthcare systems. This is due to the inherent expense of today’s top flight medicine. The very best care requires costly high technology and drugs that are intrinsically hard to produce. And you have to know where to look. I am very thankful for my medical degree, and that I have kept up with current advances.
You would probably need a Government entirely of physicians to develop the willpower to do something for health, which always starts with PREVENTATIVE MEDICINE, A hard sell, given that you must spend money and effort to block something which will probably, but may not always, occur.
There is low hanging fruit. Why are sugary drinks not heavily taxed, since they produce obesity which causes a lot of costly medical disorders, such as diabetes, inflammatory diseases, and cancer, but not everybody all the time?
Why is efficiency of telehealth not more widely embraced, but stymied by moneymaking lobbiests and lawyer powered difficulties, in addition to Patient’s and doctor’s old habits?
And then there are the jealously guarded American freedoms to do stupid things, such as avoid vaccines and masks, even in a prodigiously expensive and dangerous Covid epidemic.
Given human nature, a complete solution would seem to be impossible, and we should content ourselves with minor victories wherever they can be attained.
Embrace sleep, diet, and exercise, and KEEP HEALTHY.
–Dr. C
Tachycardia: Types, Causes & Symptoms (Mayo Clinic)
Tachycardia is the medical term for a heart rate over 100 beats per minute. There are many heart rhythm disorders (arrhythmias) that can cause tachycardia.
Types of tachycardia
There are many different types of tachycardia. They’re grouped according to the part of the heart responsible for the fast heart rate and cause of the abnormally fast heartbeat. Common types of tachycardia include:
- Atrial fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic, irregular electrical impulses in the upper chambers of the heart (atria). These signals result in rapid, uncoordinated, weak contractions of the atria.Atrial fibrillation may be temporary, but some episodes won’t end unless treated. Atrial fibrillation is the most common type of tachycardia.
- Atrial flutter. In atrial flutter, the heart’s atria beat very fast but at a regular rate. The fast rate results in weak contractions of the atria. Atrial flutter is caused by irregular circuitry within the atria.Episodes of atrial flutter may go away themselves or may require treatment. People who have atrial flutter also often have atrial fibrillation at other times.
- Supraventricular tachycardia (SVT). Supraventricular tachycardia is an abnormally fast heartbeat that starts somewhere above the lower chambers of the heart (ventricles). It’s caused by abnormal circuitry in the heart that is usually present at birth and creates a loop of overlapping signals.
- Ventricular tachycardia. Ventricular tachycardia is a rapid heart rate that starts with abnormal electrical signals in the lower chambers of the heart (ventricles). The rapid heart rate doesn’t allow the ventricles to fill and contract efficiently to pump enough blood to the body.Ventricular tachycardia episodes may be brief and last only a couple of seconds without causing harm. But episodes lasting more than a few seconds can become a life-threatening medical emergency.
- Ventricular fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the lower heart chambers (ventricles) to quiver instead of pumping necessary blood to the body. This can be deadly if the heart isn’t restored to a normal rhythm within minutes with an electric shock to the heart (defibrillation).Ventricular fibrillation may occur during or after a heart attack. Most people who have ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.
Doctors Without Waiting Rooms 