All posts by doctorswithoutwaitingrooms

EMPOWERING PATIENTS THROUGH EDUCATION AND TELEMEDICINE

Medicine: Adult-Onset Autoimmune Diabetes

  • Adult-onset autoimmune diabetes encompasses a wide spectrum of heterogeneous genotypes and phenotypes, ranging from classic adult-onset type 1 diabetes mellitus to latent autoimmune diabetes in adults (LADA)
  • The heterogeneity of LADA arises from its definition as being present in any adult with diabetes who does not require insulin and who is positive for any islet autoantibody, regardless of titre, number or epitope specificity
  • The heterogeneity of LADA manifests in different clinical phenotypes, ranging from prevalent insulin resistance to prevalent insulin deficiency, each of which might be associated with different autoimmune and metabolic markers
  • Although patients with LADA are leaner and have healthier lipid and blood pressure profiles, evidence shows that there is no difference in cardiovascular outcomes between these patients and those with type 2 diabetes mellitus

Medicine: Using Stem Cells To Treat Osteonecrosis

Daniel Wiznia, MD, an orthopaedic surgeon with Yale School of Medicine, is practicing a surgical technique designed to render 10% of hip replacements unnecessary. Regenerative properties from a patient’s own stem cells are responsible for regrowing bone, restoring blood flow, and being able to avoid further interventional surgery.

Osteonecrosis, also known as avascular necrosis, occurs in more than 20,000 Americans each year. As the condition progresses, bone cells known as osteoblasts become unable to repair themselves and sustain the integrity of the bone, and ultimately die. The bone deterioration leads to a decrease in blood flow to the area, further weakening the entire skeletal structure of the upper leg.

If unaddressed, the ball portion of the hip’s ball and socket joint will cave in on itself and collapse, requiring a total hip replacement. The fact that patients often receive this diagnosis during their 30s and 40s presents a particular challenge.

While the lifespan of hip prosthetics has dramatically increased in recent years, a patient who undergoes a total hip arthroplasty, or total hip replacement, at that age will almost certainly require a revision later in life. This redo of the same surgery at an older age comes with an entirely new set of risks and potential complications, making it that much harder to manage down the road.

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Blood Pressure: What Is Hypertension? (Video)

Learning about hypertension can be intimidating. Leslie Thomas M.D., a nephrologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:39 What is hypertension? 1:13 Who gets hypertension? / Risk factors 2:18 Symptoms of hypertension 2:36 How is hypertension diagnosed? 3:14 Treatment options 3:51 Coping methods/ What now? 4:05 Ending

COMMENTARY:

Hypertension is an elevation of the blood pressure in the arteries. It is measured conventionally by blood pressure cuffs, although a catheter in the artery is more accurate. I’ve had my blood pressure taken countless numbers of times by nurses and doctors who sometimes put the cuff on my arm through a piece of clothing, making it less accurate. Sometimes it is taken by an automatic blood pressure cuff even in the doctors office. The automated cuff can be purchased for $20 or less for you to use it at home, but it’s accuracy is questionable when you have an irregular heartbeat with atrial fibrillation such as I do.

The blood pressure reading which is considered to be normal Is dropping. In the present video, following 2017 guidelines , they state that a systolic reading of more than 120 mmHg is elevated, and anything more than 130 is hypertension. It may be true that studies have been done to show that these slight elevations cause problems, but so can the drugs that are used to lower blood pressure; a cough can be caused by ACE inhibitors. Fatigue and fainting can be caused by an excessive dosage of any blood pressure medication.

Healthy diet, especially avoiding extra salt, Regular exercise and good sleep will go a long way towards keeping your blood pressure at 120 or below on the high reading (systolic), and 80 on the low reading (diastolic).

My systolic blood pressure varies between 120 and 140 systolic, and is usually around 60 diastolic. For a long time I thought the relatively low (diastolic) blood pressure was more important, since diastole is of greater duration than systole, but it has now been determined that the systolic blood pressure reading is the one to worry about. Calcification and lack of elasticities in the arteries as you get older can lead to higher systolic blood pressure.

It used to be thought that the normal systolic blood pressure was 100+ your age in years. Those days are gone, however, and greater life expectancy and health Is one result of carefully monitoring your blood pressure, and working hard to keep it down.

Please refer to the Mayo Clinic article to give you (much) more information.

—Dr. C.

Dr. C’s Journal: What Is Achilles Tendinitis?

The Achilles tendon, or “heel cord”, connects your calf muscle to the heel. Overuse can inflame the tendon, or even tear or rupture it, causing a lot of pain.

Sudden increases in intensity of exercise can be a cause. It is more common in men, and as you get older. Running a lot in the soft sand of the beach has caused problems in many of my friends. Achilles tendinitis can be caused by certain antibiotics, such as fluoroquinolones.

Varying your type of exercise, or cross training, distributes the strain you put on your body and decreases the likelihood of Achilles tendinitis. Swimming comes to mind with any disturbance of your lower extremities. The pool in which I swim three days a week is disparagingly called the “injured reserve pool” in my community  Stretching before exercising is always a good idea. Pick a routine and stick with it, particularly as you get older. If you have flat feet, getting a slight lift for the heel may help to take tension off the Heel cord, and orthotics may help. Getting expert advice is always advisable.

Prevention is always far better than treatment.

If a short period of rest doesn’t get rid of the pain, check with your Doctor, who might examine the tendon, take x-rays, or order ultrasounds to check the extent of the difficulty.

—Dr. C.

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AGING: HOW BIOMARKERS HELP DIAGNOSE DEMENTIA

Biomarkers are measurable indicators of what’s happening in your body. They can be found in blood, other body fluids, organs, and tissues, and can be used to track healthy processes, disease progression, or even responses to a medication. Biomarkers are an important part of dementia research.

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Heart Disease: Symptoms & Types Of Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure.

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The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery or, in severe cases, a heart transplant — depends on the type of cardiomyopathy and how serious it is.

Types

  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy

Symptoms

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

  • Breathlessness with activity or even at rest
  • Swelling of the legs, ankles and feet
  • Bloating of the abdomen due to fluid buildup
  • Cough while lying down
  • Difficulty lying flat to sleep
  • Fatigue
  • Heartbeats that feel rapid, pounding or fluttering
  • Chest discomfort or pressure
  • Dizziness, lightheadedness and fainting

Signs and symptoms tend to get worse unless treated. In some people, the condition worsens quickly; in others, it might not worsen for a long time.

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Diet: Consuming Olive Oil Daily Lowers Heart Risks

Consuming just a half-tablespoon or more of olive oil a day is linked to a lower risk of dying from heart disease and other chronic health conditions, new research suggests.

photo of a hand holding a bottle of olive oil and drizzling it on a dish of quinoa

The study included more than 92,000 women and men from the Nurses’ Health Study and the Health Professionals Follow-up Study, who filled out diet questionnaires every four years for 28 years. Olive oil intake was calculated from how much they reported using in salad dressings, on bread and other food, and in baking or frying.

Compared with participants who rarely or never consumed olive oil, those who consumed the most (about a half-tablespoon or more daily) had a 19% lower risk of dying from heart disease during the study. Researchers also noted lower death rates over all among people who substituted olive oil for a similar amount of margarine, butter, mayonnaise, or dairy fat. The findings, published Jan.18, 2022, in the Journal of the American College of Cardiology, lend further support for choosing olive oil — a key component of the heart-friendly Mediterranean diet.

Read more at Harvard Health

Strokes: Subarachnoid Hemorrhage Treatment

Subarachnoid hemorrhages account for approximately 1.2 million cases of stroke each year, and nearly 40% of those cases are fatal. Dr. Rabih Tawk, a Mayo Clinic neurosurgeon explains the early signs of a subarachnoid hemorrhage and how it’s treated.

Bleeding in the space between the brain and the tissue covering the brain.

Subarachnoid hemorrhage, a medical emergency, is usually from a bulging blood vessel that bursts in the brain (aneurysm). It may lead to permanent brain damage or death if not treated promptly.

The main symptom is a sudden, severe headache.

Hospital care is needed for supportive care and to stop bleeding and limit brain damage. Treatment may include surgery or catheter-based therapy.

Telemedicine: UCM Digital Health Aids NY Hospitals

Telemedicine could soon offer relief local emergency rooms desperately need.

UCM Digital Health offers a digitally integrated, whole person health solution that provides patients with immediate access to care on their terms.

UCM combines a digital front door platform, multi-disciplinary team of providers, and a 24/7 telehealth triage, treatment, and navigation service to provide a range of patient services, including emergent and urgent care, primary and specialty care, behavioral health, and more. Care begins digitally and can seamlessly integrate across other points of care for a simple patient experience.

UCM brings together clinical expertise, advanced technology and compassionate care to offer powerful advantages for insurers, employers, patients and providers.