Category Archives: Dr. C “Comments”

Dr. C "Comments", Men's Health, Technology, TELEMEDICINE, Women's Health

TECHNOLOGY: “TELESTROKE” NETWORKS ARE SAVING LIVES

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From Fast Company article (June 26, 2020):

An increasing number of hospitals are now equipping emergency vehicles to treat stroke patients while en route to the ER. UCHealth is a health system in Colorado that has a tricked-out ambulance, the Mobile Stroke Treatment Unit. A neurologist at the hospital is connected wirelessly through telehealth to the vehicle. First responders’ gear includes portable CT scanners and tPA.

Currently, there are also more than two dozen telestroke networks in the United States. At the hub of each is a large hospital with on-call neurologists, and broadband that connects the hospital directly to satellite hospitals and clinics. There’s always a neurologist on call to guide the smaller hospital staffs’ treatment of a stroke patient.

When I had a stroke five years ago at 10:20 on a Saturday night, telehealth saved my life. At the time, only 3% to 5% of people in the United States were able to get the “clot-busting” drug called tPA in time to avoid brain damage.

In addition to offering telestroke capabilities, healthcare providers should equip emergency vehicles with portable ultrasound devices and defibrillators. Rural communities can consider strategically deploying high-powered wired and wireless hotspots in case patients need immediate medical attention while still en route to the hospital. Following natural disasters such as earthquakes or floods, mobile hotspots configured for telehealth could be helicoptered into isolated communities.

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COMMENTARY

SPEED is especially important when a blood clot blocks an artery servicing an important organ. Our Heart and BRAIN top the list of vital organs. TELESTROKE  showcases Telemedicine at its best.

RECOGNITION of a stroke is a weak link in the chain of prompt Brainsaving treatment, and a Mnemonic helps.

—Facial assymetry or drooping
—Arm or leg weakness on one side
—Speech disturbance
—Time is all important

FAST is a good mnemonic, and adding B for balance and E for Eye, or vision loss, for BEFAST gives 2 more parameters to think about.

Living alone adds to the challenge, so be as focused as you can. I was interested to hear that some TELESTROKE ambulances are adding mobile CT and drug (tpa) capabilities, in addition to TELECONFERENCING with a NEUROLOGIST. Treating a stroke within 15 minutes is becoming a possibility.

So particularly if you have risk factors such as hypertension, diabetes or obesity, be on the alert for symptoms of stroke.

—Dr. C.

Dr. C "Comments", Men's Health, Prevention, Videos

MEN’S HEALTH: YOUR “FIRST PROSTATE CHECKUP” (UCLA)

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Dr. Jesse Mills, Director of The Men’s Clinic at UCLA talks about what to expect during a first prostate checkup.

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COMMENTARY

Prostate checking, especially by PSA, has been controversial in recent years.

The naysayers have cited statistics that show too many unnecessary operations on slow-growing, non-life threatening cancers lowering quality-of-life.

My old urologist was following a prostate nodule with yearly checks with PSA tests. He retired, and the enlightened, younger urologist, who replaced him, thought PSA superfluous.

A friend, also a Doctor, was similarly advised, dropped the PSA screening, developed high grade prostatic Cancer, and died of it.

I continued checking my PSA every 6 months, risking a positive test, leading to biopsy, leading to unnecessary treatment.

The UCLA prostate checkup video touts Prostate MRI as an intermediate step, and, in my mind validates my choice of continuing PSA screening.

—Dr. C

Dr. C "Comments", Men's Health, Prevention, Technology, TELEMEDICINE, Videos, Women's Health

PREVENTION: “FORWARD CLINICS” ARE ALL-INCLUSIVE, FLAT-FEE PRIMARY CARE

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Forward care is evidence-based, focused on prevention and improvement. Set goals and collaborate for better health.

  1. Connect Your Biometrics Sensors
    • Receive your Sensor Kit
    • Record measurements in the app
    • Review insights together with your doctor
  2. Complete Your Labs at Home
    • Schedule your at-home blood draw with a lab specialist
    • Receive comprehensive results
  3. Create a Personalized Plan During Your Baseline Visit
    • Discuss your health goals and concerns
    • Review your biometrics and lab results
    • Develop a personalized, preventive plan
  4. Answer Questions In-App for Insights on Your Mental Health
    • Answer a short series of questions in-app
    • Receive a measure for anxiety and depression
    • Partner with your doctor on your results
  5. Customize Your Plan Based on Your Genetics
    • Receive your Genetics Kit
    • Review the results with your doctor
    • Update your plan to address your risks
  6. See Your Doctor In Person for a Custom Follow Up Visit
    • Request an in-person visit in the app
    • Review your progress with your doctor
    • Complete a physical exam and diagnostics
  7. Assess Your Skin Cancer Risk
    • Complete a physical exam of your skin
    • Capture high-definition images of any moles or blemishes
    • Discuss your skin health and cancer risks with your doctor
  8. Receive a Message From Your Doctor to Update Your Plan
    • Your doctor will check-in regularly 
    • Update your doctor on progress and goals 
    • Ask questions, anytime from anywhere
  9. Develop Nutrition Goals Based on Recurring Labs
    • Review your latest labs with your doctor
    • Develop a nutrition plan for targeted results
    • Measure progress with future labs

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COMMENTARY

Forward Healthcare differs from a conventional primary care clinic in several, generally good ways.

Most importantly, they stress PREVENTATIVE care. Blood tests that monitor diabetes, metabolic syndrome, and anemia are done regularly, since they have a laboratory on premises. They have their own EMR (electronic medical record) platform, and their own telemedicine platform, which are downloaded on the initial visit.

They give out a “sensor kit” consisting of temperature monitor, Pulse-oximetry, and a BP monitor, which wirelessly sends information to medical records.

Telemedicine is available through their own Downloaded platform. Although I get the impression that Telehealth isn’t as central as I would have expected in a technology oriented operation, it is increasingly important.

The monthly membership fee of $149 pays for the above and unlimited Doctor Availability 24/7 without copay.

Concierge Medicine has the monthly/yearly fee and unlimited access, but has a copay. Both will utilize your insurance, and neither treats patients in the hospital or provides referral care.

Government Health care is coming, and with it longer waiting times, shorter Doctor interaction times, and probably less time for Preventative Health Care.

Systems like Forward Health and Concierge Medicine will be the upper tier of a 2-tier system.

Proactive attention to Health in my opinion is essential in the future if we are to have a healthy nation, and not “bankrupt the system”. Telehealth is growing in importance, and offers help in making medical expertise more convenient, widely available and for less cost.

I am happy to see progressive Systems like Forward Health offer a preventative option to the present, broken, reverse-incentivized, fee-for-service System.

—Dr. C.

Dr. C "Comments", Medicine, Men's Health, Women's Health

INFOGRAPHIC: A LOOK AT “CANCERS ASSOCIATED WITH OVERWEIGHT & OBESITY

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There is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers (6), including:

  • Endometrial cancer: Obese and overweight women are two to about four times as likely as normal-weight women to develop endometrial cancer (cancer of the lining of the uterus), and extremely obese women are about seven times as likely to develop the more common of the two main types of this cancer (7). The risk of endometrial cancer increases with increasing weight gain in adulthood, particularly among women who have never used menopausal hormone therapy (8).
  • Esophageal adenocarcinoma: People who are overweight or obese are about twice as likely as normal-weight people to develop a type of esophageal cancer called esophageal adenocarcinoma, and people who are extremely obese are more than four times as likely (9).
  • Gastric cardia cancer: People who are obese are nearly twice as likely as normal-weight people to develop cancer in the upper part of the stomach, that is, the part that is closest to the esophagus (10).
  • Liver cancer: People who are overweight or obese are up to twice as likely as normal-weight people to develop liver cancer. The association between overweight/obesity and liver cancer is stronger in men than women (11, 12).
  • Kidney cancer: People who are overweight or obese are nearly twice as likely as normal-weight people to develop renal cell cancer, the most common form of kidney cancer (13). The association of renal cell cancer with obesity is independent of its association with high blood pressure, a known risk factor for kidney cancer (14).
  • Multiple myeloma: Compared with normal-weight individuals, overweight and obese individuals have a slight (10% to 20%) increase in the risk of developing multiple myeloma (15).
  • Meningioma: The risk of this slow-growing brain tumor that arises in the membranes surrounding the brain and the spinal cord is increased by about 50% in people who are obese and about 20% in people who are overweight (16).
  • Pancreatic cancer: People who are overweight or obese are about 1.5 times as likely to develop pancreatic cancer as normal-weight people (17).
  • Colorectal cancer: People who are obese are slightly (about 30%) more likely to develop colorectal cancer than normal-weight people (18).A higher BMI is associated with increased risks of colon and rectal cancers in both men and in women, but the increases are higher in men than in women (18).
  • Gallbladder cancer: Compared with normal-weight people, people who are overweight have a slight (about 20%) increase in risk of gallbladder cancer, and people who are obese have a 60% increase in risk of gallbladder cancer (19, 20). The risk increase is greater in women than men.
  • Breast cancer: Many studies have shown that, in postmenopausal women, a higher BMI is associated with a modest increase in risk of breast cancer. For example, a 5-unit increase in BMI is associated with a 12% increase in risk (21). Among postmenopausal women, those who are obese have a 20% to 40% increase in risk of developing breast cancer compared with normal-weight women (22). The higher risks are seen mainly in women who have never used menopausal hormone therapy and for tumors that express hormone receptors. Obesity is also a risk factor for breast cancer in men (23).In premenopausal women, by contrast, overweight and obesity have been found to be associated with a 20% decreased risk of breast tumors that express hormone receptors (22).
  • Ovarian cancer: Higher BMI is associated with a slight increase in the risk of ovarian cancer, particularly in women who have never used menopausal hormone therapy (24). For example, a 5-unit increase in BMI is associated with a 10% increase in risk among women who have never used menopausal hormone therapy (24).
  • Thyroid cancer: Higher BMI (specifically, a 5-unit increase in BMI) is associated with a slight (10%) increase in the risk of thyroid cancer (25).

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COMMENTARY

Obesity increases the incidence of cancer, and complicates its treatment.
A healthy life style.,’including good sleep, diet and exercise, should prevent obesity in all but extreme genetic aberrations.

It is better to prevent problems than to grapple with them.
Stay healthy!

—Dr. C.

Dr. C "Comments", Technology, TELEMEDICINE, Videos

TECHNOLOGY: H4D “CONSULT STATION” – 1ST CONNECTED LOCAL TELEMEDICINE BOOTH

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H4D facilitates access to healthcare by allowing patients to consult a doctor remotely in the Consult Station®, the first connected local telemedicine booth. This medical device allows quality healthcare to be delivered for primary care, occupational health, and general health promotion.

https://www.youtube.com/watch?v=GmYaP1B6C00&feature=emb_logo

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COMMENTARY

CONVENIENCE, SIMPLICITY, and SAFETY area all goals of TECHNOLOGY going forward.

The “hands-free” check-in for hospitals and hotels are convenient and safety, but require a certain level of familiarity with technology, and may be Hard for the elderly to use. I think about the airport check-in kiosks, and store check-out points. The solution is to have “helpers” stationed by to assist.

The Telemedicine booth, with devices for examination of the ears, nose, and throat, a stethoscope probe for the lungs, payment port, video camera, etc certainly offers convenience, but may need helpers for guidance, and to clean after every use.

I’m betting on a super I Phone in all areas, although cost and band width improvement will be needed.

—Dr. C

Dr. C "Comments", Medicine, Men's Health, Women's Health

INFOGRAPHIC: A LOOK INTO “CANCER’S COMPLEXITY”

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Technology Networks Cancer Drug Discovery-page-0

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This infographic is a high-level discussion of cancer, with plenty of information to keep a Physicians’ interest.

The Human Body is a complex Community of individual cells that normally work together with admirable Harmony. Each individual cell is supplied with all its’ wants, and vigorously does its’ part for the Body.

Occasionally a ROGUE CELL escapes constraints and GOES ITS’ OWN WAY.

This has been happening from the beginning of multicellular life, and these MISCREANTS have EVOLVED to preserve themselves and have an amazing bag of TRICKS.

They are Very resourceful just like VIRUSES, which can also cause CANCER.

These twin threats give modern medical technology about all it can handle, and more.

PREVENTATIVE care offers a remedy.

Prevention is not at all complex, but of course requires thought, energy and planning. Prevention is difficult to square up with the easy, effortless, intuitive  life we yearn for.

Do you have the resolve to give SLEEP, DIET and EXERCISE a chance?

–DR. C

Dr. C "Comments", Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE: THE RISE OF TELEDERMATOLOGY (AMA)

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From AMA.org (June 12, 2020):

Teledermatology

“There’s an aging population, and there’s a lot of skin out there,” said Dr. Isaacs. “One in five people in the country develop skin cancer, but there is a plethora of benign skin conditions that also require the expertise of the dermatologist. So, you have increasing demand and a limited supply of dermatologists.”

A basic example of how the TPMG teledermatology program works involves a patient who is concerned about a suspicious lesion or mole on their body. The patient can take a picture of the location in question and send it to their primary care physician for review. The physician can request the patient come in for a more thorough evaluation, or if the physician determines that a dermatologist should be involved, they can send the photo to an on-call dermatologist to review.

If the patient does an in-person evaluation, the physician can also take a higher-quality image and forward that to a dermatologist. The dermatologist can then decide whether there is a problem, if a prescription is needed, or if there should be an in-person evaluation and potential biopsy.

A study in the Journal of the American Academy of Dermatology in 2019 found that when TPMG dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.

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COMMENTARY

A high quality I-phone picture of a skin lesion can provide the dermatologist with 90% of the information needed for a diagnosis.

Melanoma diagnosis depends even more on the visual. In fact, Artificial  Intelligence evaluation of Melanoma may be  overtaking dermatologist expertise.

Size can be indicated by including a dime in the photo.

It is true that the roughness, softness or hardness may be important in diagnosis, but perhaps these characteristics could be described by the Patient.

This week, I started worrying about an itchy, rapidly growing lesion on my back. I sent a picture of this to my dermatologist, hoping he would call it a wart and reassure me. It was very regular, soft, and had a rough surface like warts I have had in the past.

However, he saw some redness and had me come in for removal. We will see what the pathology shows.

Dermatologists are in short supply, and making more efficient use of their expertise attractive.

Calling the Doctor’s office, arranging for e-mail Photo transmission, and a talk with the Doctor on the phone could save a visit. The Primary Doctor could send you directly to the dermatologist, or might be comfortable with watching and waiting.

Dermatology is indeed a field ripe for Telemedicine.

—Dr. C.

Dr. C "Comments", TELEMEDICINE

TELEMEDICINE: WHAT ITS FUTURE GROWTH LOOKS LIKE OVER THE NEXT 5-10 YEARS

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From McKinsey & Company (June 11, 2020):

For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.

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COMMENTARY

Health Providers, especially the systems and networks, are the key to “next Generation” health care delivery. They are the main target audience of this article. If they invest in Telehealth, and make it easy and integrated, Patients will adopt Telemedicine happily.

The article Classified the elements of the future Telehealth,  citing Telemedicine As the digital equivalent of the traditional Doctor-Patient verbal Interaction. They call this “synchronized” Telehealth.

Everything else, the myriads of other activities that comprise the totality of health care, is labeled something else. The Patient is involved in some of these activities, such as being monitored by a device at home, being the recipient of her records or medications, or even interfacing with technology as in “E-triage”.

Many interactions such as Doctor-Doctor, Doctor-Pharmacist, Doctor-insurance,  Rounding, To mention a few, take place away from the Patients’ sphere. The REAL change will be when these are Eventually taken over by Computers, aided by Artificial intelligence.

In the meanwhile, Providers should invest in Technology to remain competitive. Also, it goes without saying, Patients should invest in Knowledge and Technology if they are to get the most out of this new Reality.

—Dr, C.