Tag Archives: Diagnosis

Dr. C’s Journal: What Is Hereditary Hemorrhagic Telangiectasia (HHT)

HHT is a rare hereditary condition with abnormal connections between the arteries and the veins. it’s most obvious sign is little spidery blood vessels, which increase with age, most apparently on the lips, but more importantly in the nose, where they lead to the most common problematic symptom, recurrent nosebleeds.

The abnormal connections between arteries and veins, called arteriovenous malformations, most commonly affect the nose, lungs, brain, and liver.

The AVMs in the lung can short-circuit the blood circulation and lead to shortness of breath, as can iron deficiency anemia caused by the frequent nosebleeds, and bleeding from the G.I. tract. Liver nodules, detected by imaging techniques such as CT and ultrasound, can be helpful in confirming the presence of the disease.

The AVMs in the brain can cause headaches and seizures.

The diagnosis is often delayed, unless it is known to run in the family. HHT is often called the great masquerader because of the variety of problems it can cause.

Children of proven HHT should have genetic testing, since the symptoms and telangiectasia are often not present in childhood. There are also other genetic abnormalities linked to HHT that can produce such disparate things as colonic polyps.

If I had this problem, I would invest in a device to monitor my hemoglobin level so as not to slip silently into debilitating anemia. I might also invest 15 or $20 In a fingertip oximeter. If I were short of breath, and not anemic, I might have a pulmonary AVM which bypasses the lung and produces a decrease in the Oxygen saturation.

With respect to Nose bleeds, it is important to maintain an adequate hemoglobin, preferably above 12g, using oral iron on a daily basis, and if necessary supplemented by intravenous iron. It  is also important to avoid medication and foods which cause increased bleeding. This includes the NSAIDs, fish oil, ginkgo, and St. John’s wort. News to me is the possible contribution to nosebleeds of blueberries, red wine, dark chocolate, spicy fruit and spicy foods. It may well be advisable to keep a food diary that that also records when nosebleeds occur. Perhaps you are eating something that affects coagulation that is not on the common lists. Take it with you to your doctor visit.

This is a rare condition, and should be evaluated in a medical center specialized to treat HHT.

CureHHT has some interesting information. My alma mater, UCSF, specializes in this condition.

Mayo clinic and the Cleveland clinic, as well as Wikipedia, have broader, more organized articles on HHT. A link to the former will be attached, and the latter is the most detailed.

—Dr. C.

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Eye Health: The Signs And Diagnosis Of Cataracts

Cataracts in the eye lens are a later-in-life reality that leads to vision problems for many people. This video shares describes what cataracts are, how they form, and warning signs to help you detect them early.

Chapters: 0:00 Intro 0:10 What are cataracts? 0:43 What are the warning signs of cataracts? 2:44 How are cataracts diagnosed? 3:04 Talk to your eye doctor

Lung Cancer Diagnosis: Robotic Bronchoscopy

Robotic GPS system for early lung cancer detection.

Lung cancer typically is diagnosed at a later stagethan other malignancies, due to the lack of early warning indications. In 2020 it was China’s most common cancer and the leading cause of cancer-associated mortality. LungHealth MedTech, a medical robotics company in Shanghai, has developed a robotic-assisted bronchoscopy platform that can address some of the current diagnostic challenges and treatment limitations.

Women’s Health: Finding A Lump In Your Breast (JHM)

Johns Hopkins Medicine: What To Do When You Find a Lump in Your Breast? Breast imaging radiologist, Emily Ambinder discusses common questions one may have when discovering a lump in the breast.

Video timeline: 0:03 Why do lumps form in the breast? 026 What are the different types of lumps? 0:55 Can breast lumps form because of physical impact? Could those lumps become cancerous? 1:23 What do i do if i have found a lump? 1:47 What makes breast imaging at Johns Hopkins different? 2:01 What is a mammogram? 2:29 What is a breast ultrasound? 2:53 What else do I need to do if I have a lump?

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NEJM: Atrial Fibrillation And Catheter Ablation

In this instructional video, Drs. Jane Leopold, Elliott Antman, William Sauer, and Paul Zei provide an overview of the classification and diagnosis of atrial fibrillation, management strategies, and mitigation of stroke risk with anticoagulation therapy.

Video timeline: 0:00 Pathophysiology and Symptoms 3:11 Stroke Risk, Anticoagulants, and Arrhythmia Control 6:32 Catheter Ablation 10:11 Post-Procedural Monitoring and Care

The video also focuses on the new rhythm-control strategy of catheter ablation therapy, with attention to the success rate, potential complications, postprocedural monitoring for recurrence of atrial fibrillation, and consideration of ongoing anticoagulation therapy in these patients. The New England Journal of Medicine is the world’s leading general medical journal.

Continuously published for over 200 years, the Journal publishes peer-reviewed research along with interactive clinical content for physicians, educators, and the global medical community at https://NEJM.org.

COMMENTARY:

This is a very good video well worth watching by general physicians and interested patients. There are several general and some specific comments I would like to make.

First, in my opinion, the best physician is none too good. In any operative or serious procedure, the decision to operate should be made by the patient in conjunction with a physician that does not do the operating. In my case, as a physician, I consulted an electrophysiologist.

Second, in my opinion, a good medicine is better than surgery. For atrial fibrillation, there has been no new medication treatment for decades. The main drugs are still amiodarone and Propafenone. The latter is less consistently effective, but has a better long-term safety profile; amiodarone often produces ‘floaters”  in the eye, and Propafenone merely a bitter taste which you’ll get used to.

Third, it must be realized that catheter ablation is often not curative, especially as you get older, which was rather glossed over in this video. Ablation also requires a great deal of expensive equipment, which is constantly evolving, hence the importance of getting your ablation at a major center where it is done all the time. These major centers have less complications such as  atrial wall perforation; Yes, you can rarely wind up worse off after any operation.

I am a physician, currently 90 years old. I developed atrial fibrillation of the persistent type when I was in my late 70s. I had a cardioversion to get me into sinus rhythm, and then tried Propafenone, which kept me in sinus rhythm for less than a month. My main motivation to get a radio frequency ablation was to stay off of anticoagulants. I had my ablation, and remained in sinus rhythm, and off anticoagulants, for three years. I could always tell when I went into atrial fibrillation from normal sinus rhythm because I produced a lot of urine and had to go to the bathroom all the time; atrial fibrillation causes release of a hormone called atrial naturetic peptide. I could also tell by taking my own pulse, which was quite irregular in comparison to my very regular sinus rhythm pulse, which ticked along with a rate in the high 50s. I had always thought my rate was low because I exercise a lot. Actually, my EKG shows a second-degree heart block which is probably partially responsible.

After three years, I returned to atrial fibrillation, and needed a another ablation. They found very few areas of abnormal electrical activity, and gave me a “touchup”, which lasted another two or three years after which I went back into atrial fibrillation. Probably as a result of my age, a fibrillated at a slow rate, and at least did not need any extra medication for rate control, although I did, of course, need to take a regular anticoagulant, in my case Eliquis.

In summary, atrial fibrillation is a common electrical storm in the upper chambers of the heart, causing a rapid, irregular beat. AF increases in frequency as you get older. In the video they mention the “substrate”, which is the structure of the atrium. In my own case, this was an enlarged atrium, and probably a tendency towards atrial fibrillation; my brother also has AF. The main complication is stagnation of blood in the atria, resulting in increased tendency toward stroke. Fibrillation therefore requires an anticoagulant.

There is some discussion about the irregular rate causing an inefficiency of cardiac action, contributing to heart failure, This is logical, but not clear cut statistically.

—Dr. C.

Cervical Cancer: Its Risks, Symptoms & Treatment

Learning about cervical cancer can be intimidating. Kristina Butler, M.D., a gynecologic oncologist 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 0:38 What is cervical cancer? 1:16 Who gets cervical cancer? / Risk factors 2:23 Symptoms of cervical cancer 3:03 How is cervical cancer diagnosed? 4:26 Treatment options 5:20 Coping methods/ What now? 6:10 Ending

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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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Skin Conditions: Five Types Of Contact Dermatitis

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

Diagnosis: The Signs And Symptoms Of Monkeypox

The World Health Organization recently declared monkeypox a global public health emergency – with cases being reported in many different countries, including here in the United States. Our expert explains what exactly the virus is, the symptoms and how it spreads.

For more information about monkeypox, please visit https://cle.clinic/3ABwZTH

Tendinopathy: Diagnosis, Treatment & Prevention

Tendinopathy is the broad term for any tendon condition that causes pain and swelling. Your tendons are rope-like tissues in your body that attach muscle to bone. When your muscles tighten and relax, your tendons and bones move. One example of a tendon is your Achilles tendon, which attaches your calf muscle to your heel bone and causes ankle movement. If you have pain and/or swelling in that area, you might have Achilles tendinopathy.

The pain from tendinopathy can interfere with your daily life. For example, it can keep you from playing sports and from doing housework. So, if you have pain or swelling, make sure to contact your healthcare provider for help.

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