Healthy Rounds

Creating a Culture of Safety

2011-05-30T08:13:00.000-07:00

I recently had an opportunity to interview Dr. Amy Ship on the Healthy Rounds radio program. Dr. Ship is a primary care internist at Beth Israel Deaconess Hospital and assistant professor at Harvard Medical School. She recently published a column in the New England Journal of Medicine that addressed the responsibility of physicians to inquire about safe habits among our patients.

Specifically Dr. Ship addresses the topic of texting while driving and other distracted driving practices. She points out that physicians already direct patients' health habits regarding smoking, diet and sexual practices safe driving should be an extension of that responsibility.

Interestingly, a recent law was passed in Florida prohibiting physicians and specifically pediatricians from asking if there are weapons in the home and if they are safely secured. This law was passed despite the rising number of gun-related injuries in children.

In conclusion, it is the responsibility of all adults, and not just physicans to work toward creating a "culture of safety" by directing the behavior of children and setting a good example.

Do you think physicians should inquire about guns in the home?
What ideas do you have toward creating a "culture of safety" in America?

Bicycle Safety

2011-03-15T17:58:00.000-07:00

I have recently spent time in the Tampa Bay area as part of my annual spring training tour. I have been consulting for the New York Yankees for fifteen years and this year, I have also been invited up to Lakeland, Florida to discuss the early recognition and treatment of concussion with the Detroit Tigers medical staff.

While here, two bicyclists have died from injuries after being hit by motorists. A total of 15 bicyclists have died in the Tampa Bay area since July of 2010. This situation has captured my attention because it may indicate that we should expect more injuries in Connecticut this year as weather warms and gas prices soar.

I am also alarmed by the fact that despite the usual precautions of wearing a helmet, making yourself visible and remaining alert, many may still be harmed. The reason for many of these incidents is distracted driving. More drivers are now texting, or trying to make a call while operating a vehicle. In the split second that these drivers divert their attention away from the road, bicycle riders can be hit and severely injured.

The only recourse is for bicyclists to be vigilant at all times and to avoid riding in traffic when possible. If we are to encourage bicycling as an alternative means of transportation, communities must crack down on distracted drivers and create safer bike lanes for travel.

What ideas do you have for safer bicycle travel?

A Pulmonary Embolism Can Strike Anyone

2011-03-04T19:07:00.000-08:00

Tennis champion Serena Williams was recently hospitalized for treatment of a life-threatening pulmonary embolus. While it may be surprising to hear about a world class athlete being stricken by a condition typically associated with inactivity, athletes can be particularly susceptible to this condition.

A pulmonary embolus is the result of a clot traveling through the circulatory system and lodging in the lungs. There it will obstruct blood flow to the lungs. These emboli usually originate in the veins of the lower extremities as a thrombosis.

Symptoms of a pulmonary embolus include; chest pain, shortness of breath, unexplained coughing and rapid heart rate. Each year 600,000 Americans suffer a pulmonary embolus and 60,000 of these patients will die.

Traveling long distances, dehydration, trauma, immobilization, oral contraceptive use and family history are all risk factors. Many of these factors are common among injured athletes.

Ms. Williams has recently had two surgeries for a foot injury and has been wearing an immobilizing brace. The event occurred shortly after a transcontinental flight. Fortunately, her condition was treated quickly with anti-coagulant (blood thinning) medications.

The best way to prevent pulmonary emboli is to stretch often when traveling, remain well hydrated and be aware of symptoms.

Pulmonary emboli can affect anyone, but a few simple steps can avoid serious injury.

Stroke, Migraine Or Seizure

2011-02-20T15:29:00.000-08:00

Recently, TV news reporter Serene Branson suffered an episode of slurred, unintelligible speech and facial weakness while reporting live at the Grammy Awards. This event was a frightening demonstration of an evolving neurological process. The question was what was the process?

Many brain injuries including stroke, migraine, seizure and concussion initiate a cascade of events known as "spreading depression." These events are based on an electrical imbalance resulting in transient symptoms. In the case of stroke, the symptoms are often permanent.

Ms. Branson's symptoms were part of a condition known as migraine with aura. Stroke-like symptoms are the prodrome of a severe headache to follow within 20 to 30 minutes. These striking symptoms fortunately subsided.

Stroke symptoms of abnormal speech, facial asymmetry, and weakness on one side of the body require urgent medical attention. Although the eventual diagnosis may be more benign, any delay can increase the likelihood of permanent deficit.

Abusive Behaviors

2010-09-30T21:07:00.000-07:00

Two recent Healthy Rounds programs dealt with the topics of domestic abuse and bullying.

Dr. John Foley, a cardiologist from Norwich, Connecticut, is a frequent lecturer on the topic of domestic violence and partner abuse. There are roughly 8.5 million incidents of intentional partner violence (IPV) each year. IPV is not restricted to adult heterosexual couples. It is often seen among dating teens and in same sex relationships. Some examples include physical injury or threats, sexual assault, psychological abuse and economic control. If you suspect someone you care about may be in an abusive relationship open a line of communication by asking if they are being abused. Although they will most likely deny it at first it is important for them to know you care and they can come to you when needed.

Dr. James O'Dea is a clinical psychologist at the William W. Backus Hospital. We recently discussed the alarming rise in school bullying. Each day approximately 150,000 young people fear going to school because of bullying. In the past, bullying consisted of verbal confrontation, physical violence or written messages. In the Internet age bullying has entered a new and much more harmful dimension. If bullying is suspected contact the child's school. Each school should have a process for dealing with bullying that involves everyone in the building including teachers, security, kitchen workers and janitorial staff.

Colorectal Cancer Awareness

2010-03-28T17:18:00.000-07:00

March is colorectal cancer awareness month. Colorectal cancer is the third most common cancer diagnosed in men and women.

Dr. Christina Czyrko, a colorectal surgeon from the Hospital of Central Connecticut, was a recent guest on Healthy Rounds. She emphasized the importance of diet and exercise as a way of avoiding this deadly condition:
-grilled and processed meats should be avoided
-a diet rich in whole grains and fruits is preferred
-regular exercise is crucial

Colonoscopy remains the best screening examination and should be performed at regular intervals as recommended by a primary care physician.

More information can be obtained by going to the Healthy Rounds website, http://www.wtic.com/pages/5546567.php? at WTIC.com.

National Cheer and Dance Championship

2010-01-10T16:38:00.000-08:00

This weekend the Mohegan Sun Casino hosted the Spirit National Cheer and Dance Championships. I served as the physician for this event. Cheerleading has been referred to as "the most dangerous sport in America" based on the frequency of injury. Although there were injuries at the event, none were serious and all were evaluated by certified athletic trainers and physicians.

Many people have offered solutions on how to make cheer and dance safer. Some have advocated for greater regulation and others for banning it entirely. After working with these athletes who are passionate about their sport, I believe there is only one way to improve safety.

Parents who are collectively spending millions of dollars on lessons, entry fees, uniforms and make up should demand that the sport be made safer by insisting that they will only spend their hard-earned dollars in gyms where instructors are certified in teaching as well as first aid. Parents must also insist that they will only allow their children to compete in venues where licensed medical professionals are available in case of a catastrophe.

The American Association of Cheerleading Coaches and Administrators can help guide parents to the safest gyms and competitions.

Sadly, it is only through the power of the almighty dollar that this sport will become safer.

Do you have a cheer and dance story to share?
If you are a "cheer parent" would you make the hard choice of keeping your child out of an unsafe competition?

Bariatric Surgery

2009-12-13T16:04:00.000-08:00

If you are considering weight loss surgery be sure to do your homework. This week's guest on Healthy Rounds was Dr. Carlos Barba. Dr. Barba is director of the Bariatric Surgery Program at the Hospital of Central Connecticut. He is among the busiest bariatric surgeons in the country with over 14 years experience.

Dr. Barba stresses the need for a team approach such as the one taken at the Hospital of Central Connecticut where registered dieticians, psychologists and exercise physiologists work with patients before and after surgery.

The two most commonly performed operations are the gastric bypass and the lap band procedures. Gastric bypass is a much more radical approach and less popular than laporoscopic banding.

The key to success with either of these procedures is commitment to a program of regular exercise and eating right. The procedure is just a way of getting started on a life-long journey to good health.

Listen to the podcast of Dr. Barba's interview http://www.wtic.com/topic/play_window.php?audioType=Episode&audioId=4226868

If you are interested in bariatric surgery contact the Hospital of Central Connecticut at 1-866-668-5070 or http://thocc.org/services/weigh/surgery.aspx?fontsize=Large

Feel free to post any questions or information you may have about bariatric surgery.

Haitian Health Foundation

2009-12-08T17:47:00.000-08:00

I just returned from my third trip to Jeremie, Haiti. Jeremie is a remote area in the poorest nation in the western hemisphere. Malnutrition, poor sanitiation and inadequate drinking water are among the biggest challenges. As a physician, it affords me the opportunity to diagnose and treat diseases I'd only read about like malaria, tuberculosis and various parasitic infections.

Despite these adverse conditions patients were grateful for whatever treatment is provided. Sometimes that treatment was only a kind word and a smile since there is an extreme shortage of medication and virtually no diagnostic equipment.

The Haitian Health Foundation (HHF) of Norwich, CT is the organization that sponsors the clinic where I worked along with many other outreach efforts in Haiti. Its' founder, Dr. Jeremiah Lowney has been making these trips four times a year for the past 27 years. I had the plaesure of interviewing Dr. Lowney on the "Healthy Rounds" radio program just before leaving for Haiti. http://www.wtic.com/topic/play_window.php?audioType=Episode&audioId=4216171

This trip differed from my other visits because I left with a feeling of hope and pride. My hope was based on having the opportunity to work with a group of young, American volunteers who have left the comforts that we have become accustomed to so that they can help those in need for an extended period of time. My pride was based on the fact that my youngest daughter Stephanie was one of those volunteers.

If you wish to donate time or money to help this outstanding effort please contact HHF at www.haitianhealthfoundation.org

Gluten Free Diets

2009-11-24T18:25:00.000-08:00

This week's guest on Healthy Rounds (WTIC 1080 and WTIC.com Saturdays 11-noon) was Carrie Taylor. Ms. Taylor is a registered dietician for Big Y foods and Head of the Living Well Eating Smart Program.

One topic discussed was the gluten-free diet. Gluten is a protein found in wheat, barley and rye. People with celiac disease, dermatitis herpetiformis and gluten intolerance are unable to properly digest gluten-containing foods.

One in 133 people suffer from celiac disease, an autoimmune disease that alters the small intestine. The demand for gluten-free recipes is increasing, according to Ms. Taylor.

A gluten-free diet is not a method for weight loss or to increase a person's energy level despite being touted as such in the popular literature.

I highly recommend the http://www.bigy.com/ website for more information.

Are you on a gluten-free diet?

Do you have some recipes to share?

Physicans Attending Funerals

2009-10-25T18:31:00.000-07:00

Several weeks ago while preparing to do a weekly studio interview, the host and his previous guest noticed that I was wearing a dark suit. Both were surprised when I told them that after the show, I was attending the funeral of a long-time patient of mine.

I don't know if attending patients' funerals is the norm for physicans but in this case, and in several others during my career, it just seemed like the right thing to do. When treating patients over a period of years it is not uncommon to develop personal relationships and their passing creates a sense of loss for a physician as well as the office staff.

In this case, I had known the patient for almost 20 years. She had suffered several strokes and over the years I had come to know and treat many family members. I recall making house calls on occassion when she couldn't come to the office.

Fortunately, she lived a full life and passed on peacefully. I was pleased to see so many people attend the service and that I had a chance to express my condolences in person.

Do you think it is comforting for a patient's family when a physician attends a funeral or wake?
Is it odd?

Concierge Medicine: An Old Concept with a New Twist

2009-07-07T17:38:00.000-07:00

The terms "concierge medicine" and "boutique medical practice" have recently appeared in the news after the death of Michael Jackson. Apparently, Mr. Jackson employed a personal physician for his various medical needs.

Some family physicans have become frustrated by the need to see increasing numbers of patients to maintain their practice in the face of declining reimbursement. They are opting for a different model of health delivery where they can see fewer patients and deliver more personalized care 24/7 for direct payment from the patients. This model has become popularized in a recent TV program called "Royal Pains." The concept has also been harshly criticized as "elitist."

Actually, this model for health care delivery originated in the early 19th century under the term of "contract practice." A contract practice was one where a physician was expected to deliver care to a family, plantation or indigent members of a commuunity for a fixed annual fee.

I believe the concept of contract medicine will be gaining in popularity both from the standpoint of medical care delivered to a community as well as to wealthy families. History has taught us that those who have the financial means will always demand a better product. Now that we are looking at the potential for a more uniform health care system in America the demand for a private and exclusive system will also increase.

Let us know what you think.

Telemedicine in Neurology

2009-05-01T11:27:00.000-07:00

I have been attending the American Academy of Neurology Annual Meeting in Seattle. While there have been many outstanding presentations at this meeting one particularly caught my attention.

Drs. Steven Levine and Steven Rudolph gave a course on telemedicine and its' implications on successful stroke therapy. Telemedicine encompasses the use of technology to perform remote medicial evaluations. They can be done simply by using a telephone or one of several audio/video technologies allowing real-time interaction with a patient and medical professional.

Telemedicine extends highly specialized medical evaluations to remote areas of the world. Acute stroke therapy now requires rapid consultation and treatment. Based on their presentation I am sure this breakthrough will soon become common in emergency departments nationwide for a variety of emergent treatments.

What do you think about this innovative means of care?

Fitness Centers Crucial to Any Health Care Plan

2009-03-26T18:06:00.000-07:00

The YMCA in Norwich, Connecticut will close its doors permanently on April 30th after 100 years of service to the community. Like many other facilities around the country the Norwich YMCA provides a place for people to swim, play competitive sports and exercise. The Y is the only access to indoor exercise for many during winter months.

New health plans that provide wider coverage under the federal government are in the
head lines every day. Unfortunately, these plans only address care after people become ill. Any new health plan must include preventive measures with wider access to fitness centers.

As exercise facilities close due to economic constraints health care costs will rise. Money spent on these facilities now is an investment in the future.

Do you have ideas on how to incorporate fitness incentives into health plans?
How should we deal with constraints placed on these facilities?

Alzheimer's Disease and Physical Activity

2009-03-19T05:01:00.000-07:00

Among the most frequent and feared neurological complaints is loss of the ability to think clearly including recognition of friends and family. Problems such as these fall into the broad category of cognitive impairment often preceeding Alzheimer's disease and other forms of dementia.

This month's issue of Archives of Neurology contains four articles addressing the link beween physical activity and dementia. Multiple studies demonstrate a higher frequency of cognitive disorders in obese people. Many of these disorders are the result of obesity in combination with diabetes, high cholesterol and vascular disease.

One study demonstated improved memory function in adults over the age of 50 who began a program of physical activity.

These recent studies add more support to the fact that even a modest exercise program of walking, aquatics or cycling will improve the quality of life for older individuals.

Do you have any suggestions of how to incorporate physical exercise into an active lifestyle?
How can you make physical activity part of a productive retirement?

Colorectal Cancer Awareness

2009-03-14T04:31:00.000-07:00

March is colorectal cancer awareness month highlighting the number three cause of death from cancer in the United States. Vigilance for signs of bowel cancer should begin at age 50 with a colonoscopy. If there is a family history of colorectal cancer these examinations should begin sooner. All adults should have annual stool guiac testing (a test for blood in stool) as part of a general physical exam.

A recent Healthy Rounds interview with Dr. David Coletti, a general surgeon at the William W. Backus Hospital in Norwich, CT, revealed the importance adequately preparing the colon for any procedure including endoscopic colonoscopy, radiologic imaging of the colon or colorectal surgery. Careful cleansing of the colon before the procedure, as outlined in the written instructions, will directly increase the ability to find a cancerous growth and remove it without complication.

If you have any helpful hints regarding preparation for colonoscopy please share them.

Automatic External Defibrillators (AEDs) Save Lives

2009-02-27T17:39:00.000-08:00

There are only two ways of dying in sports: neurologic and cardiac. The typical neurologic injury results from overwhelming head trauma, causing severe brain hemorrhage. Sudden cardiac death is caused by the heart beating out of rhythm or ceasing to beat at all.

Unfortunately, there is no way to quickly revive the brain on an athletic field. However, through the use of AEDs, the human heart can be revived by trained personnel.

Raised Bill No. 981 addresses the responsibility of schools to provide AEDs at all athletic competitions. Passage of this bill will directly save the lives of young athletes in Connecticut.

Let's hear your opinion: Do you agree with this? Are you willing to help your school raise the necessary funds (approximately $1200) to purchase an AED?

Diagnostic Imaging: Not Just X-Rays Anymore

2009-02-19T06:48:00.000-08:00

Healthy Rounds will be discussing the transition from the term radiology to diagnostic imaging with Dr. Phillip Kohanski Assistant Director of Diagnostic Imaging at the William W. Backus Hospital. The change in terminology is a result of so little radiation involved in new medical imaging techniques. The new generation of imaging has in many cases obviated the need for exploratory surgery.
MRI (Magnetic Resonance Imaging) is a procedure that has become very common but patients should be cautious. Ask questions:

What is the field strength of the magnet? Closed MRIs should have a field strenght of one Tesla or more.
Is an "open" or "closed" MRI preferred? Closed MRIs have better resolution and should always be the preferred study. Patients with claustrophobia might prefer an open study but be sure the open unit has a high field strength
Who will be reading the MRI study? The radiologist should special training in MRI.

Diagnostic Imaging is an exciting field of medicine where physicians, technologists and patients are all learning about its' impact together.

Have you had a recent procedure?

What was your experience?

Any tips on how to avoid the claustrophobic feeling of an MRI?

Welcome to the Healthy Rounds Blog

2009-02-13T11:33:00.000-08:00

This blog is intended for the dissemination of useful healthcare information. It was designed to coincide with the Healthy Rounds radio broadcast which appears on WXLM 104.7 and on the internet at WXLM.FM every Saturday at 2pm. This week's program addresses the issue of organ and tissue donation. Much has changed in this area with increasing opportunities for donation by people of all ages.
Are you an organ donor?
If so why?
If not why not?