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Today is national mesothelioma awareness day which is fitting because so few know what mesothelioma is or its impact on its victims. Mesotheliomas are rare tumors caused predominantly by exposure to asbestos. This cancer is hard to diagnose early and harder still to treat effectively but there are advances coming and multi-disciplinary care along with good palliative care can markedly improve overall treatment.
They mostly occur on the lung lining (pleura) but can…Continue
Added by Stephen C Schimpff on September 26, 2011 at 3:22pm — No Comments
Medical care is organized to treat acute conditions but the need today is to prevent, diagnose and treat chronic illnesses. Unfortunately, we are sorely lacking in a good chronic care management system. this will be the first in a series of six posts on this issue.
Our medical care system has developed over decades and even centuries around diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for…Continue
Added by Stephen C Schimpff on September 8, 2011 at 4:42pm — No Comments
Adhering to a moderate yet healthy lifestyle can reduce the risk of sudden cardiac death by about 90% according to a new study. It is well known that high blood pressure, high cholesterol, and diabetes correlate with coronary artery disease. Life style factors do as well – a combination of a Mediterranean style diet, moderate regular exercise, appropriate weight and non smoking all correlate with less coronary artery disease, less stroke, less high blood pressure, less diabetes, less…Continue
Added by Stephen C Schimpff on July 23, 2011 at 8:10am — No Comments
It was just 30 years ago in June 1981 when the first cases of what came to be known as Acquired Immune Deficiency Syndrome (AIDS) were published by the Centers for Disease Control (CDC) in its Morbidity and Mortality Weekly Report (MMWR.) These were men who had a wasting illness and died of unusual infections, ones of the types seen mostly in “immunocompromised hosts.” These were infections with which I was very familiar in my work treating and preventing infections in aggressively treated…Continue
It is often difficult to appreciate that improving the care of patients can actually reduce the costs of care. Last year Dr H Brody wrote in the New England Journal of Medicine (vol 362, p283-5) about “Medicine’s ethical responsibility for health care reform – the top five list.” In essence he challenged physicians to be first to find ways to rationally reduce health care costs by identifying the top five tests or treatments in any given specialty or subspecialty that could be markedly…Continue
Added by Stephen C Schimpff on June 8, 2011 at 1:52pm — No Comments
Drug companies can use genomics to create targeted drugs like imatinib (Gleevec) and trastuzumab (Herceptin.) Physicians can then use the results of genomic studies to guide prescribing. As discussed in prior posts, a person with Philadelphia chromosome-positive (i.e., having the BCR-ABL translocation with its aberrant tyrosine kinase) chronic myelocytic leukemia will likely respond to Gleevec. And a woman whose breast cancer shows high levels of the Her2neu receptor will likely respond to…Continue
Added by Stephen C Schimpff on June 3, 2011 at 11:33am — No Comments
The mitral valve separates the heart’s left atrium from the left ventricle. When the ventricle contracts to send blood to the aorta and out to the body, the mitral valve closes to prevent blood rushing backward into the atrium and back to the lungs. The mitral valve can become stiff and tight, called stenosis or it can become unable to close tightly, called regurgitation. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most…Continue
Added by Stephen C Schimpff on April 20, 2011 at 5:16pm — No Comments
Much of today’s foods are “ultraprocessed,” lead to obesity and its ultimate diseases such as diabetes, coronary artery disease, hypertension, many cancers and worsening of diseases such as osteoarthritis.
Ultraprocessed foods originate from just a few grains, namely corn, wheat and soy but these then undergo extensive chemical and mechanical manipulation resulting in compounds that humans have never eaten before. Just look at the ingredients list on many store products and…Continue
Added by Stephen C Schimpff on April 18, 2011 at 9:51am — No Comments
Well, probably not a surprise at all. The seeds of coronary artery disease (CAD) are laid down early and over long periods. But given our current pandemic of obesity beginning in childhood, should we worry about an epidemic of chronic disease like diabetes and CAD in the years to come? The clear answer is a resounding “Yes.”
There has been a long term study of military men in the Israeli Defense Force. An article in the New England Journal of Medicine, April 7, 2011 reports…Continue
Added by Stephen C Schimpff on April 11, 2011 at 5:52pm — No Comments
It is currently popular for government officials to single out the insurance companies for the rising cost of healthcare. Not that the insurers are without fault but the real reasons for cost increases are rarely addressed and therefore not appreciated. We are a country with an aging population (“old parts wear out”) and of many adverse behaviors (e.g., overweight, sedentary lifestyle, stress and 20% still smoke.) Combined, these are driving a rapid increase in chronic diseases such as…Continue
Added by Stephen C Schimpff on March 27, 2011 at 8:45am — No Comments
When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 ½ years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.
Clarissa had been treated for leukemia when she was 2 and had been fine for a decade when the relapse occurred. She found there…Continue
Added by Stephen C Schimpff on March 14, 2011 at 3:25pm — No Comments
During the healthcare reform debate there was the unfortunate reference to “death panels.” No such thing was ever in the proposals but it meant that an important part of medical care was set aside as too “toxic” to discuss. But end of life counseling is very important. Indeed it is good to have realistic discussions at the beginning of a serious illness; indeed it is only fair to the patient and the patient’s family.
Palliative care (I don’t like the term; it seems to…Continue
Added by Stephen C Schimpff on February 21, 2011 at 4:22pm — No Comments
We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.
Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to obtain, chemotherapy drugs, steps to prevent infection, prevent kidney…Continue
Added by Stephen C Schimpff on February 9, 2011 at 3:25pm — No Comments
Diabetes mellitus is the most common cause of kidney failure that progresses to end stage renal disease (ESRD,) meaning that the person requires dialysis or kidney transplant. ESRD is chronic and life long, is complicated to treat, has a major negative effect on quality of life and the costs are high.
So it was good news when the Centers of Disease Control reported that the incidence of ESRD among diabetics had declined by…Continue
Added by Stephen C Schimpff on January 18, 2011 at 3:23pm — No Comments
Herpes zoster (or shingles) is caused by the same virus that causes chicken pox. Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated that it reduced the incidence by about 50% and for those who still got shingles, the severity was lessened substantially. But…Continue
Added by Stephen C Schimpff on January 14, 2011 at 3:51pm — No Comments
Lung cancer is the most common cancer other than skin cancer. The survival rate is still dismal so early diagnosis presumably could make an impact. Chest x-rays just do not have the sensitivity to find early lung cancer. Computed tomography (CT Scans) can detect very small lesions in the lung. Another study has now been completed and it was able to find many early cancers.…Continue
Added by Stephen C Schimpff on January 12, 2011 at 3:36pm — No Comments
Over the past ten years and since the publication of the Institute of Medicine landmark book “To Err Is Human” there have been many attempts to reduce preventable medical errors which are estimated to take about 100,000 lives per year – perhaps many more. The question is whether all of this effort has had a substantial clinical impact.
The results of a recently published study are therefore concerning. A…Continue
Added by Stephen C Schimpff on December 14, 2010 at 11:54am — No Comments
Added by Stephen C Schimpff on December 8, 2010 at 2:25pm — No Comments
Added by Stephen C Schimpff on December 1, 2010 at 10:50am — No Comments
Added by Stephen C Schimpff on November 14, 2010 at 9:04am — No Comments