Dr. Clem's Health Blog: Attention Gulf War Veterans.If you served on ac...

Dr. Clem's Health Blog: Attention Gulf War Veterans. If you served on ac...: Attention Gulf War Veterans. If you served on active duty during 1990 to 1991 and were deployed to Operation Desert Storm, you may be eli...

Attention Gulf War Veterans.


If you served on active duty during 1990 to 1991 and were deployed to Operation Desert Storm, you may be eligible for a research study concerning,"The Physiological Basis of Gulf War Illness."

This program requires one visit to Boston University Medical Campus.  An initial ten minute phone call will determine if you're eligible.  If you're interested, call  617-638-5834.

Point of Contact is Joanna Cirrillo, The office is,"Gulf War Research Consortium-Boston."

It would be prudent to obtain and complete a "VA Form 10-10EZR." It is titled, "Department of Veteran's Affairs, Health Benefits Update Form." You can obtain it at your local VA.

Transient Ischemic Attack (TIA) is an episode of temporary memory loss that lasts less than an hour. It may be due to compression of the spinal cord. However, it doesn’t cause spinal tissue damage. People who suffer a TIA have an eleven percent risk for stroke over the subsequent five years. In most cases, rapid transport to a hospital is recommended for an evaluation. Symptoms could include slurred speech, limping, confusion, and memory disturbance.

Initial medical exam includes blood pressure monitoring, speech function, heart rate assessment, respiratory function, and oxygen monitoring. The care provider evaluates the patient’s attentiveness, speech, and function. Periodic finger stick blood testing includes blood sugars, blood counts, and cardiac enzymes. In some instances, the patient would need a “lumbar puncture” for spinal fluid analysis.

Symptoms could include problems with walking, behavioral changes, short term memory, blurred vision, swallowing difficulty, and incomplete eye closure. Symptoms resolve over minutes. Prior medical history should include investigation of recent surgery, seizures, illicit drug use, previous TIAs, diabetes, heart disorders (i.e., patent foramen ovale) and migraines.

Medical history is crucial. This includes recent surgery, behavior changes, diabetes, previous stroke, seizures, central nervous system infection, clotting disorders, heart abnormalities, migraine, and illicit drug use. TIAs decrease consciousness. Lower extremity weakness and tingling is not uncommon.

Those who have had a TIA have risk for “vascular dementia” (bleeding in the brain, or a blocked blood vessel). An electroencephalogram might be considered to rule out seizures.

A spinal lumbar puncture is considered to rule out brain infection (meningitis). Additional workup might include a brain CT and MRI.

Those who have had a TIA within a week of hospital admittance should take aspirin 50-325 mg daily, instead of Coumadin, to prevent bleeding in the brain. Blood pressure should be maintained at 140/90.

Additional symptoms may include low blood sugar (hypoglycemia), seizures, tumor, migraine with aura, nerve root disorders, buzzing in the ears (tinnitus), and brain bleeding.

Heart evaluation includes ultrasound and testing for atrial fibrillation. This is done by “holter monitoring.”

Hospitalization is recommended for those who have symptoms more than an hour.

Blood pressure should be kept no higher than 220/120. Smoking cessation, lipid control, lowered glucose, and alcohol elimination lower it. In most cases, a weight loss and exercise program is recommended.

Source:http://www.medicinenet.com/transient_ischemic_attack_tia_mini-stroke/article.htm

Famous quote: “People who really want help may attack you if you help them. Help them anyway.”

Mother Theresa. 

Cataracts?  Put on your sunglasses!

1."Senile cataracts" are a leading cause of vision loss world wide. They are due to aging.  Failure to treat them could cause vision loss or glaucoma.  African-Americans have a higher risk than Caucasians. Treatment delay could progress to swelling, and blindness.

2.  Risk factors include older age, female gender, smoking, diabetes, ultraviolet light exposure, hypertension, drug and alcohol ingestion, and myopia. Higher education lowers risk. Workers exposed to infrared radiation without sunglasses have a higher risk of senile cataracts.

3,  Diagnosis and exam.  A thorough exam includes a slit exam,  Some one who can't read better than 20/200 on the the vision chart may have a "mature cataract."  The eye is dilated to look for pupil size and brunescence (hardening and darkening of the lense and cataracts A slit lamp should include lens opacity (cloudiness) but also other eye structures. Cornea thickness and presence of opacities,such as gutta (tear drop shaped opacities) require a detailed exam. Not all cataracts need surgical removal at the time of diagnosis.  If vision isn't impaired or if the patient isn't ready for surgery,then followup visits are recommended.

4, Recovery and prognosis.  Patients are discharged home when they have recovered from surgery  The're prescribed topical eye drops, anti-inflammarory and prescription steroids, and antibiotics. Six to eight weeks weeks after surgery, prescription glasses are provided, and medicines are tapered. Most cataract surgeries are done on an outpatient basis.

5. Following  surgery, an eye shield is put over the operated eye. It is removed several hours later. At any stage following surgery, there is risk for inflammation and infection.  Heavy lifting is not recommended for a period of time to prevent injury.

Source:  Source: Medscape http://www.emedicinehealth.com/cataracts/article_em.htm

Questions or comments?  Contact Dr. Clem at   clementhanson.blogspot.com

Breast cancer is the most common malignancy diagnosed in women. Survival rates have increased. The number of deaths is declining due to earlier detection and prompt treatment.

Five to ten percent of breast cancers are due to genetic mutations passed through family generations. Inherited mutated genes increase cancer likelihood. The most common are cancer gene 1 (BRCA1) and 2 (BRCA2). Both of these increase risk for breast and ovarian cancer.

Presence of genetic risk doesn't mean that cancer will occur. However, risk is higher with increasing age. Cancer in one breast increases risk for cancer in the opposite breast. A family member with breast cancer at a young age increases risk. The majority of those have known family history. Risk factors include obesity, onset of early menstruation, and menopause at older age. Women who gave birth to their first child after age thirty and those who haven’t been pregnant but took hormone (estrogen) have elevated risk. However, risk decreases when the medicines are stopped.

Presence of a lump requires a mammogram. If there is a lump, a diagnostic mammogram is more specific. Ultrasound is reasonable to distinguish a solid mass or cyst.

Biopsy should be ordered to determine if tissue and cells are cancerous. An MRI with contrast is reasonable. Biopsy or surgery could determine the stage or type of cancer.

Further workup includes a blood count, bone scan, CT (computerized tomography), breast MRI, and PET (positron emission tomography) scan.

Stage four cancer indicates that the cancer that has spread. Simple mastectomy or modified radical mastectomy is considered. Chemotherapy, hormone therapy, or radiation treatment is initiated

If surgery is considered, a second opinion from a breast specialist is appropriate. Surgery includes lumpectomy, breast sparing surgery, and removing the tumor with a small margin of surrounding healthy tissue. Simple mastectomy involves removing all breast tissue, including the lobules, ducts, fatty tissue and skin, including the nipple and areola.

Removing a limited number of lymph nodes (sentinel node biopsy) could determine whether cancer has spread to the lymph nodes. If the nodes are cancer free, probability of finding cancer in remaining nodes is minimal. Should there be cancer in the sentinel node, additional nodes are removed. Those with cancer in one breast could decide to have their other (healthy) breast removed if there is a strong family history. However, most women with cancer in one breast won’t develop cancer in the other.

 Plastic surgery reconstruction involves a breast implant (silicone or water-filled) or reconstruction using one’s own breast. Radiation therapy is considered to obliterate remaining cancer cells.

External beam radiation, or brachytherapy, involves placing radioactive material inside the tumor area. It’s performed after lumpectomy for early-stage breast cancer. Radiation to the chest wall after mastectomy could be considered if cancer has spread to the lymph nodes.

Radiation side effects include fatigue and red, sunburn-like rash where radiation is applied. The tissue could appear swollen or firm. Rarely, damage to the heart or lungs could occur in the treated area.

If cancer has spread outside the breast, chemotherapy is given to mitigate the cancer and decrease symptoms. Effects include hair loss, nausea, vomiting, fatigue, and infection. Rare effects include premature menopause, infertility (if premenopausal), injury to the heart and kidneys, nerve damage, and blood cell cancer.

Hormone-blocking therapy treats breast cancers sensitive to hormones. It might be considered after surgery to decrease recurrence. (SERM) selective estrogen receptors, block estrogen from attaching to the estrogen receptors, slowing tumor growth, and obliterating cancer cells.

There are no alternative medicine treatments that have been found to cure breast cancer. However, complementary and alternative medicine (CAM) may help. Survivors have fatigue during and after treatment that could continue for years. When combined with a doctor's care, CAM could relieve fatigue and improve sleep. Exercising three to four times a week, journaling, walking, yoga, Tai Chi, and swimming decrease depression and improve mood.

A breast cancer diagnosis is overwhelming. Local groups, such as the American Cancer Society, give support. .

 Women who eat a Mediterranean Diet supplemented with extra-virgin olive oil and mixed nuts reduced cancer risk. The diet focuses on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. Those who follow this diet choose healthy fats, like olive oil, over butter and fish, instead of red meat. Estrogen-blocking medications reduce cancer risk. These include Tamoxifen and Raloxifene (Evista). Removal of the ovaries further reduces risk.

 Signs and symptoms include a breast lump or thickening different from the surrounding tissue, bloody discharge from the nipple, and change in breast size, shape, and appearance. Nipple scaling with redness or pitting are suspicious findings.

Make an appointment with your treating doctor to review your current medical history and medications. An annual checkup is crucial.

http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/definition/con-20029275

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front. The flu virus traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WWI, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces’ campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during WWI than did enemy weapons.

Autumn is coming; the CDC (Centers for Disease Control) recommends everyone six months and older be immunized against the flu, except for rare contraindications. The flu season begins in early October till May.  Those who receive the vaccine have protection two weeks after receiving it.

The vaccine is sixty to seventy percent effective in preventing the flu. The vaccine can be given by either injection or inhalation. Most people have no significant side effects. Both children and adults might prefer the inhaled spray instead of the injection.

 Babies less than two years of age should not take the inhaled spray. Kids two to eight years of age may have better immunity with the spray. FluMist is simple to administer. Those who choose the spray could have mild runny nose, headache, cough, and sore throat. These symptoms are temporary and milder than getting the flu. Patients receiving the injection might have low-grade fever and soreness at the injection site. Fever and muscle aches could occur for for one to two days.  It's not necessary or helpful to get receive both.  

High priority for receiving the vaccine includes children and young adults between six months and eighteen years; children with pulmonary (lung) disease, such as asthma; diabetes; those with heart, kidney, and liver disease; and anyone with a weakened immune system, such as HIV infection, should be immunized.

Women who plan to be pregnant should get vaccinated. Children and adults who have heart disease, diabetes, kidney disease, and Guillan-Barre Syndrome should be vaccinated. Adults fifty years or older, residents of nursing homes or care facilities, as well as those who live with someone at high risk of flu complications; and caregivers; should all get the vaccine.

Those with a history of severe allergic reaction to eggs or complications from a previous flue vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant or organ transplant should not get the vaccine.

Other means of preventing flu include washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching the eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent. 

Questions or comments?  Contact Dr. Clem at  clement.hanson@blogspot.com

Source: http://www.riversideonline.com/health_reference/Infectious-Disease/ID00017.cfm

  

Women who will be pregnant during flu season; adults fifty and older; children with pulmonary (lung) disease, such as asthma; those with heart, kidney, and liver disease; and adults and children with weakened immune systems (i.e., HIV infection) should be immunized.

People who live in nursing homes or care facilities, those who live with someone at high risk of flu complications, caregivers, children under six months of age, and health care workers should all get the vaccine.

FluMist spray is recommended for healthy children two through eight years of age.

Those who shouldn't get the spray vaccine include children less than two years of age; adults; children or adults who have heart disease, diabetes, kidney disease; and Guillan-Barre Syndrome, a condition that includes a weakened immune system.

Anyone with a history of severe allergic reaction to eggs or complications from prior a previous flu vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant should not get the vaccine. The vaccine is safe for those who have a suppressed immune system, such as those with diabetes or HIV.

FluMist, the nasal spray, is easy to administer. Children and adults might prefer it to the injection. Children ages two to eight have better immunity with FluMist than the injection.

The highest priority for flu vaccine includes children between six months and eighteen years old, children on long-term aspirin therapy, women who will be pregnant during flu season, adults fifty and older, and children with diseases of the lungs, such as asthma.

The injectable vaccine can cause muscle aches and fever for one to two days. Possible side effects of the inhaled vaccine include runny nose, headache, and sore throat. It takes two weeks for the flu vaccine to take effect. Lowering flu risk includes washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent.

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front The flu virus

traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WW2, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces' campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.

Autumn is coming. The CDC (Centers for Disease Control) recommends everyone six months and older be immunized against the flu, unless there is a medical reason not to. Those who are two to forty nine years of age need the annual flu vaccine.

Flu season begins early October and lasts through May. Those who receive the vaccine have protection two weeks after receiving it. The vaccine can be given by either injection or inhalation.

 Most people have no side significant effects. Low grade fever and soreness at the injection site could occur. The inhaled nasal spray might cause runny nose, headache, fatigue, and mild fever. These symptoms resolve in a few days. The vaccine is sixty to seventy percent effective in preventing the flu.

The U.S. Centers for Disease Control (CDC) recommends the nasal spray instead of the injection for children between two and eight. The spray might cause mild runny nose, headache, cough, and sore throat. These symptoms are temporary and are milder than the flu. Those who choose the inhaled vaccine, FluMist, could have similar symptoms which are not caused by the flu.  Those who receive the injection don't need the inhaled spray.

Children and adults might prefer the inhaled spray instead of the injection. Kids two to eight years of age have a better response with the spray.  

High priority for receiving the vaccine include children and young adults between six months and eighteen years, and children on long-term aspirin for Reye’s Syndrome, a rare condition that causes swelling in the liver and brain after getting the flu.

 Women who will be pregnant during flu season; adults fifty and older; children with pulmonary (lung) disease, such as asthma; those with heart, kidney, and liver disease; and adults and children with weakened immune systems (i.e., HIV infection) should all be immunized.

 People who live in nursing homes or care facilities, those who live with someone at high risk of flu complications, caregivers, children under six months of age, and health care workers should get the vaccine.

FluMist spray is recommended for healthy children two through eight years of age.

Those who shouldn't get the spray vaccine include children less than two years of age, adults, children or adults who have heart disease, diabetes and kidney disease, and Guillan-Barre Syndrome, a condition of weakened immunity.  

Anyone with a history of severe allergic reaction to eggs or complications from prior a previous flu vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant should not get the vaccine. The vaccine is safe for those who have a suppressed immune system, such as those with diabetes or HIV.

FluMist, the nasal spray, is easy to administer. Children and adults might prefer it to the injection. Children ages two to eight have better immunity with FluMist than the injection.

The highest priority for flu vaccine includes children between six months and eighteen years old, children on long-term aspirin therapy, women who will be pregnant during flu season, adults fifty and older, and children with diseases of the lungs, such as asthma.

The injectable vaccine can cause muscle aches and fever for one to two days. Possible side effects of the inhaled vaccine include runny nose, headache, and sore throat. It takes two weeks for the vaccine to take effect. Lowering flu risk includes washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent.

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front The flu virus

traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WW2, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces' campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.