WSMA Doc Talk has a new home

September 25, 2012 — WSMA Doc Talk

The Washington State Medical Association (WSMA) is pleased to announce a redesign of its website – including a new home for the Doc Talk blog: http://www.wsma.org/articles/doc-talk.

Local physician experts will continue to weigh in on important health and wellness topics on the Doc Talk blog. Now it will be easier for you to access other useful resources designed for patients, including WSMA Wellness Report, a regular e-newsletter featuring the latest tips for healthy living, and our Physician Locator, a tool to search our database for a MD, DO, or PA member in your area.

Additionally, find out about our new campaign, Know Your Choices – Ask Your Doctor. It’s more important than ever for you to have meaningful conversations with your physician about appropriate care, cost-effective treatment options, expected outcomes, and quality of life choices. Via the Know Your Choices – Ask Your Doctor, we’ll show you how.

The Washington State Medical Association represents over 9,800 physicians in Washington state, and continues to be your resource for useful health and wellness information, as well as connecting with local physicians.

Also be sure follow WSMA Doc Talk on Twitter and Facebook for real-time health and wellness information.

Visit any of these new pages and let us know what you think, using our new commenting system. We look forward to continuing the conversation!

Posted in Uncategorized. Leave a Comment »

What is a true “emergency”? Do you know the best place to go for medical care?

June 25, 2012 — WSMA Doc Talk
Dr. Nathan Schlicher

Nathan Schlicher, MD, JD

by Nathan Schlicher, MD, JD
Emergency Physician and Associate Medical Director, St. Joseph Medical Center
Health Care Attorney
Member, Washington State Medical Association (WSMA)

As you rush to get ready for work you find your daughter coughing and with a slight fever. Do you go to the emergency room? Not necessarily. First call your doctor’s office. They can handle coughs, colds, minor broken bones and sprains.

What if it’s Saturday night at 6 p.m.? In that case an urgent care clinic might be a good option. They handle walk-in appointments and are often open seven days a week with extended hours.

What if your daughter is not just coughing, but struggling to breath and not responding to your voice or gently rubbing her arm? Call 911 or go directly to the emergency room.

We do not need to see every cough, cold, and flu in the emergency room because it takes away from the patients who are there for more life threatening illnesses like the septic child. Often I find that patients or parents don’t know they have other choices of where to go for care. In the rush to get help, they bypass their family doctor or urgent care clinic when that may have been a better choice—even if it takes a few hours or days to be seen for minor illnesses, some of which may already be resolving by the time you are seen in your doctor’s office.

Sometimes it’s confusing to know where to go for medical care, but where you choose matters.

Doctor’s office – Unless you have an immediate life threatening emergency, start with your doctor or clinic. They know your medical history and can provide care for common illnesses, minor injuries and routine health exams.

  • Common illnesses – colds, flu, ear aches, sore throats, migraines, fever, rashes
  • Minor injuries – sprains, back pain, minor cuts and burns, minor broken bones, minor eye injuries
  • Routine care – physicals, prescription refills, vaccinations, screenings

Urgent care clinics – When your doctor is not available (usually during off hours or weekends), urgent care clinics provide care for non-life threatening medical issues that could become worse if you wait. Walk-in appointments are available. They are usually open extended hours and on weekends. Some are open 24/7.

  • Common illnesses – colds, flu, ear aches, sore throats, migraines, fever, rashes
  • Minor injuries – sprains, back pain, minor cuts and burns, minor broken bones, minor eye injuries

Hospital emergency room – You should use a hospital emergency room for very serious or life-threatening problems. Open 24/7, 365 days per year. If you have an emergency, DON’T WAIT! Dial 911 or get to the nearest hospital emergency room.

  • Chest pain
  • Severe abdominal pain
  • Coughing or vomiting blood
  • Severe burns
  • Deep cuts or bleeding that won’t stop
  • Sudden blurred vision
  • Difficulty breathing or shortness of breath
  • Sudden dizziness, weakness, or loss of coordination or balance
  • Numbness in face, arm, or leg
  • Sudden, severe headache (not a migraine)
  • Seizures
  • High fevers
  • Any other condition you believe is life threatening

Still not sure where to go for care? Many insurance companies and hospitals have a 24/7 nurse help line to help you decide where to go for care.

We’d love to hear from you. Do you ever have questions about the right place to go for care? What would you do if your baby was crying inconsolably in the middle of the night? What if you cut your finger deeply while cutting an apple?

Dr. Schlicher is associate medical director and emergency physician at St. Joseph Medical Center in Tacoma. In addition, he is legislative affairs chairman and member of the board of directors for the Washington Chapter of the American College of Emergency Physicians. He is a tireless advocate for patient safety issues in Washington and nationally.

 

Posted in Emergency Medicine, Emergency Room, Urgent Care Clinic. Tags: , , . Leave a Comment »

Questions about Myelodysplastic Syndrome (MDS)? Answers from an expert…

June 14, 2012 — WSMA Doc Talk
Paul Hendrie, MD, PhD

Paul Hendrie, MD, PhD

by Paul Hendrie, MD, PhD
Hematology Specialist, Seattle Cancer Care Alliance
WSMA Member

There was a collective gasp across the country when Good Morning America host Robin Roberts announced she has Myelodysplastic Syndrome (MDS), a blood disorder possibly an unfortunate result of the curative treatment for breast cancer she received five years ago. The TV host announced she is starting “pre-treatment” for a bone marrow transplant that she will have later this summer or early fall.  How can it be that someone who has already battled cancer successfully would have this thrust upon them?  It certainly isn’t fair.  But cancer is never fair.

While there are many questions surrounding this news, there is something we all can do to help. Here’s what you should know:

What is MDS?

MDS is a bone marrow disease that leads to low levels of blood cells circulating in the bloodstream. The blood stem cells in the bone marrow of a person with MDS don’t produce enough healthy cells—red blood cells, (RBCs to carry oxygen throughout the body), white blood cells, (WBCs to fight infection), and platelets (to help clot).  The cells produced don’t mature and tend to die early, leaving the patient with fewer blood cells in their bloodstream.

These low blood counts can cause fatigue, shortness of breath, paler skin than usual, weakness, bruising, and a predisposition to infections. Each year about 10,000 to 15,000 people are diagnosed with MDS in the United States. In 10 to 20 percent of patients, MDS is associated with previous exposure to chemotherapy and/or radiation likely the result of damage to the DNA of the normal blood stem cells. MDS progresses to severe marrow failure and in some patients to a life threatening acute myeloid leukemia.

Treatments for MDS

The main goal of treatment is to increase the number of healthy blood cells in the bloodstream. This can be accomplished with transfusions and agents to stimulate blood cell production, but the benefits of these treatments are only short term. More durable results require more aggressive treatments with chemotherapy, including newer agents such as azacitidine and lenalidomide. Often, as is the case with Robin Roberts, a bone marrow transplant is the best treatment option and the only potential for cure.

Before transplant, chemotherapy is used to “condition” the body and destroy the unhealthy stem cells. In some cases the entire bone marrow and immune system is destroyed. Healthy stem cells are then given through IV from a compatible, healthy donor (in Roberts’ case, her sister was a near-perfect match).  The hope is that the suppressed immune system will not reject the healthy new cells, allowing them to flourish and grow.

Bone marrow transplantation was pioneered in Seattle at the Fred Hutchinson Cancer Research Center. And continued advances are being made every day in our region. Seattle Cancer Care Alliance has much more detailed information on MDS, as well as many other blood disorders, including various treatment options and clinical trials.

Become a Bone Marrow Donor

Swab your cheek.  Save a life. To offer support to Robin Roberts, and all of those with blood disorders, join the bone marrow registry at Be The Match. It’s especially important for people with diverse racial or ethnic heritage to register.  Adding more diverse members to the registry increases the likelihood that all patients will receive a life-saving match.  You have the power to save a life.

We’d love to hear from you. Are you on the bone marrow registry? If so, have you donated and how was the experience?  If not, what is holding you back? If you are the recipient of a bone marrow transplant, what are your thoughts?

Dr. Hendrie is a hematology specialist at Seattle Cancer Care Alliance who treats patients for blood disorders, leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome. He is also a member of the Washington State Medical Association (WSMA).

Posted in Breast Cancer, Cancer. Tags: , . 3 Comments »

Sleepless in Seattle: 10 Tips to a Peaceful Night’s Sleep

April 20, 2012 — WSMA Doc Talk
David Chang, MD

David Chang, MD

By David Chang, MD and Gina H. Chen, MD
The Polyclinic Sleep Medicine Center

It’s often noted that you spend a third of your life sleeping, but for many, that’s wishful thinking. Trouble sleeping is one of the most common complaints people have. Whether the problem is falling asleep, staying asleep, or not feeling rested when waking up, sleep deprivation can wreak havoc on your body, mind and health.

Here are 10 tips to help you improve sleep. (These suggestions are intended for “typical” adults, but not necessarily for children or persons experiencing medical problems.)

1. Maintain a regular bed and wake time schedule including weekends.
Our sleep-wake cycle is regulated by a “circadian clock” in our brain and the body’s need to balance both sleep time and wake time. A regular waking time in the morning strengthens the circadian function and can help with sleep onset at night.

Gina H. Chen, MD

Gina H. Chen, MD

2. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.
Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or family problem-solving. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional. Finally, avoid exposure to bright light before bedtime because it signals the neurons that help control the sleep-wake cycle that it is time to awaken, not to sleep.

3. Create a sleep-conducive environment that is dark, quiet, comfortable and cool.
Design your sleep environment to establish the conditions you need for sleep. Consider using blackout curtains, eye shades, ear plugs, “white noise,” humidifiers, fans and other devices.

4. Sleep on a comfortable mattress and pillows.
The mattress you have been using for years may have exceeded its life expectancy—about 9 or 10 years for most good quality mattresses. Have comfortable pillows that are free of allergens that might affect you.

5. Use your bedroom only for sleep and sex.
It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep.

6. Finish eating at least 2-3 hours before your regular bedtime.
Eating or drinking too much may make you less comfortable when settling down for bed. Try to restrict fluids close to bedtime to prevent nighttime awakenings to go to the bathroom, though some people find milk or herbal, non-caffeinated teas to be soothing and a helpful part of a bedtime routine.

7. Exercise regularly. It is best to complete your workout at least a few hours before bedtime.
In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising right before going to bed will make falling asleep more difficult.

8. Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime.
Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but they can affect some people up to 12 hours later. Avoiding caffeine within 6-8 hours of going to bed can help improve sleep quality.

9. Avoid nicotine (e.g. cigarettes, tobacco products). Used close to bedtime, it can lead to poor sleep.
Nicotine is also a stimulant, so it can cause difficulty falling asleep, problems waking in the morning, and may also cause nightmares. When smokers go to sleep, they experience withdrawal symptoms from nicotine, which also cause sleep problems.

10. Avoid alcohol close to bedtime.
Although many people think of alcohol as a sedative, it actually disrupts sleep, causing nighttime awakenings. Consuming alcohol leads to a night of less restful sleep.

If you continue to have sleep problems, try keeping a sleep diary. Note when and how your sleep is disturbed, what substances you’ve consumed and when, and note your daily activities, then look for patterns. If problems continue, see your doctor and bring your sleep diary. There may be an underlying cause that you will want to be properly diagnosed. Your doctor will help treat the problem or may refer you to see a sleep specialist.

Dr. Chang and Dr. Chen practice at The Polyclinic Sleep Medicine Center. They work closely with each patient to evaluate lifestyle and sleep patterns with the goal of developing an effective and thorough treatment plan. Dr. Chang was recently featured on the radio show Patient Power. To listen: “Sleep Disorders: Obstructive Sleep Apnea and Snoring.”

Posted in Insomnia, Sleep Disorders, Sleep Medicine. Tags: , , . Leave a Comment »

12-Point Check Could Save Your Young Athlete’s Life

March 9, 2012 — WSMA Doc Talk
Jack Salerno, MD

Jack Salerno, MD

By Jack Salerno, MD, FACC, FHRS
Director, Electrophysiology and Pacing Services
Associate Professor, Pediatrics, University of Washington School of Medicine
Seattle Children’s Hospital
Medical Advisory Board, Nick of Time Foundation
WSMA Member

In 2004, a young, strong, high school football player—with his entire life ahead of him—died from Sudden Cardiac Arrest (SCA). His name was Nick Varrenti. It’s every parent’s worst nightmare. One minute your seemingly healthy child is on top of the world competing in a sport they love. The next minute their heart suddenly stops. We’ve all heard stories in the news—the sudden death of young, competitive athletes due to cardiovascular disease which is often undetected. So how can we effectively screen young athletes for cardiovascular abnormalities and try to prevent these sudden deaths?

First, it’s important for student athletes and parents to work hand-in-hand with physicians to detect potential “red-flags” prior to competing in sports. The American Heart Association recommends a 12-Element Pre-Participation Cardiovascular Screening of Competitive Athletes that includes three sections of screening—Personal Medical History, Family History, and Physical Examination. A positive response to one or more of the 12 items may be a sufficient trigger for further testing.

Personal Medical History – Five checks important to find out if there have been any symptoms including exertional chest pain/discomfort, unexplained fainting, excessive fatigue associated with exercise, prior heart murmur, or elevated blood pressure.

Family History – Three very important questions including family history of sudden death before 50 years of age, since heart disease can run in families. Parents should verify responses with the student athletes.

Physical Examination – Four checks performed by a qualified medical professional.

There has been much debate in the medical community about pre-participation screening for athletes and how extensive they should be. Some have called for the use of an electrocardiogram (ECG), which records the electrical signals in the heart, as a screening tool. However, with more than five million kids participating in high school sports each year (and countless more at other levels), performing extensive cardiac testing of all athletes would be impractical and expensive and unless modern criteria are used they may lead to “false positives” which may require additional evaluation. The recommended practice in Washington state is that all athletes complete the Preparticipation Physical Evaluation, edition 4 [PDF] to better identify “at risk” kids. (Organizations that sanctioned the PPE4 are on the bottom of the form.)

Nick Varrenti’s family has turned their grief into action by launching the Nick of Time Foundation and shining a light on this important issue so other families won’t experience their same heartache.  Tell us what you think about pre-participation screening in the comments section below.

Additional comments:

There currently is no uniform body of law in the United States that clearly defines the legal duties of sports governing bodies and educational institutions with regard to the mass preparticipation screening of competitive athletes. In the state of Washington, the Washington Interscholastic Activities Association (WIAA) has taken the lead role and maintains the recommended sports clearance form on their website.

Posted in Cardiovascular Disease, Parenting, Physical Exam, Preventative Medicine, Sports Medicine. Tags: , , , , . Leave a Comment »

Key Medical Appointments to Schedule to Kick Off Your Good Health in 2012

January 10, 2012 — WSMA Doc Talk
Roy Gondo, MD

Roy Gondo, MD

by Roy E. Gondo, MD
Family Physician and Medical Director, Gondo Laser & Aesthetic Medicine Institute
Secretary-Treasurer, Yakima County Medical Society
Trustee, Washington State Medical Association (WSMA)

Whether you like to schedule all of your health appointments for the same week or you would rather spread them out, January is a great time to plan ahead. Make sure you get those important check-ups/tests and preventative health counseling for you and your family so they don’t fall through the cracks.

While it may be tempting to try the latest health care “fad” you read about in a magazine, or a new supplement your friend recommended, it’s important to remember that physicians—with their extensive training—are uniquely qualified to provide personalized medical and preventative care for you and your family. Patients should establish a “medical home” to develop a strong relationship with a physician they trust and who knows their medical history. Health exams should be tailored to the age, health risks, and preferences of each patient, and it’s easier to do that if you have a medical home.

To establish a medical home and find a family physician near you, check out the WSMA Physician Locator.

Check with your physician on what appointments or screenings they recommend for you and your family members. Here are some suggestions:

Children – Schedule a child wellness exam. This is more than a “sports participation” exam. Your child’s growth and development will be discussed along with screenings for issues such as learning disorders, social relations, and academic achievements. Some counseling may be provided at these wellness visits.

Adults – Men and women should schedule appointments with their physicians to discuss recommended immunizations, along with various screenings reflecting their unique medical history, social history and family history. Since no two people are identical, a personalized wellness visit is most helpful.

Seniors – For seniors in the first year of Medicare coverage, schedule a “Welcome to Medicare Physical Examination” to obtain a comprehensive evaluation. After the first year of Medicare coverage, I recommend a “Medicare Wellness Visit” to review your medical history, family history, social history, allergies and other pertinent information. In addition, your physician will discuss various screening tests (depression, alcohol use, cholesterol, memory, hypertension, vision, hearing, immunizations, colon cancer, PAP smear, mammography, advanced directives, carotid stenosis, etc). This overall review will give your physician a holistic evaluation to work with you on the best plan for your health moving forward. Both of these visits are covered benefits without need for co-pay or deductible.

We’d love to hear from you on how you plan to improve your health in 2012. Please leave a comment below.

Dr. Gondo has been a prominent family physician in Yakima for nearly 15 years, treating patients of all ages. He is committed to improving the health of people in the communities he serves. He is also actively involved in the Yakima County Medical Society and the Washington State Medical Association. In addition to family practice, Dr. Gondo is Medical Director of the Gondo Laser & Aesthetic Medicine Institute, and is involved in youth activities.

For additional information on health and wellness, check out the following websites.

http://www.medicare.gov/welcometomedicare/visit.html

http://www.medicare.gov/navigation/manage-your-health/preventive-services/medicare-physical-exam.aspx

http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

 

Posted in Immunization, Medical Home, Medicare, Parenting, Preventative Medicine, Wellness Exam, Women's Health. Tags: , , , , , . Leave a Comment »

6 Simple Steps to Keep Your Holiday Merry

December 15, 2011 — WSMA Doc Talk

Nathan Schlicher, MD

by Nathan Schlicher, MD, JD
Emergency Physician and Associate Medical Director, St. Joseph Medical Center
Health Care Attorney
Member, Washington State Medical Association (WSMA)

Don’t Drink and Drive

Just last week people in western Washington heard the tragic news that a bicyclist riding home from work was struck and killed by a drunk driver. And just this summer a suspected drunk driver slammed into another car, killing a three-month old boy.

I have witnessed firsthand the devastation and destruction caused by drinking and driving. I will never forget a woman in her twenties who was about 16 weeks pregnant showed up in the emergency room with severe injuries caused by a drunk driver. Despite our best efforts the woman and her unborn child died in the emergency room.

Each year more than 10,000 people will die in drunk driving accidents—one every 50 minutes. Mothers Against Drunk Driving (MADD) conducted a survey that ranked Washington among the worst states—# 48—for percentage of traffic deaths that are DUI-related. The study showed that 42% of traffic deaths in Washington state are DUI-related. That’s shameful. And it’s all preventable.

The holidays are a time when family and friends gather—often with refreshments—and share the joy of the season. Here are a few simple things you can do to make sure your holiday celebrations are heartwarming and not heartbreaking.

  1. ALWAYS have a designated driver. If you have many events with family and friends, perhaps you can rotate. But decide in advance who will be the driver.
  2. Always wear a seat belt and make sure any children in the car are in child safety seats. This can reduce injuries by as much as 70%.
  3. Never ride in a car operated by someone who has been drinking. Call a cab or ask a friend (who has not been drinking) for a ride home.
  4. Monitor traffic around you and decrease your own distractions. Avoid talking on your cell phone, texting, and even consider not having music playing if there is a concern for distractions.
  5. Keep a safe distance from anyone driving erratically.
  6. Report drunk drivers to law enforcement.

Dr. Schlicher is associate medical director and emergency physician at St. Joseph Medical Center in Tacoma. In addition, he is legislative affairs chairman and member of the board of directors for the Washington Chapter of the American College of Emergency Physicians. He is a tireless advocate for patient safety issues in Washington and nationally.

Posted in Alcohol, Holiday Season. Tags: , . Leave a Comment »
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