Morning Rounds

Fireworks Dangers

drscottrobertson — Mon, 30 Jun 2008 23:30:00 GMT

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Let’s first take a look at some statistics from the U.S. Fire Association. As you might expect … fires caused by fireworks peak in the first week of July and are almost unheard of the remainder of the year.

These fires cause millions of dollars in property damage … destroy thousands of acres of forests and kill an average of fifteen people every year. Remember … this is just the damage from fires started by fireworks … not the injuries or effects caused directly by fireworks.

The statistics from direct fireworks injuries are even more staggering. Seventy five percent of all fireworks-related injuries occur within thirty days of the Forth of July. Almost ten percent of those injured will be need to be hospitalized. Men are much more likely to be injured than women … and boys from the age of ten to fourteen are the most likely to be injured. The most common areas of in jury are the hands … face … and eyes.

If you do suffer an injury with fireworks … it will more than likely involved a burn. There are many myths about how to treat burns … but first you need to know how to tell the difference between the types of burns.

This diagram shows these differences which are based on the depth of the burn. A first degree burn only affects the top layers of skin. This type of burn … which is commonly caused by the sun … can be fairly painful … but rarely is there any scarring. Next … are second degree burns which penetrate deeper into the skin and are characterized by blistering. These burns are extremely painful and if you are not careful … can become infected. And lastly … there are third degree burns. As you can see … this type of burn has complete destruction of the skin and requires surgery such as skin grafting in order to heal properly.

Because of these dangers to you and your family … the safest way to enjoy fireworks is through a public display by hired professionals.

Miscarriage

drscottrobertson — Mon, 10 Mar 2008 00:55:00 GMT

Despite how common a miscarriage can be … experiencing one for yourself can be a time filled with sadness and guilt. While the majority of miscarriages are either unexplained or caused by chromosomal abnormalities and therefore are not preventable … women and their families want to know what they can do to lessen their risk of miscarriage.

There are several risk factors associated with miscarriage that have scientifically studied. Women over thirty five begin to see significant increases of miscarriage and birth defects when they become pregnant. While tobacco use has known associations with low birth weight in babies … women who smoke more than ten cigarettes per day triple their risk of losing their baby during pregnancy. Cocaine use and moderate to high levels of alcohol consumptions can also lead to higher rates of miscarriage and the American Academy of Pediatrics currently recommends that expectant mothers stay away from any alcohol consumption during their pregnancy. One substance that has been a bit of a mystery is caffeine.

Since caffeine is present in so many safe consumer products ... many pregnant women don’t think twice about having a soda or a cup of coffee. However … even before this weeks new study on caffeine in pregnancy … there have been researchers concerned about its effects and studies that have shown drinking four or more cups or coffee per day can increase the risk of miscarriage.

Looking closely at the study published on Monday … researchers concluded that consuming at little as two hundred milligrams or ten ounces per day of coffee can increase miscarriage risk. There are … however … critics of this study who point to the imperfections of the study design and are hesitant to fully embrace its recommendations. Also … the American College of Obstetrics and Gynecology as well as the American Society for Reproductive Medicine has not taken official positions on caffeine during pregnancy.

For women who are pregnant or trying to get pregnant … the best advice is to eat a well-balanced diet … take prenatal vitamins with folic acid … and try to limit consumption of any other chemicals that may affect your pregnancy … including caffeine.

Is Your Child Really Sick?

drscottrobertson — Mon, 10 Mar 2008 00:53:00 GMT

So your children are complaining they are sick and don’t want to go to school. Well … we know your children would never exaggerate their symptoms just to stay home … but thanks to a recent article in WebMD and my own experiences … I have a few tips to tell if your child is faking it.

The first step is to take their temperature. Every house should have a good quality digital thermometer.

If you are using one of those ear thermometers … go buy something else. For children … its perfectly acceptable to use a digital thermometer under the arm or in the mouth … and many hospitals are now using infrared thermometers which have been shown to be fast and accurate. Most of know a normal temperature is about ninety 98.6 degrees … but you can have normal temperatures up to 100.4 degrees. And don’t forget ... if you are using Tylenol or ibuprofen … its possible to mask a fever … so you may yneed to investigate further.

Next … be sure to look for some of the classic signs of faking illness and knowing how you how your child behaves when truly ill is very important.

If your teenager is coughing their head off and then talking on the phone to their friends … be suspicious. Also … many kids will be very tired when truly sick. So … if your child falls asleep while watching TV or takes a nap when they usually don’t … its likely they are telling you the truth about how they feel.

Next … if your child doesn’t want to go to school and it seems to be habit … be sure there isn’t another issue they are not telling you about.

Many kids who don’t want to go to school … have a specific reason. Some may be getting bullied … other may have anxiety about taking tests. These problems can have symptoms like abdominal pain and headaches and it may be important to speak with their teachers to get to the bottom of the problem.

And lastly … be sure you are not part of the problem.

All parents want their children to be successful … but sometimes high expectations can translate to high anxiety levels for their kids. As we see with adults … psychological stressors can cause physical symptoms and sometimes we need to take a step back and decide if everyone’s priorities are in order.

Athlete's Foot

drscottrobertson — Thu, 17 Jan 2008 03:52:00 GMT

What is the best over the counter treatment of athletes foot?

-Tom, Santa Maria

Tom … that is a very common question and I recommend trying Lamisil AT first. You may need to apply twice a day for 2 or 3 weeks. Its also important to remember to clear your shoes with an aerosol anti-fungal like Tinactin and be sure to clean your shower a couple of times per week with diluted chlorine bleach.

Cell Phone Safety and Children

drscottrobertson — Thu, 17 Jan 2008 03:50:00 GMT

Is it safe to give children cell phones? I have seen parents giving toddlers old cell phones to play with and it seems dangerous.

-Dale, Lompoc

Dale … that is a great question and it is important for parents to understand their old cell phone is not an appropriate toy for their young child. Several European nations have stated that children’s exposure to cell phones should be limited due to the possible dangers of electro-magnetic radiation. In addition … cell phones and their batteries are made of various materials that are not likely to be child-friendly. Most importantly though … the buttons could come off and become lodged in a small child’s throat. If you have small child ... don’t let them play with your cell phone … there are just too many dangers.

Osteoporosis in Men

drscottrobertson — Thu, 17 Jan 2008 03:48:00 GMT

My husband is 66 years old and his due for his physical. At what age should he have a bone density test?

-Carole, Arroyo Grande

A common misconception about osteoporosis is that it is a disease that only affects women. However … there are 2 million men in the United States that have the disease and another 3 million are at high risk of developing osteoporosis. Currently … the U.S. Preventative Services Task Force does not recommend routine bone density testing in men unless they are at high risk. These risk factors include … tobacco use … long-term steroid use … endocrine disorders … cancers … and unexplained bone fractures.

New Year's Health Resolutions for 2008

drscottrobertson — Tue, 01 Jan 2008 21:33:00 GMT

Let’s take a look five things you can do to make 2008 a healthy year.

Number five … wear your seat belt. Accidental injury is the most common cause of death for those under fifty ... and most of those accidents involve motor vehicles. Fortunately … buckling the seat belt comes as second nature to many of us … but all it takes is forgetting just once and you can put yourself in serious danger. Also … make sure your children are in the appropriate type of car seat for their age and weight. Most fire and police departments locally will check your child’s car seat if you just take the time to ask.

Number four … check you cholesterol. Heart attacks and stroke are by far and away the most common cause of death for all of us … so you need to know where your cholesterol levels stand. You also need to sit down with a health care professional who can explain where your good and bad cholesterol numbers need to be and if you need medication or just some good old-fashioned diet and exercise.

Which takes us to number three … be active. The biggest misconception about exercise is that you need to be training for a triathlon in order to stay fit. Many of the health benefits of activity are accomplished by simple exercise such as brisk walking or using a stationary bike. The American Heart Association recommends that we all get thirty minutes of simple … but vigorous exercise at least three times per week.

Number two on the list is … get the appropriate cancer screening tests done. For men ... that means checking the prostate and women need to be screened for *** and cervical cancer. Men and women both … should be screened at regular intervals for colon and skin cancer … although not necessarily at the same time. Remember to discuss with your health care provider exactly when and how frequent your cancer screening should take place.

Lastly … and by all accounts … the single most important thing you can do for your health … stop using tobacco products. Through its relationship with cardiovascular disease and lung cancer … cigarette smoking is the number one preventable cause of death. Unfortunately … quitting is not easy … and many smokers will fail up to ten times before they are successful. So … don’t give up and don’t forget to ask your doctor about medications that may be helpful in quitting cigarettes for good.

Alternative Sweeteners

drscottrobertson — Sun, 09 Dec 2007 00:19:00 GMT

If you are anything like me … then you probably consume your fair share of artificial sweeteners. However … for as long as I can remember … there have those who are skeptical about their safety. This issue has even been addressed in a recent book by a U-S-C professor who states that many fears about synthetic sugars are cultural in nature and not necessarily based on scientific fact. Let’s take a closer look at some of these controversial ingredients.

Saccharin … which is the active ingredient in Sweet-n-Low has actually been around for over one hundred years and it’s popularity blossomed in the nineteen fifties. Then in nineteen seventy five … a Canadian study infamously linked saccharin to bladder cancer in rats that consumed the equivalent of eight hundred cans of diet soda per day. However … in two thousand … the data was found to be faulty and the F-D-A removed cancer warning from products containing saccharin.

Equal … also known as Nutra-Sweet … and its active ingredient aspartame have also had their share of controversy with two studies linking the sweetener to brain cancer. However … another analysis in two thousand six which followed nearly a half million people found no evidence of canacer risk for the popular ingredient in diet Coke and diet Pepsi. The F-D-A has established a maximum daily dose of aspartame that equals about twenty cans of diet soda or 100 packets of Equal.

Another popular sweetener … Splenda … which is also known as sucralose has gained a significant amount of popularity since it was first introduced in nineteen ninety eight. The biggest advantage of Splenda is it can be used in baked goods without losing its sweetness. While Splenda it not linked to cancer … it did come under fire for what some claim as false marketing about its chemical structure.

Personally … I think all of the artificial sweeteners taste pretty good and like most things in life … if you consume them in moderation … there is little evidence of any negative effect on your health.

Fluorescent Light Bulbs and Mercury

drscottrobertson — Mon, 26 Nov 2007 02:35:00 GMT

"I have heard fluorescent lights contain a dangerous amount of mercury which can be toxic if the bulbs are broken. Is there any truth to this?"

-Ann, Nipomo

Ann ... fluorescent lights do contain about five milligrams of mercury per bulb. In comparison … a household mercury thermometer contains about five hundred milligrams … so you can see the amount in light bulbs is small. However … there are many websites stating broken fluorescent lights are indeed very dangerous. However .. the Environmental Protection Agency does not deem a broken bulb as an environmental or medical hazard … but they do have some suggestions on how to clean up a mess if a bulb breaks.

First … open up a window stay out of the area for at least fifteen minutes to prevent inhaling any dust. Using latex gloves … try to pick up as much debris as possible and wipe any surfaces clean with a moist paper towel. You can also use duct tape to pick up any fine pieces or powder. After vacuuming the area … be sure to seal up the vacuum bag before throwing it away.

Circumcision

drscottrobertson — Mon, 26 Nov 2007 02:32:00 GMT

"I am interested in your thoughts on male circumcision. We are expecting our first son and I hear the procedure is no longer routine."

-Miguel, Santa Maria

You are exactly right … circumcision is no longer routine in the United States …although about sixty percent of male babies undergo the procedure. According to the American Academy of Pediatrics … there are benefits and risks to circumcision. Benefits include men being less likely to develop penile cancer and urinary tract infections … and recent research provides some definitive evidence that circumcision prevents the transmission of HIV. The risks are obvious and can include pain … scarring and infection at the wound site. In addition … there can be social stigma associated with circumcision in certain cultures. Ultimately … it is up to the parents to decide whether to have their son circumcised as an infant.

Thyroid Disorders

drscottrobertson — Tue, 23 Oct 2007 01:50:00 GMT

Most people have heard of the thyroid gland. It sits in the lower part of your neck secreting the powerful hormone thyroxine into your bloodstream. But what does thyroxine do … and more importantly … what happens when the thyroid stops working properly?

The thyroid is one of the most important and biggest glands in the body. Its primary hormone … thyroxine … also known as T4 … has many important functions in the body. These include the regulation of our metabolism … the synthesis of proteins … and how our body responds to other hormones. As with many other parts of our endocrine system … the thyroid is controlled by the small … but powerful … pituitary gland located near our brain.

When it comes to thyroid problems … most can be classified into one of two categories … those that make to much or too little thyroxine. As you might expect … when the amount of hormone is unbalanced … we can start developing symptoms. Some types of thyroid disorders … like Graves’ Disease … cause excessive production of thyroxine … or hyperthyroidism.

Hyperthyroidism can cause many different symptoms … including … weight loss … rapid or irregular heart rate … diarrhea … tremor … swollen neck or goiter … and irregular menstrual periods.

On the flip side … having not enough thyroxine … or hypothyroidism … can cause an entirely different set of symptoms. These include … fatigue … a slow heart rate … depression … numbness or tingling in the hands or feet … constipation … and weight gain.

As you can tell … many of these symptoms are common and could be caused by many other conditions or they just could be a normal part of getting older … but fortunately … thyroid disorders can be diagnosed with simple blood tests. If there are symptoms you feel are abnormal for you … make sure you let your health care provider know and they can order a thyroid stimulating hormone or TSH test … which is a fast and simple way to tell if your thyroid is working properly.

Glycemic Index

drscottrobertson — Tue, 16 Oct 2007 01:22:00 GMT

Unfortunately … losing weight is not easy. Being overweight puts us at risk of heart disease … stroke … diabetes … and many other dangerous conditions. For most people who fail at losing weight … their diet is the culprit. As we have said before … you need to focus on calories to lose weight … but also knowing the composition of your food may be helpful at shedding a few pounds. This is especially true if you have diabetes … in which blood sugars can fluctuate wildly depending on your diet.

Many of us have heard of good and bad carbohydrates … but aren’t exactly sure what this means. Bad carbohydrates have what is called a “high glycemic index”. Some examples of these naughty foods are breads … pasta … rice … cereals … and most baked goods.

People who have diets high in these types of food have been shown to have higher percentages of body fat … higher body mass index … and higher rates of heart disease and diabetes.

On the other hand … there are foods with lower glycemic indices. Some examples of these foods include fruits ... vegetables … whole grains … and legumes like peanuts and soybeans.

There are many great resources on the Internet or your local bookstore that can tell you a particular foods glycemic index. Registered dieticians are also another excellent source for information of food composition. As a rule of thumb … a glycemic index less than 55 is good and higher than 70 is bad.

As you might expect … there are some scientists that believe when you eat a meal that also contains other types of food … such as proteins and fats … it really doesn’t matter which type of carbohydrates you have … they all seem to raise blood sugar equally fast.

This takes us back to calories … and the simple rule that if you burn more calories than you eat … you lose weight. It is indeed simple … but not always as easy to put into practice.

Stress Management

drscottrobertson — Tue, 09 Oct 2007 02:48:00 GMT

When you are stressed … your body undergoes a series of changes … most of which are associated with the release of certain hormones. These chemicals … like epinephrine and cortisol … can dilate your pupils … increase your heart rate and blood pressure … and even improve your strength and endurance. Unfortunately … too much of a good thing is usually a bad thing … and when we experience too much stress every day … it can cause health problems.

Some of the symptoms and diseases that are associated with stress are … muscle aches … insomnia … headaches … high blood pressure … heart disease … immune system problems … and depression.

So … a question I often get is “How do I manage the stress in my life?” Well … first you have to figure out the source of the stress. Some sources are obvious such as … a death in the family … a new baby … or a serious illness. You may think that your job is stressful … but it could be the demands of family or friends that are impacting your work. Keeping an inventory or a stress journal may provide clues to the subtle causes of stress. Once you find the cause … what’s next? Well … there are many techniques for stress reduction.

First and foremost … is time management. Making a schedule and prioritizing your assignments can go a long way at reducing stress. Try to improve your coping skills and not take out frustrations on others. Next … get plenty of rest. As Randall can tell you … staying up too late can make for a very stressful morning. Other stress reducers are … exercise … finding a hobby or even volunteer work. And lastly … many people can reduce their stress by learning to say no.

So … if you are feeling stressed … don’t forget to follow some of these simple steps … your family and friends will be thankful and your health may depend on it.

Special thanks to WebMD as a source for this topic

Patient-Requested Blood Tests

drscottrobertson — Mon, 08 Oct 2007 02:43:00 GMT

"Why can’t I get a blood test without a physician’s order first?" - Nancy, Los Osos

If you call around … I’m sure there are several labs that will do blood tests without an order from your doctor but … be prepared to pay for it. Your insurance plan will definitely not cover medical tests without a healthcare provider's order. Also … if you don’t get the right tests … you may find yourself back at the lab … which means another stick of the needle.

Benefits of Niacin

drscottrobertson — Mon, 08 Oct 2007 02:39:00 GMT

"I have a cholesterol problem but have stop taking my Lipitor. I’ve read that niacin can help lower cholesterol … but I don’t know how much to take … the daily requirement is 20 milligrams." -Wayne, Arroyo Grande

That is a great question and there is a lot of good research on the cholesterol-lower effects of niacin. In fact … Niaspan is an FDA approved niacin that has shown to lower bad cholesterol and raise good cholesterol. You can try the OTC niacin … but you will need to take 500 to 1000mg twice a day for it to be effective. I must warn you though … most patients will experience significant flushing at that dose … so if you don’t tolerate it … be sure to follow up with your doctor.