three dot medicine

Saturday, June 24, 2017

Time for three dot medical journalism, with a nod of respect to Herb Caen.

Fractures...Just because you can move it, doesn’t mean that it isn’t broken. All it means is that the muscles and tendons surrounding an injured bone still work…If you thought that a normal x-ray means that the bone is okay, think again. In some circumstances, regular x-rays miss significant breaks and CT or MRI are needed if the clinical suspicion of a fracture is high…And by the way, fractured, broken and cracked all mean the same thing.

Strep…People equate a sore throat and strep infection…Most sore throats are caused by a virus and do not need antibiotics…When an antibiotic is prescribed for strep, it is not to make the throat feel better faster…Once upon a time, untreated strep throat could lead to rheumatic fever and then rheumatic heart disease, an inflammation of the heart valves…Now, rheumatic fever is so rare in the US that the Centers for Disease Control and Prevention don’t require it to be reported…There is an exception for children of Samoan or Fijian descent who live in Hawaii have an increased predisposition to post strep heart disease.

Narcotics...The downside to the national opioid prescription crisis…If you wonder why it might be taking longer to get your narcotic pain prescription written… many states now require providers to log onto controlled substance registries to check how often and how many prescriptions have been filled in the recent past…The goal is to limit the abuse of narcotics and sedatives but it also makes patients wait…Some of the websites can be more than a little slow.

Drug interactions...Summer is the time to travel and included in the packing list should be an update list of medications including names and dosage…Having just returned from giving a talk in Pinehurst NC, a mecca for golf vacationers, I had an earful from local docs whose ability to care for patients is hamstrung by a lack of information…Many medications, including antibiotics can interact with each other causing problems… Remember that herbal and over the counter medications count.

Wound infections...Summer is also the time to hang out on the water…Cuts and scrapes will happen but it’s important to avoid the reflex of washing them in the natural water…What was a simple laceration that could be sutured can be turned into a complicated mess if the wound was dunked into a river…Each region of the country has its own bad bacteria and the “do no harm” caveat holds especially true when it comes to sewing up wounds.

Watching…And for those who wonder why medical care takes so long to happen…A reminder that on television, most medical dramas have 40-45 minutes of action, 15 minutes of more of commercials and a minute tease for the next episode…in the real world, going straight to a high tech test or treatment may not be appropriate…Sometimes, time is an important part of the diagnosis and observation may be the way to go…Watching  what happens to a patient over time may not make great television but it may make great medicine.



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