Category Archives: In the News

AFP Pearls

I read the American Family Physician journal, sent to all members of the American Academy of Family Physicians and anyone else who subscribes, and sometimes an issue comes out with a few pearls that I want to pass on. The Oct 15, 2016 edition was one of them and here are a few of the tidbits of wisdom I’m sharing from this issue today:

     –TRAVELERS DIARRHEA UPDATE:  Traveler’s diarrhea is the most common infection in international travelers.  It can occur in 30-70% of travelers in some areas.  Despite the universal advice to avoid food from street vendors, don’t drink tap water, avoid raw foods and ice there is evidence that these precautions have not been shown to reduce the incidence of travelers diarrhea.  Although a short course of ciprofloxacin has been the usual recommendation (500 mg initial dose followed by 500 mg 12 hours later) there are reasons that this may no longer be optimal.  First resistance to this class of antibiotics is high in some areas, especially in Campylobacter infections in SE Asia.  Second is the FDA warning to limit fluoroquinolone use due to side effects risk. Azithromycin is also effective at a dose of 500 mg daily for 1-3 days, or as a single 1000 mg dose. It may now be the best recommendation worldwide. 

     -TWO GOOD PLACES TO FIND MALARIA PROPHYLAXIS INDORMATION:  Advice for Malaria prophylaxis is available on the CDC site or from the WHO Malaria information web page.

     -SPECIFIC GENERIC INEXPENSIVE BIRTH CONTROL PILLS ARE SAFER THAN SOME NEW EXPENSIVE BRAND NAME OPTIONS:   In a huge French study of the use of ischemic stroke, heart attack and pulmonary embolism with birth control pill use came good news.  First as has been previously shown the risks are very low, roughly 6 per 10,000 women.  Not just that but the risks are lowest with the lowest dose estrogen pills, i.e. 20 mcg.  Not only that but the specific progestin used makes a difference, and the older, generally less expensive oral contraceptive ingredient levonorgestrel is associated with the lowest risk.  Newer progestins used in the considerably more expensive branded birth control pills specifically desogestrel (in Desogen and Mircette) and gestodene (in Gynera, Femogen, and others).  The lowest risk was in  pills using 20 mcg estrogen and levonorgestrel.   Examples are Alesse, Aviane, Lessina, Levlite, and Lutera all of which have 20 mcg. of ethinyl estradiol and 0.1 mg of levonorgestrel.  Although some women may have breakthrough bleeding on these fixed dose birth control pills, they seem like the optimal first choice option for many women who choose a daily use pill for contraception.  (A caveat to this report is that some types of birth control pills were not looked at because they were not used in the French national health formulary.)

It takes more than Ankylosing Spondylitis to Keep Guti Down

One of the very few good things about my beloved Seattle Mariners this year, besides Nelson Cruz crushing the ball, has been the call up of Franklin Gutierrez. Guti has been one of my favorite M’s over the years, and to see him struggle with his health concerns since 2011 has been really sad and… Continue Reading

SGR is History- Finally!

I started to write a post about the house and the senate finally coming up with a way to get rid of the regularly occurring threat to implement major Medicare payment decreases mandated by the SGR.  Last night, appropriately at nearly the last minute the Senate passed the house bill to repeal the SGR and… Continue Reading

Bill Maher’s Illogical Thoughts on Vaccinations

I’m visiting my mother-in-law and so Friday night we watched Real Time with Bill Maher and I enjoyed watching satire of the news from the left side.  I recently visited my Dad and endured Fox Network’s Justice w/Judge Jeanine so Maher seemed like a Rhode’s Scholar in comparison to Ms. Pirro.  Much of what Mr. Maher… Continue Reading

The Theory of Everything Except a Theory of How Mr. Hawkins Survives

For our date night yesterday Kay and I went to the new movie The Theory of Everything, a docudrama about the life of Stephen Hawkins.  The movie was really quite good, a fine tale of a brilliant physicist who despite being diagnosed with what in the movie is described as “motor-neuron disease” as well as “Lou… Continue Reading

Pneumonia Vaccination Is More Complex but Better Than Ever

In my 30+ years as a family physician I’ve seen first hand the effects of a relatively new type of vaccines called conjugate polysaccharide vaccinations. In the 1980’s nearly every year I had one or more young children in the hospital with meningitis due to either Hemophyllus influenza B or Streptococcus pneumoniae.  Now there are… Continue Reading

Ebola Primer

Ebola virus has been front-page news recently and the arrival of Dr. Kent Brantley at Emory University Hospital in Atlanta was the first Ebola infected patient to be transported to the U.S. for care.  This required a specially equipped air evacuation plane for transport from Liberia to Atlanta and for Emory University Hospital to work… Continue Reading

Chikungunya Virus: The Latest Exotic Illness in the U.S.

Another disease previously not documented to have been acquired in the  continental US surfaced this month. A case of Chikungunya virus infection was diagnosed in a man in Florida on about July 15th, and in a Florida woman shortly thereafter.. I have to admit that this caught my eye primarily because of the unusual name… Continue Reading