The Daily Apple™© Volume 2, Number 10
October 3, 2013
The questions below were posed last month in association with a Lecture on Pulmonary Edema given by me to the residents, fellows and medical students on the Critical Care Service at Geisinger Medical Center. If you would like to see the lecture, email me.
Oh, yes, by the way, I am required by Geisinger to tell you that the opinions expressed are strictly mine and based on the latest
evidence ... in every sense of the term. None of this is the opinion
of, supplied by or belongs to Geisinger in any way. Yes, I do share the information with Geisinger as a part of my Clnical, Administrative, Teaching and Research obligation. In other words, I work for Geisinger.
And ... Please Join us @ Veritas Health Care www.VeritasHC.org to Help Build Better Health Care
Introduction to Pulmonary Edema
Pulmonary Edema is, fundamentally, excess water in the lungs and this extra water interferes with normal lung function. There are three fundamental pathophysiologic mechanisms that underlie pulmonary edema and they help us to group the pathology we find in clinical cases. Pulmonary edema may be found in patients with normal pulmonary vascular pressures (NPPE or Normal Pressure Pulmonary Edema), high pulmonary vascular pressure (HPPE or High Pressure Pulmonary Edema), or a combination of the two (MPE or Mixed Pulmonary Edema). These mechanisms help us distinguish and define the causes and proper treatment options. All treatments are therapeutic trials and patients must be monitored closely to verify effectiveness, or change treatment, if ineffective. Always go back to the patient (not the record) to verify effectiveness.
Questions Posed
Pulmonary Edema: Back to Basics QUESTIONS for interactive discussion and debate
September 2013 Geisinger Talk by Michael F. Mascia, MD, MPH
masciam@aol.com and Dr.Mike@ihealsolutions.com
©IHS Michael F. Mascia, MD, MPH Pulmonary Edema v972013
1. What is Pulmonary Edema?
2. What is Edema (oedema): Transudate vs Exudate?
3. What are the Symptoms of Pulmonary Edema?
4. What are the Clinical Signs of Pulmonary Edema?
5. What are the Causes of Pulmonary Edema?
6. What is Noncardiogenic pulmonary edema?
7. What is Cardiogenic Pulmonary Edema?
8. What is the pathophysiology leading to pulmonary edema: Cardiogenic vs Noncardiogenic vs Mixed?
9. How can you confirm your clinical diagnosis?
10. What is the treatment of Pulmonary Edema?
11. Is it cost effective?
12. What is the expected outcome after treatment for pulmonary edema?
13. What is the evidence to support your answers?
14. What is optimal cost effective care in Pulmonary Edema?
Have a great day and StepWisely®™© with us @ihealsolutions, Infinity Health Solutions and Veritas Health Care
Ciao for now,
Dr. Mike
Michael F. Mascia, MD, MPH
Thursday, October 3, 2013
Thursday, August 29, 2013
One More Thing on EMR Flaws, Dangers: Why Patients First?
The Daily Apple™© Volume 2, Number 9
August 29, 2013
Technology Failed Again. That reminds me to remind you about the need for redundancy, when it comes to HIT stuff.
When thinking about EMR<>EHR<>HIT stuff and designing better HIT systems ... remember this.
Wall street went down on (Thursday, August 22, 2013)
http://dealbook.nytimes.com/
but, nothing happened. A few guys made less money? There was a delay in trading ... so what? Who cares? If I were one of those trader guys, I would have hiked out of the office, grabbed a cup of coffee, walked down to the river, felt the sunshine and watched the water run by. "Call me when things are back up and running." But, in my business, I can't do that.
There are few things in life during which time is critical. In fact, time is usually irrelevant. But, in the spectrum of life, health, healthcare and death, the natural history of injuries and diseases dictate some of the critical moments in life. So, chill when you can ... drink the coffee and smell the roses. And, recognize those things that require immediate attention ... true emergencies.
In other words, there are certain illnesses and injuries during which minutes ... even seconds of delay in proper diagnosis and definitive treatment may result in permanent cell damage, organ damage, loss of limb, or loss of life. The diagnosis and treatment of these conditions is CRITICAL CARE ... That's my day job. In this business, there is no excuse or time for "systems down". In other words, we have to be ready to take care of these sorts of problems 24 x 7 with or without technology. That is the simple truth. Veritas!
During Katrina, ALL SYSTEMS WERE DOWN within a few hours and they stayed down for days to weeks. In the immediate aftermath of Katrina, we had NO RECORDS on many patients, some of whom were critically ill. Direct care Patient<>Physician<>Provider prevented many disasters in our hands.
Intermittently, every electronic record and system I have used has failed.
Intermittently, every piece of technology I have ever used has failed.
Conclusion: There is no such thing as failsafe. But, we can build redundancy into EMR<>EHR<>HIT Systems that will generate smart cards and "hard copy" intermittently, at a frequency to be dictated by the "situation" the patient happens to be in at the moment. If "the patient" is in the hospital, or the Intensive Care Unit, hard copy of the EMR/flow sheet should be printed out at least every 8 - 12 hours. At the push of a button, the "system" should generate a smart card and paper summary for each patient. In critical situations, attach that summary and smart card with all essential data, at least a problem list, to name tag that hangs on the patient's neck. That way, the patients and the folks on the front lines with the patients who are responsible for their care will have a little something to help them get some background information. And, the folks who receive them will also have something to go on. Add this capacity to the design of any robust EMR<>EHR<>HIT System. Just my opinion.
And, HIT guys ... don't look at me as if I have two heads when I tell you these things. Fix it!
Dr. Mike
Michael F. Mascia, MD, MPH
August 29, 2013
Technology Failed Again. That reminds me to remind you about the need for redundancy, when it comes to HIT stuff.
When thinking about EMR<>EHR<>HIT stuff and designing better HIT systems ... remember this.
Wall street went down on (Thursday, August 22, 2013)
http://dealbook.nytimes.com/
but, nothing happened. A few guys made less money? There was a delay in trading ... so what? Who cares? If I were one of those trader guys, I would have hiked out of the office, grabbed a cup of coffee, walked down to the river, felt the sunshine and watched the water run by. "Call me when things are back up and running." But, in my business, I can't do that.
There are few things in life during which time is critical. In fact, time is usually irrelevant. But, in the spectrum of life, health, healthcare and death, the natural history of injuries and diseases dictate some of the critical moments in life. So, chill when you can ... drink the coffee and smell the roses. And, recognize those things that require immediate attention ... true emergencies.
In other words, there are certain illnesses and injuries during which minutes ... even seconds of delay in proper diagnosis and definitive treatment may result in permanent cell damage, organ damage, loss of limb, or loss of life. The diagnosis and treatment of these conditions is CRITICAL CARE ... That's my day job. In this business, there is no excuse or time for "systems down". In other words, we have to be ready to take care of these sorts of problems 24 x 7 with or without technology. That is the simple truth. Veritas!
During Katrina, ALL SYSTEMS WERE DOWN within a few hours and they stayed down for days to weeks. In the immediate aftermath of Katrina, we had NO RECORDS on many patients, some of whom were critically ill. Direct care Patient<>Physician<>Provider prevented many disasters in our hands.
Intermittently, every electronic record and system I have used has failed.
Intermittently, every piece of technology I have ever used has failed.
Conclusion: There is no such thing as failsafe. But, we can build redundancy into EMR<>EHR<>HIT Systems that will generate smart cards and "hard copy" intermittently, at a frequency to be dictated by the "situation" the patient happens to be in at the moment. If "the patient" is in the hospital, or the Intensive Care Unit, hard copy of the EMR/flow sheet should be printed out at least every 8 - 12 hours. At the push of a button, the "system" should generate a smart card and paper summary for each patient. In critical situations, attach that summary and smart card with all essential data, at least a problem list, to name tag that hangs on the patient's neck. That way, the patients and the folks on the front lines with the patients who are responsible for their care will have a little something to help them get some background information. And, the folks who receive them will also have something to go on. Add this capacity to the design of any robust EMR<>EHR<>HIT System. Just my opinion.
And, HIT guys ... don't look at me as if I have two heads when I tell you these things. Fix it!
Dr. Mike
Michael F. Mascia, MD, MPH
Friday, August 9, 2013
EMR Flaws and Dangers: Patients First, Not the Medical Record
The Daily Apple™© Volume 2, Number 8
August 9, 2013
PGY 41, Day 40
Electronic Medical Records: Flaws and Dangers
ALWAYS GO TO THE PATIENT FIRST
Here are ten reasons why you & every provider should ALWAYS go to the PATIENT FIRST and NEVER go to the record first, or copy and paste from the ELECTRONIC MEDICAL RECORD (EMR)
1. SICK PATIENTS CHANGE FAST: INTERVAL CHANGES IN HISTORY AND PHYSICAL EXAMINATION WILL BE MISSED
You may miss clinical changes that are important to early diagnosis and treatment
2. THE RECORD MAY NOT BE ACCURATE: THERE MAY BE ERRORS AND OMISSIONS
Previous examiners may have skipped parts of the history or physical examination
3. SOMETHING MIGHT HAVE BEEN MISSED IN THE LAST EVALUATION
The natural history of most diseases includes a preclinical, or undetectable phase, which may or may not be symptomatic. Frequent evaluation of the patient, including repeat history and physical examination is an essential part of early definitive diagnosis and treatment.
4. THE RECORD MAY BE INCOMPLETE
5. YOU MAY BE LOOKING AT THE WRONG RECORD
6. SOMEONE MAY HAVE MADE AN ERRONEOUS ENTRY INTO THE RECORD
7. DISEASES EMERGE OVER TIME: EARLY & DEFINITIVE DIAGNOSIS AND PRECISION TREATMENT MAKES A DIFFERENCE
This is intuitively obvious and proven empirically for several diseases. Follow the data and use your intuition for now. Target: Early Definitive Diagnosis and Precision Treatment
8. THE MORE PEOPLE WHO EVALUATE THE PATIENT (NOT THE RECORD) THE MORE ACCURATE WILL BE THE EVALUATION
Intuitively obvious. Do you need proof? Talk with me and we will do some research to prove it.
9. THE MORE OFTEN THE PATIENT IS EVALUATED, THE MORE ACCURATE WILL BE THE EVALUATION
As in number 8 above.
10. COPY AND PASTE IS CHEATING, PLAGIARISM & FRAUD
Yes, and it is a bad idea to cheat patients and cut corners on patient care. This is a problem that results in suboptimal outcome. Do you need proof for this?
SUMMARY AND CONCLUSION
Sick Patients, especially when critically ill, can change rapidly. The natural history of each disease, the way in which each disease presents in a particular patient (host), the preclinical phase and the clinical presentation can vary dramatically from one -DISEASE<>PATIENT (host)- to another. This is the reason for frequent and repetitive patient evaluations. In other words, frequent evaluation by multiple providers increases the accuracy and speed of diagnosis and proper treatment, and this is the right thing to do for all patients at all times. It is NEVER OK to cut corners on patient care.
Electronic Medical Records make it very easy to cut corners, to go to the record first, to copy and paste, to take the note that someone else wrote, to copy it and paste it in as if it were your note. In other words, if you don't write the note based upon your history and physical examination ... if your note is not based upon your evaluation of the patient, you are cheating the patient. Don't do it! ALWAYS go to the PATIENT FIRST. To copy in paste is plagiarism, fraud and cheating the patient out of best possible care.
At best, the Medical Record, Electronic or otherwise, is an imperfect reflection of the patient. In other words, even if it is a "perfect" record, or a "perfect" EMR, it is limited by our knowledge of the patient at one point in time. Over centuries, the medical profession has learned a few things that are easily undone by the EMR. You in the EMR business? HIT people? Do NOT ENABLE COPY AND PASTE for history and physical examinations and interval notes.
Each note, history and physical examination should stand alone at a point in the timeline of each patient's life. It is a reflection of each physician<>patient relationship at one point in time. Each is personal and unique ... not to be undone by technology or methodology. And, if done properly, Doctor, your notes will be accurate and lead to better and best outcomes in patient care.
Salute! Amore e buona fortuna. It is all about Love. There is not enough money in the world to make this right.
Join us. Help Build Better Health and Healthcare through Patient<>Physician Cooperation and Cooperatives @ www.ihealsolutions.com and our non profit @ www.VeritasHC.org
Dr. Mike
Michael F. Mascia, MD, MPH
August 9, 2013
PGY 41, Day 40
Electronic Medical Records: Flaws and Dangers
ALWAYS GO TO THE PATIENT FIRST
Here are ten reasons why you & every provider should ALWAYS go to the PATIENT FIRST and NEVER go to the record first, or copy and paste from the ELECTRONIC MEDICAL RECORD (EMR)
1. SICK PATIENTS CHANGE FAST: INTERVAL CHANGES IN HISTORY AND PHYSICAL EXAMINATION WILL BE MISSED
You may miss clinical changes that are important to early diagnosis and treatment
2. THE RECORD MAY NOT BE ACCURATE: THERE MAY BE ERRORS AND OMISSIONS
Previous examiners may have skipped parts of the history or physical examination
3. SOMETHING MIGHT HAVE BEEN MISSED IN THE LAST EVALUATION
The natural history of most diseases includes a preclinical, or undetectable phase, which may or may not be symptomatic. Frequent evaluation of the patient, including repeat history and physical examination is an essential part of early definitive diagnosis and treatment.
4. THE RECORD MAY BE INCOMPLETE
5. YOU MAY BE LOOKING AT THE WRONG RECORD
6. SOMEONE MAY HAVE MADE AN ERRONEOUS ENTRY INTO THE RECORD
7. DISEASES EMERGE OVER TIME: EARLY & DEFINITIVE DIAGNOSIS AND PRECISION TREATMENT MAKES A DIFFERENCE
This is intuitively obvious and proven empirically for several diseases. Follow the data and use your intuition for now. Target: Early Definitive Diagnosis and Precision Treatment
8. THE MORE PEOPLE WHO EVALUATE THE PATIENT (NOT THE RECORD) THE MORE ACCURATE WILL BE THE EVALUATION
Intuitively obvious. Do you need proof? Talk with me and we will do some research to prove it.
9. THE MORE OFTEN THE PATIENT IS EVALUATED, THE MORE ACCURATE WILL BE THE EVALUATION
As in number 8 above.
10. COPY AND PASTE IS CHEATING, PLAGIARISM & FRAUD
Yes, and it is a bad idea to cheat patients and cut corners on patient care. This is a problem that results in suboptimal outcome. Do you need proof for this?
SUMMARY AND CONCLUSION
Sick Patients, especially when critically ill, can change rapidly. The natural history of each disease, the way in which each disease presents in a particular patient (host), the preclinical phase and the clinical presentation can vary dramatically from one -DISEASE<>PATIENT (host)- to another. This is the reason for frequent and repetitive patient evaluations. In other words, frequent evaluation by multiple providers increases the accuracy and speed of diagnosis and proper treatment, and this is the right thing to do for all patients at all times. It is NEVER OK to cut corners on patient care.
Electronic Medical Records make it very easy to cut corners, to go to the record first, to copy and paste, to take the note that someone else wrote, to copy it and paste it in as if it were your note. In other words, if you don't write the note based upon your history and physical examination ... if your note is not based upon your evaluation of the patient, you are cheating the patient. Don't do it! ALWAYS go to the PATIENT FIRST. To copy in paste is plagiarism, fraud and cheating the patient out of best possible care.
At best, the Medical Record, Electronic or otherwise, is an imperfect reflection of the patient. In other words, even if it is a "perfect" record, or a "perfect" EMR, it is limited by our knowledge of the patient at one point in time. Over centuries, the medical profession has learned a few things that are easily undone by the EMR. You in the EMR business? HIT people? Do NOT ENABLE COPY AND PASTE for history and physical examinations and interval notes.
Each note, history and physical examination should stand alone at a point in the timeline of each patient's life. It is a reflection of each physician<>patient relationship at one point in time. Each is personal and unique ... not to be undone by technology or methodology. And, if done properly, Doctor, your notes will be accurate and lead to better and best outcomes in patient care.
Salute! Amore e buona fortuna. It is all about Love. There is not enough money in the world to make this right.
Join us. Help Build Better Health and Healthcare through Patient<>Physician Cooperation and Cooperatives @ www.ihealsolutions.com and our non profit @ www.VeritasHC.org
Dr. Mike
Michael F. Mascia, MD, MPH
Friday, June 28, 2013
Eleven Steps: HOW TO FEEL BETTER MORE OF THE TIME AND REDUCE YOUR CHANCES OF A MAJOR ILLNESS
The Daily Apple™© Volume 2, Number 7
Friday, June 28, 2013
PGY #40 Day #363
Take The Best Care™© of Yourself
From Dr. Mike and Infinity Health Solutions
HOW TO FEEL BETTER MORE OF THE TIME AND REDUCE YOUR CHANCES OF A MAJOR ILLNESS
From The Stress Management Workbook: An action plan for taking control of your life and health
Pages 156 and 157
The last blog post made reference to these pages, so here they are. These 11 rules will help you get healthy and stay healthy.
Dr. Mike
HOW TO FEEL BETTER MORE OF THE
TIME AND REDUCE YOUR CHANCES
OF A MAJOR ILLNESS
The following list of rules gives you a general
summary of what we
think is reasonable health behavior. Review them and
keep the list
for future reference.
1. Awareness of Behaviors You Can Change:
You
have control over many factors that may significantly affect your
health. Take advantage of the opportunity to learn how your own behavior
affects your health. Strive to change your behavior in such a
way
as to promote
your health. Learn to
differentiate
between those
things you can change and those you must accept.
2. Preparation for Conditioning:
Establish
a relationship with a physician whom you can trust. Make sure .you are
able to communicatewith your personal physician. Visit your physician
annually in order to continually assess your health status.
Do not
start an exercise program without a health
evaluation and advice
from your physician.
3. Immunizations:
Be
sure you are fully immunized. Diphtheria/tetanus
should be received at least every 10 years. Other
immunizations
may be necessary under certain circumstances.
4. Exposure:
Avoid physical, chemical, and
biological hazards in the
environment. This is the essence of risk reduction.
Some things
are obviously more hazardous than others depending
on your age.
The major health hazards for the 30- to 40-year-old individual
are the automobile, alcohol, smoking, and weapons.
There are
other significant factors such as drugs, air and
water pollution,
and food additives that have adverse health effects,
although they
may be difficult to quantify.
5. Diet:
Learn what you are eating and
what you should not be
eating. Food additives, such as flavor enhancers,
artificial flavors,
artificial colors, artificial sweeteners, and
preservatives, as well
as hormones and antibiotics, are chemicals. Some are
known to
be hazardous and others are suspect. These should be
avoided. In
addition, excess sweets, starches, and fats should
be avoided.
Your diet should contain fresh fruits and
vegetables, lean meats,
fish, and low-fat dairy products. Excess salt can be
a problem.
Obesity or overweight is a major health hazard.
6. Drugs:
Avoid the use of drugs unless
absolutely necessary. All
drugs are potentially hazardous. Their benefit must
be carefully
weighed against their danger. Discuss this with your
physician.
7. Exercise:
Develop a regular exercise
program and go through
your daily activities in a way that promotes
fitness. Exercise, if
done regularly and under supervision, reduces the
risk of hypertension
and heart disease.
8. Recreation and Relaxation:
These
two are critical to
your sense of well-being. They probably also prolong your life.
9. Sleep:
When you are tired, go to sleep. Distractions such as
television
that keep you awake during your period of greatest
evening
fatigue are the single greatest cause of insomnia.
10. Goals and Expectations:
Examine
your personal expectations and
the expectations which you have of others very
carefully. Make
sure that they are reasonable. If unreasonable, they should be
changed. If you
are unable to
examine or change
them on your
own, seek help.
11. When and How To Seek Aid:
A serious, or
persistent problem deserves prompt evaluation by your personal physician, or, if necessary, the physician who is on call.
The following list of rules gives you a general summary of what we
You have control over many factors that may significantly affect your health. Take advantage of the opportunity to learn how your own behavior
2. Preparation for Conditioning:
Establish a relationship with a physician whom you can trust. Make sure .you are able to communicatewith your personal physician. Visit your physician annually in order to continually assess your health status. Do not3. Immunizations:
Be sure you are fully immunized. Diphtheria/tetanus4. Exposure:
Avoid physical, chemical, and biological hazards in the5. Diet:
Learn what you are eating and what you should not be
6. Drugs:
Avoid the use of drugs unless
absolutely necessary. All7. Exercise:
Develop a regular exercise program and go through8. Recreation and Relaxation:
These two are critical to your sense of well-being. They probably also prolong your life.
9. Sleep:
When you are tired, go to sleep. Distractions such as television10. Goals and Expectations:
Examine your personal expectations and11. When and How To Seek Aid:
A serious, or persistent problem deserves prompt evaluation by your personal physician, or, if necessary, the physician who is on call.The Daily Apple™©: Take The Best Care™© of Yourself
The Daily Apple™© Volume 2, Number 6
Friday, June 28, 2013
PGY #40 Day #363
Take The Best Care™© of Yourself
From Dr. Mike and Infinity Health Solutions
For our final blast of PGY 40 I take you back to The Stress Management Workbook. In fact, I take you to the end of the book, page 162, which I have reproduced here. There is ONE critical point to make with regard to altering your life and lifestyle to promote optimal health and well being. It takes time to do it right.
This is true for many reasons, not the least of which is this: we are programmed to behave in a certain way. Not completely hard wired, humans have the capacity to change and to change themselves, but the biology of change involves reprogramming the brain and nervous system and that does take about two years. This is about a mix of genetics and biology that amounts to "plasticity" of the nervous system. If you eat well, sleep well, and get proper exercise, your body will enable the necessary changes in the nervous system that facilitate your ongoing path to health. I will not dwell on the science of this phenomenon now, but ask if you have questions about it.
The point is this: You can change. Don't give up. Take the time necessary to make the change stick. If you screw up, fall down, make a mistake, go out of line, fall off the track ... get back on track ASAP. The more time you spend on track, the easier it will be to stay there. Do not give up ... do not surrender.
Below is the relevant page from The Stress Management Workbook.
Enjoy!
Dr. Mike
162 THE STRESS MANAGEMENT WORKBOOK
PITFALLS ON THE
PATH TO HEALTH,
OR WHY CHANGE IS
DIFFICULT
Change is not always easy to implement. There are
several reasons
for this. You have been practicing your present
style of thinking and
behaving for many years. Much of your behavior and
attitude has
become habit. You will have trouble realizing you
have engaged in
the habit until after the fact.
Do not make your
goal the immediate
and total elimination of the old behavior or the
addition of new ones:
You will set yourself up for failure and add to your
stress. A realistic
goal would be to reduce the frequency of the
behavior(s) or increase
the frequency ofnew behaviors over time so that one
or two years from
this date you can recognize substantial change.
You
can change habits
faster by
(1) asking
friends to tell you when you are engaged in the
old behavior;
(2) deliberately engaging in the habit
in an exaggerated
manner several times a day so that you become
supersensitized to it;
and
(3) keeping a log with you and writing down each
time you or a
friend notice the habit-reward yourself for
specified reductions in the
frequency of the behavior.
Often people will not change even if the present
situation is not
satisfactory because the discomfort of the known is
not as great as
their fear of the. consequences of unknown behavior.
If you become
more assertive, for example, you will have to deal
with the reactions
ofthose around you, some ofwhom may prefer that you
stay meek and
docile. If you
discover that you seem reluctant to change even though
intellectually you believe you would be better off
altering your lifestyle,
then list all the consequences you can think of that
would occur
if you did make the specified changes. Which of these
would present
new problems for you? How can you decrease your fear
of being different?
If this problem seems to have you stymied, seek
professional
counseling or medical care.
Refer back to your Action Plan for Change (page
158). Ifthe number
of changes you believe you have to make is substantial,
where to start
and how to achieve so much may seem overwhelming.
This may give
you the excuse you need to avoid beginning. Do not
be upset if
you
have found yourself with a long list of changes to
make as a result of
reading this workbook. Look at it as a long-range
plan. Make a list of
the priorities and work away at it over the next
couple of years, rewarding
yourself at each step. Gradual change is better for
you than
sudden major shifts in thought, behavior, job
situations, etc.
Do not give up. You may review the material and
revise your plans
repeatedly without harm. Take your time and remember
to enjoy yourself
along the way to your goals.
Saturday, June 15, 2013
Tick Season Again: One more reason to avoid tick bites
The Daily Apple™© Volume 2, Number 6
Saturday, June 15. 2013
PGY 40, Day #350
Tick Season Again: One more reason not to get tick bites ... Red Meat Allergy
I found at least one of the nasty creatures on me each day this this week. Fortunately, none of them had stared feasting on me. Nevertheless, it is a reminder that this is the time to be especially careful about ticks and the troubles they can cause.
It is is not bad enough that they are nasty creatures that can transmit Lyme Disease, and a long list of other infectious diseases (below), tick bites are now found to be associated with RED MEAT ALLERGY. So, if you did not have enough reason to protect yourself from tick bites before, you can now add the risk of red meat allergy to your list.
That's right, you have one more reason NOT to get tick bites. New science has emerged from researchers at the University of Virginia the associates tick bites with RED MEAT ALLERGY, including, but not limited to life threatening anaphylaxis. The symptoms of red meat allergy usually occur several hours after eating the red meat, because the offending agent, alpha-gal is most abundant in animal fat, so absorption is delayed.
Beware tick bites!
Have fun and be careful out there. StepWisely®™© with us and Go to Health™©
Dr. Mike
Michael F. Mascia, MD, MPH
REFERENCES
CDC LIST OF TICK BORN DISEASES:
Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of babesiosis in the United States are caused by Babesia microti. Babesia microti is transmitted by the blacklegged tick (Ixodes scapularis) and is found primarily in the Northeast and upper Midwest.
Ehrlichiosis is transmitted to humans by the lone star tick (Ambylomma americanum), found primarily in the southcentral and eastern U.S.
Lyme disease is transmitted by the blacklegged tick (Ixodes scapularis) in the northeastern U.S. and upper Midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.
Rickettsia parkeri Rickettsiosis is transmitted to humans by the Gulf Coast tick (Amblyomma maculatum).
Rocky Mountain Spotted Fever (RMSF) is transmitted by the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and the brown dog tick (Rhipicephalus sangunineus) in the U.S. The brown dog tick and other tick species are associated with RMSF in Central and South America.
STARI (Southern Tick-Associated Rash Illness) is transmitted via bites from the lone star tick (Ambylomma americanum), found in the southeastern and eastern U.S.
Tickborne relapsing fever (TBRF) is transmitted to humans through the bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes.
Tularemia is transmitted to humans by the dog tick (Dermacentor variabilis), the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Tularemia occurs throughout the U.S.
364D Rickettsiosis (Rickettsia phillipi, proposed) is transmitted to humans by the Pacific Coast tick (Dermacentor occidentalis ticks). This is a new disease that has been found in California.
PGY 40, Day #350
Tick Season Again: One more reason not to get tick bites ... Red Meat Allergy
I found at least one of the nasty creatures on me each day this this week. Fortunately, none of them had stared feasting on me. Nevertheless, it is a reminder that this is the time to be especially careful about ticks and the troubles they can cause.
It is is not bad enough that they are nasty creatures that can transmit Lyme Disease, and a long list of other infectious diseases (below), tick bites are now found to be associated with RED MEAT ALLERGY. So, if you did not have enough reason to protect yourself from tick bites before, you can now add the risk of red meat allergy to your list.
That's right, you have one more reason NOT to get tick bites. New science has emerged from researchers at the University of Virginia the associates tick bites with RED MEAT ALLERGY, including, but not limited to life threatening anaphylaxis. The symptoms of red meat allergy usually occur several hours after eating the red meat, because the offending agent, alpha-gal is most abundant in animal fat, so absorption is delayed.
Beware tick bites!
Have fun and be careful out there. StepWisely®™© with us and Go to Health™©
Dr. Mike
Michael F. Mascia, MD, MPH
REFERENCES
CDC LIST OF TICK BORN DISEASES:
- Anaplasmosis is transmitted to humans by tick bites primarily from the blacklegged tick (Ixodes scapularis) in the northeastern and upper midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.
http://uvamagazine.org/
http://online.wsj.com/article/
REFERENCE FOR PREVENTION AND TREATMENT OF LYME DISEASE
http://cid.oxfordjournals.org/
CDC LYME DISEASE LINK
http://www.cdc.gov/lyme/
Sunday, June 9, 2013
This is Personal: The Patient-Physician Relationship
PGY 40, Day 344
"This is Personal: The Patient-Physician Relationship", was written by me and it is, simply, my opinion ... perhaps not?
I sent it to the Veritas Health Care Working Group on June 8, 2013, and it is posted here so anyone who wishes can read and respond.
TO: Veritas Health Care Working Group (VeritasHC.org)
From: MFM
Regarding: This is personal.
Please respond, be critical and tell us about your personal experiences inside "The Business of Medicine."
Thanks,
MFM
This is Personal: The Patient-Physician Relationship
by
Michael F. Mascia, MD, MPH
Why would I put my life in the hands of someone whom I do not trust? Why would I put my life in the hands of a Physician who is forced to cut corners on care by hospitals and third parties? Don't do it! Elective? Put it off.
I work with all the casualties ... I see the ones that come in off the street and I see those that come from the hospital. What I see is very disturbing. It is NOT RIGHT and it has to change. Help us change it.
Picture this: Imagine you are the patient. You come in for elective surgery first thing in the morning. Your attending anesthesiologist is with you and there are no records to reflect preoperative clearance. He has 2 other patients ... 2 other cases to start at 7:15 ,,, the same time your case is scheduled to start. So he is hustling and he has little help. Your "anesthesia provider" is an inexperienced resident and the attending anesthesiologist has to teach and verify that everything is done properly to minimize the risk to you. And, the anesthesiologist knows this: standards of care dictate that certain information in addition to his history and physical is required to meet BEST PRACTICE STANDARDS. These STANDARDS also dictate certain preconditions. But the anesthesiologist does not have that information ... he requests it. And ... your blood sugar is a little high ... got to bring it down before we go. And, we have to make sure we have blood available in case of a disaster. Big surgery = high risk.
BUT, the factory pushes ... all eyes are on this anesthesiologist ... because he is SLOWING THE LINE DOWN. Yes, that's right, you are being treated like a hunk of meat on a production line. That's the way you are seen ... A HUNK OF MEAT BEING PROCESSED ... and, God forbid the Anesthesiologist hold up the line, or STOP THE LINE for the sake of good OUTCOME. Yes, I have been that anesthesiologist and when I work that line, I put myself in the position of the patient ... that is the only way to guarantee BEST PRACTICES. But, if I stop the line, I become "THE PROBLEM" and all the pressure is on me, and they just want to REPLACE ME with someone who does not know any better. They call this "Production Pressure" and it is an evil reflection of Profit over People that is rampant throughout US hospitals ... every day ... across the country.
Yes, the Business of Medicine in conjunction with third party payers has violated our trust. By undermining the Physician, they undermine the Patient-Physician Relationship and "Best Care" in favor of Profit. We all feel it and some of us know it. That's why everyone I ask ... Patient, Physician, Nurse, other provider ... is disgusted by it. And, that's why Veritas Health Care is working to create alternatives to Business as usual in Health and Healthcare.
It is the allegiance between patient and physician, and yes, the strength of the bond between Patient and Physician that dictates the healing power of the Patient-Physician relationship. Over the last 30 years, third parties have systematically disrupted this bond, in favor of "medicine by the numbers", corporate doctoring, third party power and profits over patients. There is increasing awareness of the problems
Veritas Health Care recognizes the values of the physician-patient relationship and is dedicated to supporting others who value it.
This is personal.
Please join us.
We have tools that will help you Take The Best Care™© of yourself and we will teach you how become an equal member of the healthcare team ... how to help your doctor Take The Best Care™© of you, if and when that becomes necessary.
Dr. Mike
"This is Personal: The Patient-Physician Relationship", was written by me and it is, simply, my opinion ... perhaps not?
I sent it to the Veritas Health Care Working Group on June 8, 2013, and it is posted here so anyone who wishes can read and respond.
TO: Veritas Health Care Working Group (VeritasHC.org)
From: MFM
Regarding: This is personal.
Please respond, be critical and tell us about your personal experiences inside "The Business of Medicine."
Thanks,
MFM
This is Personal: The Patient-Physician Relationship
by
Michael F. Mascia, MD, MPH
Why would I put my life in the hands of someone whom I do not trust? Why would I put my life in the hands of a Physician who is forced to cut corners on care by hospitals and third parties? Don't do it! Elective? Put it off.
I work with all the casualties ... I see the ones that come in off the street and I see those that come from the hospital. What I see is very disturbing. It is NOT RIGHT and it has to change. Help us change it.
Picture this: Imagine you are the patient. You come in for elective surgery first thing in the morning. Your attending anesthesiologist is with you and there are no records to reflect preoperative clearance. He has 2 other patients ... 2 other cases to start at 7:15 ,,, the same time your case is scheduled to start. So he is hustling and he has little help. Your "anesthesia provider" is an inexperienced resident and the attending anesthesiologist has to teach and verify that everything is done properly to minimize the risk to you. And, the anesthesiologist knows this: standards of care dictate that certain information in addition to his history and physical is required to meet BEST PRACTICE STANDARDS. These STANDARDS also dictate certain preconditions. But the anesthesiologist does not have that information ... he requests it. And ... your blood sugar is a little high ... got to bring it down before we go. And, we have to make sure we have blood available in case of a disaster. Big surgery = high risk.
BUT, the factory pushes ... all eyes are on this anesthesiologist ... because he is SLOWING THE LINE DOWN. Yes, that's right, you are being treated like a hunk of meat on a production line. That's the way you are seen ... A HUNK OF MEAT BEING PROCESSED ... and, God forbid the Anesthesiologist hold up the line, or STOP THE LINE for the sake of good OUTCOME. Yes, I have been that anesthesiologist and when I work that line, I put myself in the position of the patient ... that is the only way to guarantee BEST PRACTICES. But, if I stop the line, I become "THE PROBLEM" and all the pressure is on me, and they just want to REPLACE ME with someone who does not know any better. They call this "Production Pressure" and it is an evil reflection of Profit over People that is rampant throughout US hospitals ... every day ... across the country.
Yes, the Business of Medicine in conjunction with third party payers has violated our trust. By undermining the Physician, they undermine the Patient-Physician Relationship and "Best Care" in favor of Profit. We all feel it and some of us know it. That's why everyone I ask ... Patient, Physician, Nurse, other provider ... is disgusted by it. And, that's why Veritas Health Care is working to create alternatives to Business as usual in Health and Healthcare.
It is the allegiance between patient and physician, and yes, the strength of the bond between Patient and Physician that dictates the healing power of the Patient-Physician relationship. Over the last 30 years, third parties have systematically disrupted this bond, in favor of "medicine by the numbers", corporate doctoring, third party power and profits over patients. There is increasing awareness of the problems
Veritas Health Care recognizes the values of the physician-patient relationship and is dedicated to supporting others who value it.
This is personal.
Please join us.
We have tools that will help you Take The Best Care™© of yourself and we will teach you how become an equal member of the healthcare team ... how to help your doctor Take The Best Care™© of you, if and when that becomes necessary.
Dr. Mike
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