DrJohnHong.com

Congestive Heart Failure

Congestive heart failure: acute decompensation causes shortness of breath. Fluids builds up in the lung. Usually CHF from left ventricle disease so doesn’t pump well. Also from fluid overload (like in blood transfusions or IV fluids), severe high blood pressure, severe kidney disease, renovascular HTN. CHF from acute heart attack. Atrial fibrillation with fast heart beat can cause it. Shortness of breath is main symptoms. blood pressure can drop and kidneys function drops. Legs can become very swollen. From fluid build up, there is acute weight gain. Often requires hospitalization to improved blood pressure, reduce fluid, improve heart function, help oxygenation.

Crestor The Jupiter Study

JUPITER: Randomized Clinical Trial, double blinded, placebo controlled. 1315 sties in 26 countries. To see if cardiovascular naïve people with high hsCRP will have less CV events on Crestor.

Endometriosis

Endometriosis: endometrial glands and stroma that is present outside the uterus. Prevalence not known. Can be asymptomatic and found on autopsy and incidentally during surgery. But prevalence when involved with other diseases are such: 1% all women undergoing major gynecologic surgery; 1-7% tubal ligation; 12-32% reproductive age with pelvic pain undergoing laparoscopy; 9-50% laparoscopy for infertility; 50% teenagers laparoscopy for chronic pelvic pain or dysmenorrhea.

Risk factors: delayed pregnancy (so professional women might have it more). 25-35yo. Taller, thinner women. Ovarian steroids needed so rare in those menopausal or pre-menarche. Endometriosis might be a risk factor for developing ovarian cancer. The ovarian cancer risk is reduced with OCP but higher with HRT or tamoxifen.

Endometrial tissue goes on in descending order: ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, oviducts, sigmoid colon and appendix, round ligament. Appendix in 2-4% cases. Has even been reported in breasts, spine, lungs, and extremities. Can cause adhesions.

Pain usually with menstrual period, but it can be continuous. Pelvic pain, dysmenorrheal, subfertility, deep dyspareunia, cyclical bowel or bladder symptoms, chronic fatigue. If under skin, bruising from the bleeding can be seen! On exam can mimic PID. The endometriosis tissue unlike that in the uterus contains fibrous tissue, cysts, and blood.

Caffeine - Love it! But is too much of a good thing not good?

Caffeine stimulates the brain. Commonly found in coffee, tea, cola, chocolate. But it also stimulates the nervous system and can cause shakiness, nervousness, and fast heart beat. Nervousness, overly excited, irritable, insomnia. Has been consumed since ancient history. 80% the world consumes caffeine.

5oz of the following drinks have caffeine: drip coffee 146mg, percolated coffee 110mg, instant coffee 53mg, espresso (1-2oz) 45-100mg, Starbuck Venti 415-550mg. 1 min brew tea 9-33mg, 3min brew tea 20-46mg, Canned ice tea 12oz 22-36mg. 12oz diet or regular cola 46mg. Chocolate: milk 1oz 6mg, 6oz cocoa mix 10mg, baking 1oz is 35mg.

Munchausen’s Syndrome

Faking illness just to have attention

Gamblng Problem

Gambling problem

Lose Weight

Don’t get caught with False Hope Syndrome. Losing weight takes time…and discipline.

Asthma

Asthma is chronic inflammatory disorder of the airways of the lungs. 75% cases diagnosed before age 7. For many, remission occurs during puberty but comes back later. Usually doesn’t develop after age 50. The airways close up so exhaling becomes difficult. Symptoms: intermittent sob, cough, wheezing, chest tightness. Usually worse at night and/or early a.m. Symptoms go away after time or with treatment, so reversibility is easier than with COPD. Wheezing usually occurs exhaling, not as much with inhaling (this is called stridor), that is a high-pitched whistle sound. Cough is dry or wet (pale yellow or mucoid). Chest tightness from the airways closing up: band-like constriction. Exacerbating factors cause the inflammation of the airways. Allergens are a big factor: mold, pollen, dust, furry animals, cockroaches, smoke, fumes, mite poop. Cold air can trigger off asthma attack. Exercise induced asthma – 10-15min after exercise asthma attack occurs. Change in weather. Viral and bacterial illness. Postnasal drip and GERD. Many will have allergies of the skin (eczema) and/or allergic rhinitis (nose allergies). Nasal polyps can be a sign person has asthma, and in this aspirin can make it worse. Occupational exposures.

Heart Attack (Acute Coronary Syndrome)

Myocardial Infarction (MI) is a “heart attack” in which heart muscle doesn’t get enough blood/oxygen and dies. Main cause is from a coronary artery getting blocked by a clot that forms on an atherosclerotic plaque (called acute coronary syndrome (ACS) that occurs abou 1,200,000 times a year). 38% die each year from ACS (450,000 people). That is 1 in every 5 deaths making coronary heart disease (CHD) #1 cause of death in USA. 16 million Americans have CHD. ½ millions new cases of stable angina a year.

ACS: Chest pains aren’t pain – squeezing of the chest, heaviness like an elephant standing on the chest. Under the sternum more than 15 minutes. 20min heart muscles die. Radiation of discomfort like a numbness to neck, jaw, shoulder, down left arm, maybe back. N, SOB, palpitations, lightheadness, sweating. Often occurs with exertion though can occur at rest especially with h/o angina.

Menopause

Menopause: cessation of menstrual periods. For 12 months. Mean age 51.4 years old. 5% start 40-45yo & 5% after 55yo. <40yo premature ovarian failure. STRAW staging system: -5 to +2. -5 to -3 is reproductive stage. Menopause transition: -2 early, -1 late. 0 is menopause . +1 early postmenopause. +2 late postmenopause. Early menopause transition: variable cycle length greater than 7 days change from normal (which is 21-35d). Follicular phase shortens, inhibin B falls, FSH rises. Estradiol is normal to high still from increased aromatase activity but lower progesterone in luteal phase.Late menopause transition: 2 or more skipped cycles and no periods 60 or more days. Often hot flashes occur. FSH spikes but then drops to normal.Menopause: 12mo no periods after the final period. Ovaries stop ovulating and secreting estrogen. Early menopause: first 5 yrs after final menstrual period. Accelerated bone loss and ovarian failure. hot flashes common. Late menopause: after 5 years to death.

Medicare Cuts?

Senior citizens tend to have the most need for health care, and the demand on Medicare is increasing. The 35 million elderly folks will increase to 71 million by 2030. That is 20% of the US population. However, each year the rich US government officials try to slash Medicare benefits to patients and payment to health care providers. Right now you pay more at the gas pump to fill your car than Medicare pays your doctor for a 15 minute visit. Hmmm, maybe I should start selling gas at the office? My nurses can fill your tank while I treat your congestive heart failure. I didn’t realize George W. Bush is only 62. I thought he was 108. (Isn’t it interesting how presidency makes men old? Bill Clinton went from a hip saxophone player to Father Time during his presidency.) But on July 15, 2008, almost-Medicare-eligible Bush vetoed the legislation to stop a 10.6% cut in payments to doctors. Hello! I don’t see him cutting fuel prices (or his own salary).

West Nile Virus

West nile virus notes: 1st isolated in West Nile province of Uganda in 1937. reappeared USA ’99 and found across most of the nation. Arbovirus goes from bird to mosquito to bird.

1/150 result in meningitis or encephalitis. <10% people are infected during outbreaks. Peaks late summer and early fall. 60 varieties of Mosquito gives to humans. Blood is screened before transfusions. Incubation 2-14d.

Most asx. 20% will have sx: 6d fever, headache malaise, back pain, anorexia. +/- eye pain (chorioretinitis and vitritis), sore throat, n/v/d, abd pain (hepatitis, pancreatitis), maculopapular rash. Central DI. Myocarditis. Neuro: enceph, meningitis, and/or flaccid paralysis (anterior horn cell process). CN palsies. Possible guillain-barre syndrome. Once infected, prob lifelong immunity.

Food Poisoning

Food Poisoning occurs about 76 million times a year in Americans, leading to over 300,000 hospitalizations and 5,000 deaths. Ones most hurt by food poisoning are the elderly, immunocompromised, and young kids. Food poisoning is usually from bacteria, but also viruses and chemical ingestion. Incubation time most c/w: <1 hr chemical ingestion, 1-7 hrs toxins from staph aureus or bacillus cereus, 8-14 hours bacteria, and 15 or more hrs viruses.

For outbreaks, Salmonella is #1. Though Listeria account for like 0.2% cases, it is the #1 cause of death from food poison outbreaks. #2 is viruses, in particular norovirus. Chemical ingestion and then parasites follow.

Swimmer’s ear

Otitis Externa: Inflammation of external auditory canal or auricle. Infectious, allergic, and dermal disease. Up to 10% of people develop during lifetime. Acute bacterial external otitis most common form seen. Other causes otomycosis, contact dermatitis, necrotizing otitis externa, chronic suppurative otitis media, and external auditory canal carcinoma Lateral (outer) cartilaginous portion approximately two-thirds of canal, and medial (inner) bony portion other one-third. Outer cartilaginous portion lined by thicker skin with numerous adnexal structures including cerumen glands, sebaceous glands, and hair follicles. Cerumen is formed here: mixture of secretions from cerumen glands, sebaceous glands, and desquamated epithelium. The inner osseous portion contains thin skin without subcutaneous tissue. The dermis direct contact with the underlying periosteum. Minimal inflammation or instrumentation of the bony canal causes significant pain. The inferior tympanic recess is a small depression in the inferior medial aspect of the ear canal, adjacent to the tympanic membrane. Debris can collect in this area and cause or perpetuate infection.

Male Sexual Dysfunction

erectile dysfunction is more recognized probably because of Viagra and the other ED medicines – and their huge ad campaigns. In 1994 the Massachusetts Male Aging Study found male sexual dysfunction begins 40 years of age and worsens each decade of life. 40 year old men: 40% some level of dysfunction and 10% had declining libido. Sexual dysfunction includes ED, decreased libido, less satisfaction with sex or orgasm, or abnormal ejaculation. ED worsens by age 50. One study showed 47% of men 55 or older had ED.

Risk Factors: smoking, obesity, depression, neurological disorders, diabetes, high blood pressure, high cholesterol, cardiovascular disease, alcohol, drugs, and some meds. Exercise decreases the risk of ED. In obese men, ED improves with exercise and weight loss.

Bipolar Disorder - Manic Depressive Illness

Bipolar disorder involves mania. 2 types: bipolar disorder I and II. Focus on I: episodes of sustained mania and usually depressive episodes. bipolar disorder is often undetected and a person is treated for depression instead. 1% prevalence. Probably genetic component to this disorder. Men and women are equally affected, and usually onset age 15-30.

Mania has 5 criteria per American Psychiatric Association 1) at least 1 week of abnormally and persistently elevated, expansive, or irritable mood. 2) During this time of mood disturbance, 3 of the following (4 if mood is only irritable): a) inflated self-esteem or grandiosity b) decreased need for sleep c) more talkative than usual or pressure to keep talking d) flight of ideas or subjective experience that thoughts are racing e) distractibility f) increase in goal-directed activity g) excessive involvement in pleasurable activities that have a high potential for painful consequences 3) The symptoms don’t meet criteria for mixed episode 4) The mood disturbance a) is sufficiently severe to cause marked impairment in occupational functioning, usual social activities, or relationships with others, b) necessitates hospitalization to prevent harm to self or others, or c) has psychotic features. 5) The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment) or a general medical condition (eg, hyperthyroidism).

Alzheimer’s Disease

Alzheimer’s Disease is the #1 type of dementia in the elderly – about 60-80% of cases. About 4 million Americans. Occurs between ages 40-90, is progressive, and causes memory loss, global cognitive dysfunction, personality changes, and loss of independence due to poor executive functioning. It comes on slowly, usually starting with short-term memory loss.

Hemorrhoids

Netipot and Allergies

Good enough for Oprah, good enough for Dr. Hong. Watch me do the netipot for my allergies

Sunburn

Don’t become a rock lobster