Would your doctor write you a note like this?

Donald Trump, in his quest for the presidency, has released a statement of his health prepared by his personal physician.  In this article from Yahoo Health, several physicians, myself included, took a look at that note and commented on what it says, and how it says it.

What Does Donald Trump’s Doctor’s Note Really Mean?

It feels good to get out, but you’re still stuck inside!

So you’re off on your vacation and to get there, you have to endure a few hours locked up in an aluminum cylinder soaring through the sky.  It feels really good to get out of the plane, but what do have to face while you’re confined?  Can you do anything to help keep yourself healthy during the flight?  Here is an article on Yahoo Health that looks at some of what happens during a flight, with several of my suggestions and ideas.

What Happens to Your Body on an Airplane

Men and women are different? Who knew?

The medications and medical procedures that are in use today first saw light in medical studies, with a population selected upon which to test the product.  While this may seem to be counter-intuitive, studies have often limited their subjects by gender, age, or ethnicity, which may skew the final results.  Here is an article addressing this situation, with my comments on several of the points raised.  One can only hope that someone is listening.

Are Clinical Trial Samples Too Narrow?

You gonna take that pill?

It seems to happen to me every week or so.  A patient was watching television and saw some advertisement, or the news and heard a brief piece about a drug, and decided, on the basis of ten words or less of questionable authority, to discontinue a medication.  If he or she is lucky, there are no immediate repercussions, but there well may be.  Do you think this is a problem?  Do you have trouble understanding why someone would act that way?  Well, here is commentary on a study which looked at the question, with me being given the final words in the article.

Bad News on Statins Linked to Quit Rates

Oh my aching head

No question about it, migraine headaches impact many people on a regular basis, preventing daily functioning and productivity.  To treat them, folks use a wide variety of preparations, both prescription and over the counter.  This feature on WBAL-TV was promoted by a new review article that looked at two agents, riboflavin and Coenzyme Q-10, in the prevention of migraines.  Enjoy the piece, then keep reading.

Recent study links chronic migraines, antioxidant levels

Although you might think from this news article that the use of these over the counter agents is a new finding, there are articles going back at least ten years that speak of the apparent efficacy of them in the prevention of common migraine headaches.  Riboflavin, which is also known as Vitamin B2, is a water soluble vitamin that is present in small amounts in just about every multivitamin.  There is, however, just the amount of the Recommended Dietary Allowance in these pills, about 1.7 mg.  For migraine prevention, the usually cited dose is 400 mg daily, taken as a single or divided dose.  There are capsules of 100 mg, 200 mg, and 400 mg available from a variety of sources.  Most references cite a two or three month lag time from starting the product until full effect is appreciated, and the mechanism of action, although there are lots of theories, is really unknown.  Because this is a water soluble vitamin, the excess that is unneeded by the body is excreted in the urine, which develops a lovely glowing yellow color as a result.  

Co-enzyme Q-10, also known as CoQ-10, is a naturally occurring substance in the body, which has anti-oxidant properties.  The most common use as a supplement is in people who are taking statins, where it appears to help minimize muscle cramps.  It has also been looked at for the prevention of migraines and, again, there does appear to be a positive effect in some studies.  Dosage appears to range from 150 mg to 300 mg daily, and, again, the studies do show a significant reduction without appreciable side effects.  

Whether these products can be used together is not clear, I was not able to find any references which used a combination.  As always, you should check with your physician before embarking on any therapeutic plan, whether by prescription drugs, over the counter products, or even techniques that don't involve ingesting something!  Be frank and open with your doctor, and you both will benefit.

Stuff Happens

You’re about to go out for a run or to exercise.  You have your shoes nicely laced.  You are wearing the proper clothing for the activity.  Got your music player, water bottle, sunglasses or hat.  But are your ready for the unexpected?  When you are out on the road or track, situations can arise that can significantly impact your health.  Here’s an article from Men’s Fitness in which I was interviewed about some of those dangers, and how to handle them.

The Runner’s Survival Guide

Does your thermometer meter correctly?

Vital Signs have been a part of the medical examination since such examinations morphed into the age of modern medicine.  While men seem always to claim an extra inch on their heights, and women deny the accuracy of their weights, those minor aberrations likely do not impact their overall health management.  More than a few, however, when confronted with a temperature reading, claim that their temperature is always a degree or two low, saying such as, “I always run a 95° temperature.”  The truth is that their temperature is not being measured correctly, and this article speaks to this as more than a casual problem.

For Inpatients, Core Temp Readings a Must

A Sobering Statistic

The Center for Disease Control and Prevention, that arm of our government charged with monitoring the ills that befall our population, has come out with an alarming report.  No longer are cancer, heart disease, and lung disease the rising causes of death among a large segment of the population; but rather self inflicted ills including alcohol, drugs, suicide and resultant liver disease are now the most prominent.  The middle aged white man has done this to himself, and in this article from The Gupta Guide, my opinions of this study, and its implications, are examined.

Mortality Rate Spikes for Middle-Aged Whites

Legs feel weak as a baby?

Out there exercising at the top of your game when your legs feel too weak to hold you up?  Is this something serious, or is something more subtle going on?  Here is a look at this not uncommon situation, with the likely cause.  As well, there are thoughts as to how you can prevent the unsteady condition.

Legs Suddenly Too Weak to Stand After Sports

I'm a Doctor, Jim, not a Provider

Do you go to a Doctor, a Physician, or a Health Care Provider?  If you see a Nurse Practitioner, is it an NP or a HCP?  Do you automatically call the person examining you "doctor" no matter what the degree or position?  It may seem trivial, but there are strong feelings about terminology, and this article looks at many reactions to the question

Blog: 'Provider' Label Fuels Physician Ire

It’s always nice when someone else validates a view I have had for so long.  I totally agree that calling a physician a “provider” is just one more example of the dumbing down of language and blurring the lines between those caring for a patient.  In the effort to appease, English now has constructs such as “chairwoman,” which has no linguistic validity, and now “provider” for anyone involved in health care.  Thirty years ago I struck this term from documents and replaced it with “physician.”  I have asked those using the term just what I was providing?  If it was information and health education, then the word derived from the Greek word for teaching would be appropriate, and that word is “doctor.”  I wholeheartedly agree with the author’s position, and encourage my fellow physicians to throw the word “provider” back in the face of those promulgating it. Let physicians, nurse practitioners, physician assistants, and others be identified for their unique positions, skill sets, and range of practice.  We should be celebrating our educations and achievements, providing distinction and distinguishment to ourselves and our practices.

Is the PCP a partner or a stranger?

In the case of devastating news, cancer or the like, is your Primary Care Physician, your family doctor who may have diagnosed the problem and sent you to the specialist, included in the healing process, or relegated to reviewing forwarded reports without being allowed any input?  Is that familiar hand not an important part of the treatment as well?  Here is an article which looks at this issue, with opinions from others as well as myself.

PCP/Oncology Partnerships Vital for Cancer Care Wave

Lies my patient tell me

You might think that people would be honest with their doctors, after all, their lives may depend on the information they relate.  But they are not.  Almost always, the truth is altered, shaded, omitted, or otherwise just a lie at some point.  Here is a little piece with an interview with WebMD where I added to the picture, with a plea to always be honest in the exam room.  It is that serious!

5 Fibs Your Doctor Is Fed Up Hearing

It hurts when I touch that

If you're like me, you have had the occasional ache or pain without apparent cause.  While you should not ignore symptoms that are troubling, often those little pains are of little concern, and go away as mysteriously as they appeared.  Here is a little piece on the Scary Symptoms site looking at the little tender spot that shows up on your head.  Remember though, that bad things do happen sometimes, so if there are any questions about a pain or such, see your physician for an evaluation.

Occasional Tender Spot on Head; no Injury

A Cup or More in the Morning?

Morning would not be complete for me without that cup of coffee, but the controversy continues about just how much you can have, and what can it do to you.  Here is a little calming article on the Scary Symptom site, where I was asked about just how much coffee one can have safely.

How Much Caffeinated Coffee Is Safe a Day?

Is that a wink or are you ptotic?

People can have all kinds of infirmities, and many of them are visible to others.  But with the belief that the eyes are the windows to the soul, abnormalities of the eyes are quickly noticed, and frequently cause for comment.  When there is a drooping lid, or a constricted pupil, it may be quite obvious, to onlookers or the affected individual.  It may be serious, it may not be, and here is a little piece that looks at these conditions.

What Is Ptosis and Miosis?

Healthy woman needs for 30,000 mile checkup

I got an interesting question from a website devoted to health about the requirements for a 30 year old well woman's periodic physical.  Truth is, the points here, allowing for some gender specific information, can benefit men as well, and older folks can also use this as a starting point.  So, no matter who you are, your age or gender, have a look at:

15 pasos que puede incluir tu examen médico anual

or

15 Tests That may be Included in Your Yearly Medical Exam

Just to expound on this a bit more than in the article, here are my full thoughts on the subject.

For the healthy woman in her 30s, there are at least a few items which should be screened on an annual basis, in the interests of good health. These may be part of a Women's Wellness examination by a gynecologist, or shared with a primary care physician dealing with the non-gynecologic parts of the examination.

With that Primary Care Physician in mind, I would start with the visit, itself. Having a physician who knows you, your history and yourself, is vitally important. During the conversation of the visit, evidence of anxiety, depression, abuse of multiple types, and social ills may be evident. While you may not want to think about it, these non-physical illnesses are very common, and need to be screened for and acted upon when present.

Turning to the more “routine” physical issues, certainly women in their 30s should have an annual gynecologic screening, to include breast examination and education for breast self-examination, a Pap smear and pelvic examination. Having said that, breast self-examination has come under fire recently as not being effective, and even the annual pelvic examination is seen as unnecessary in some recent studies. See the posting on my blog about this at:  Are routine pelvic exams indicated?

If there is a history of breast cancer before 50 years old in a first degree relative, such as mother or sister, one might consider beginning mammography earlier than the usual starting age of 40 years old. While colonoscopy is not normally started until age 50, the same considerations would be given to an early start if a close relative developed colon cancer at an early age.

General health measures, such as weight, blood pressure, and body mass index should be evaluated as part of a basic examination which should include listening to the heart, lungs, and examining the abdomen for abnormalities. Attention should be paid to any part of the body which demonstrates anything unusual, in form or function. With many spending time in the sun, a good skin check should be done to evaluate for dangerous lesions, potentially cancerous, over the entire surface of the body.

Minimal laboratory evaluations should include a hemogram, to screen for anemia, blood sugar and cholesterol. Many would also screen for thyroid disease, particularly postpartum, as hypothyroidism can be seen often in that population.

One other item that should be checked on an annual basis is an eye examination. Best done by an ophthalmologist, not a local store that sells glasses, your should be examined for any changes to the retina or lens, including those caused by systemic diseases and sun exposure.

Numb is numb, and common is common

Pressure on a nerve can disrupt its function, and it can be in just about any sensory nerve and does not take that much pressure.   Sitting on the throne can yield a numb leg, or sleeping in the wrong position may result in your thinking that a stranger's hand is hitting you, when it's your own.  The problem comes when your mind starts to run away, and you turn to Dr. Google only to come away fearing for your life.  But, to recycle a famous saying, the only thing you have to fear is fear itself.  So take a step back, and read this little article.

Sudden Numbness in Index Finger;

Don’t Fear ALS, MS

When the world goes 'round and 'round

I will never forget the feeling when, at about 3 a.m., I awoke feeling as though my bed had just turned over.  The feeling of dizziness, coupled with nausea and a cold sweat, was my introduction to vertigo.  It was not a pleasant introduction.  Here's a short article that looks at vertigo, its causes and treatments.  It's good to know even if you've never had vertigo; I hadn't!

What Kind of Doctor Treats Vertigo?

Coffee is good, but is it good for you?

I'll admit it, my morning just does not get started without a mug of hot coffee.  I like it black, others have other ideas.  What is it about this brew that so captivates us?  Are there healthy reasons to drink coffee?  Are there cautionary notes that should be sounded?  Here is a nice article for which I was interviewed that appears to be making the rounds right now, with some facts and thoughts about the morning cup.

Your Body Within an Hour

of Drinking a Cup of Coffee

Is Ring Around The Calf A Bad Thing?

It's the end of a hard, long day.  You slip off your shoes, roll down your socks, and OMG, there are GROOVES in your calves!  "Am I dying?" you ask yourself (because no one else would listen to you).  Probably not, my friend, it's all about the physiology and circulation of the legs.  Here's a little piece with my thoughts from the Scary Symptoms website to try to put your mind at ease.

Can Tight Socks Cause Edema?

Is Waking Up Hard To Do?

Sometimes it seems just too easy, and you wake up in the middle of the night. Or is it just sometimes?  Here is a little article from Prevention Magazine online that looks at:

5 Reasons You Keep Waking Up At Night

Water: Bottled or Tap, and other fun facts

It's all around us, we need it to live, but how much do you really know about water?  Here's a little article that explores a few facts and myths about this ubiquitous beverage, with my thoughts at the end about the source of your drink.

How much water do you need to drink to stay healthy?

10,000 views

This may be the last little marker post until we hit 20,000 ... just to note that we went from 9,000 views to 10,000 views in a little less than a month.  Wow.  I really appreciate all of the visitors to this blog, and I hope you tell your friends about it, share the information, and benefit.  Use this String of Medical Pearls to guide you to a good health!

Thank you one and all.

Can you drop too many drops?

Over a hundred and fifty years ago, the first versions of what we now know as “cough drops” were developed.  After centuries of trying various preparations to quell a nagging cough, two compounds commonly used in the mid-19th century were found to have excellent cough suppressive powers, and were formulated into a candy based drop.  Unfortunately, neither of these effective drops, first marketed by the Smith Brothers and Ludens, would survive on the market for long, as their ingredients, morphine and heroin, were addictive, dangerous, and fatal in large doses.  The drops we have on the market today are not quite so dangerous when taken to excess, but there are still risks.

That there are a variety of ingredients scattered among dozens of brands and styles of drops only confounds the simple concern about dangerous overdosing.  The base material of most cough drops is a simple sugar based candy, the excess consumption of which can raise blood sugar in diabetics, lead to tooth decay, and conceivably weight gain if taken to extreme.  The sugar free variety may have sorbitol as a sweetening agent, which can cause diarrhea when taken to excess, or any of a number of artificial sweeteners that can also be of questionable toxicity in large quantities.

There are several classes of ingredients unique to cough drops that can lead to a variety of problems when overdosed.  These include demulcents, used to protect irritated areas of the throat; several anesthetic or analgesic ingredients, used to help ease the pain of a sore throat; and medications which act to suppress a cough directly.  Each of these classes has a distinct group of hazards.

The demulcents may be the least troubling of the group.  Compounds such as pectin, which is also used in canning, and glycerin, which is used as a laxative, help to soothe the throat.  Take too much of these and you may have some loose stools, but it would be difficult to take a dangerous dose of demulcents by popping cough drops.

Several of the anesthetic ingredients may cause more problems.  Menthol, one of the more common ingredients used in cough drops, is present only in tiny quantities in the drop, making overdosing difficult.  Nonetheless, getting too much menthol can cause difficulty with breathing, a rapid heartbeat, nervous system problems including convulsions and becoming unconscious, nausea, vomiting, diarrhea, and kidney malfunction.  Phenol, also known as carbolic acid, is another anesthetic in many cough drops, which has its share of issues with overdosing.  Phenol toxicity can cause severe disruption of the cardiovascular, gastrointestinal, or nervous systems, even leading to death.  If one suspects an overdose of any agent in this group, contact a local Poison Control Center immediately.

Eucalyptus oil is another of those unique cough drop ingredients, used to soothe the cough and throat.  Pharmacologically complicated, overdosing with this substance can affect just about every organ system in the body, from central nervous system through the skin; the heart, lungs, GI tract, and everything in between. While, again, it is hard to get enough to cause a problem, a word to the wise should be sufficient.

One of the more dangerous substances in cough drops, and it is not in all of them by any means, is dextromethorphan, or dextromethorphan hydrobromide, also known as “DM.”  This is a non-narcotic cough suppressant, which for many is effective as codeine, but which carries a significant potential for side effects.  Because dextromethorphan works similarly to narcotics, the side effects parallel that class as well.  That means that breathing and neurological issues, which can lead to death, have been seen with overdoses.  This drug has become one which is abused by youth.  In fact, medications which are used to treat narcotic overdoses are used to try to treat overdoses of dextromethorphan.

Depending on which of the compounds is involved, overdosing by two to three times the recommended dose can cause a potentially severe problem.  Bottom line, take cough drops only as recommended on the product label.  If the cough is not clearing, don’t take more of the product, see your doctor to find out what could be wrong.

Wait, which way works to lose weight?

I’ve been in this profession for some four decades, and through it all, obesity has been the common thread of so many illnesses.  I’ve seen techniques come and go, and now, with the release of yet another device designed to help people shed unwanted, or unneeded, pounds, the question arises.  Is this it?  Have we found the panacea to cure obesity?  Several experts joined in on a MedPage Today Friday Feedback, and they invited my thoughts as well.  Take a look at:

Friday Feedback:

Expanding Options to Treat Obesity

Answers from Autopsy?

The saga of Bobbi Kristina Brown has prompted many columns, and much speculation.  Now that she has passed, one wonders if the postmortem examination, the autopsy, will shed any light on the cause of her sudden illness and ultimate death.  Here's an article from Newsmax which takes a look at that question:

Bobbi Kristina Autopsy:

Will It Solve Mystery of Her Death?

Bobbi can rest in peace

After almost six months in a comatose state, Bobbi Kristina Brown, the daughter of Whitney Houston, succumbed to her prolonged illness.  The nature of a prolonged coma, dealing with the confusing signs and situations, as well as the emotional turmoil can be very difficult for a family involved in such a case.  Here is an article from Newsmax in which this picture is examined.

Bobbi Kristina Brown Suffered No Pain at the End: Doctor

Breathing Trouble or Trouble with Breathing?

Language is a difficult issue when it comes to medicine, and so much of what a physician learns about a patient's problems are through the words used in describing the issue.  One might say "shortness of breath" or "trouble with breathing" or the medical term "dyspnea," and they all have different nuances of meaning.  The task is to accurately communicate the problems that the person is having, because the range of pathology that can affect the ease of breathing is incredibly broad.  Here is just one look at the topic, in the Scary Symptom post:

Shortness of Breath vs.

Trouble Breathing

Turn up or tune out your nose?

It seems as though it's common to "tune out" or ignore an irritating sound, whether background noise or music.  But can you do the same to an odor?  Understand that when you work in an environment with a background odor, you often don't smell it after a while, but that is called "olfactory fatigue," in which your nose kind of wears out for that smell.  Can you do that willfully?  And if not, why not?  Here's an article from Scary Symptoms that explores that situation.

Noise vs. Odor Sensitivity:

Which Should You Tune Out?

Gotta go when you run?

We looked at this question, and it's a real one, years back in medical school with an experiment involving all of us running around the block.  Some basic thoughts about an often observed phenomenon, from the Scary Symptom site:

Why Does Running Increase Urge to Urinate?

Is it a good twitch, or a bad twitch?

We all know the feeling.  You're sitting at your desk and a muscle twitches; your leg, your side, or even your eye.  What does it mean?  Might it be something terrible?  Here is an article from Scary Symptoms in which I help the author explore the facts behind the troubling twitch.

Muscle Twitching:

Why You Should Feel Good About Twitching Muscles

Number Nine Nods

Keeping with the billiards theme for now, I note the hitting of the 9000 view mark, about six weeks after we hit 8000.  Will it keep going at this rate or speed up?  Thanks to all of you who have viewed and shared my posts, and I look forward to posting more in the coming weeks.

Bush falls - Are you in danger?

The recent fall at home of President George H.W. Bush and his subsequent injury highlights the danger that older individuals face in their most familiar surroundings.  While we hope for a full recovery for our 41st President, there are many other seniors that need to pay attention to this event, and look around to be sure that they remain safe.  Here is an article from Newsmax which looks into this picture:

George HW Bush's Broken Neck

Spotlights Home Fall Dangers

Supplements ... my thoughts and advice

No doubt about it, dietary supplements are big news, and big business.  You’ll hear about various supplements when you are at the gym, around the coffee pot at work, in various columns in the newspaper, and in endless commercials and advertisements.  They are touted as providing near infinite benefits with no risk nor side effects by celebrity pitchmen, and come in a dazzling array of products and forms.  Where did they come from, and are any of them worth the money, sometimes a lot of money, that they cost?

I’m old enough to have been practicing before many of the most popular current prescription pharmaceuticals were developed, and in those days various supplements were often used as a form of treatment.  While I don’t feel that they are nominally potent enough to deal with severe or significant issues, they are typically accepted by patients who fear medications.   Using such products which have been found to be safe, they may, in fact,  provide benefits to a number of patients.  Whether those benefits are based on pharmacologic effectiveness or acceptance and internalization of anecdotal reports of the products’ effects, such benefits can be useful for many in need.  Having a patient acknowledge that there is an issue to be treated, even treated with a supplement, may act as a stepping stone to further therapy if desired goals are not reached.

The most effective supplement I use would have to be Vitamin D, which really is a critical nutrient which is deficient in a significant number of people.  Adding either over the counter or prescription doses of Vitamin D clearly benefits these patients.  Although bone density is a clear marker used with Vitamin D, there are many studies which have suggested much more widespread effects of the vitamin.

In addition, I am likely to look favorably to the use of Glucosamine/Chondroitin products in patients looking to help with knee pain, and have pointed out to those expecting more global relief that there is a some evidence to support such use.  Unfortunately, there is also a growing body of work that points to flaws in former proofs. In addition, studies highlighted in some consumer magazines have pointed out that many preparations of Glucosamine/Chondroitin do not contain the amount of active product advertised on the label.  This may be true for other products, as well, and a word to the wise should be taken under advisement.

And then there’s melatonin.  Although some years ago, there were concerns about trace contaminants in some formulations, this no longer appears to be the case, and melatonin for the most part appears to be a safe product that can be useful for sleep disorders.  It has been used both to induce sleep, as well as to help reset sleep after travel, helping with jet lag.  A businessman patient of mine related to me that he was able to use melatonin with his cross-country flights to lessen the jet lag of the flight, allowing him to be more productive at work.  

If you are looking at supplements, fish oil always seems to bubble up to the surface.  Widely used in years past for a variety of ailments, the product has come under fire lately, with real questions raised as to whether or not the supplement form of fish oil, in capsule, tablet or liquid form, can improve one’s health.  There are studies, though, that say that fish oil that is still in the fish -- eating fish three times a week -- is clearly a healthy thing to do.  Certainly, constraints on types of fish with regards to mercury or other concerns, within reason, may come into play; but it is likely healthier to eat fish than take the processed oil contained in a capsule.  After all, there are many more nutrients in fish than just that oil.

Further, many supplements in popular use, such as Creatine, Vitamin C, mixes of B vitamins, general use of multiple vitamins, caffeine or ginko infused products, or those multi-element mixes often marketed for muscle building or weight loss do not hold any place in my medicine cabinet.  While there are many spokesmen pushing these products, including high profile television doctors, there is no convincing evidence that they offer any positive effect and may, in some cases, do quite the opposite.

Yes, there are micronutrients, also called phytonutrients, in plants, and they are good for you.  But rather than taking a supplement with several hundred of them, better to eat the fruit or vegetable which has them all, numbering in the scores of thousands.  Besides, it’s less expensive and tastes better!

Please understand that these are my beliefs and opinions, and others are free to differ with me, and probably do.  As always, consult your physician or healthcare professional before starting or stopping any medication or supplement, and understand that we are all unique, and what is good for one person may not help another.  Ask questions, look at the evidence, and act in the best interest of your health.

© 2015 - Marc I. Leavey, M.D. - Baltimore, MD - All Rights Reserved

Fast asleep .. or asleep fast?

For many people, turning out the light and slipping into bed is enough to whisk them off to a good night's sleep.  Others are not so lucky.  There are some simple tips to pay attention to and changes in behavior that can help promote a restful night.  Here is a little article with some of my thoughts:

How to Fall Asleep Fast

Weighing the needs, many or few ... or one?

The ethics of medicine, now perhaps more than ever, are coming front and center into medical practice.  How do we approach a patient with serious disease, whose treatment may consume valuable resources?  How do you balance the patient in front of you with those yet to be seen?  These are tough questions, but real ones in today's world.  Here is a Friday Feedback piece from MedPage Today where five professionals, and I am one of them, look at the issue:

Balancing Patient Care and Public Health

I don't want to rib you, but ...

So there are those that think this is a problem:  women's ribs showing when they exercise.  Truth is, sometimes yes, sometimes no, but there is more to say to flesh out this question.  So have a look at this article from Scary Symptoms that looks at the issue of visible ribs:

A Woman’s Ribs Showing Doesn’t Mean She’s Too Thin!

Sometimes a nosebleed is a nosebleed

Blood is scary, and when it's coming out of your face, even more so.  Our friends at Scary Symptoms asked me a question about the association of nosebleeds with leukemia which, apparently, is something that people worry about all the time.  I can understand the concern, if you take your mind down that path.  So, here is a piece I pretty much wrote for them to address the concern ...

Normal Nosebleed vs. Leukemia:

Is There a Difference?

If Dents not enough...

So here is the other article about muscle dents.  You know, I never knew this was really a problem, but many of my patients who work out have told me that this kind of angst really does fly around the locker room.  So look folks, take a deep breath, engage your sense of reason and logic, and read this:

Benign Calf Dent or Muscle Atrophy:

Your Last Article!

Dents not the end of the story

A bit ago, the Scary Symptoms website carried an article with my comments about "dents" that athletes may see in limbs with well developed muscles.  Apparently, this causes anxiety in some folks, thinking that they have some terrible disease.  Well, here's a little more on the subject, from the same website, with a little more content and explanation of the issue:

ALS Anxiety, Muscle Atrophy and Twitching

Conquering This Stress

Vomiting with Vigorous Exercise

Here's another of those Scary Symptoms to help stop you from worrying and thinking that you have some unknown disease.  This post is about the not too infrequent situation of vigorous exercising, lifting weight, running or the like, followed by vomiting.  It turns out, your body it just trying to be itself.  Read about it at:

Nausea, Puking from Lifting Weights:

Advice from Doctor

... and I guess I don't have to tell you whom the doctor with the advice is?

An old Maxim surfaces

Last year, Maxim magazine had posed a bunch of rather far out questions to me.  Although many were published in the magazine, some were not, and the magazine reportedly changed its format and is no longer featuring the "ask the doctor" type question.  So, when a friend sent me a link to the South African Maxim site, I did a double take!  Check out this informative column!

Why Does Scaring Someone Cure the Hiccups?

Just in case this link goes down ....

Why Does Scaring Someone Cure the Hiccups?

-Marcus Sims

Marc I. Leavey, M.D at a medical centre in the USA, breaks it down, “When your diaphragm is having spasms that produce hiccups, a good, swift stretch, such as that produced by the involuntary gasp from a scare, often is enough to break the cycle.” Now, if you can tell us our financial future, chances are our hiccups will be gone for good.

String of Medical Pearls is Blog of the Month!

My thanks to Melissa Ibarra of the Blog Blog for naming this blog the Blog of the Month.  That's more blogs than a sentence should permit!  Here's her posting, with the interview we did about my little corner of the Internet:

June 2015 Blogger of the Month

Is it a good stitch or a bad stitch?

I have recently been approached by a writer at the Scary Symptoms website to have a medical look at, well, scary symptoms.  You know, these are the thoughts that pop into your head when something happens and your first thought is if you finished your will.  But, more likely, it is something much more innocent.  Check out this first entry:

Lower Stomach Pain From Running Could Be Serious

and watch for more to come.

The magic 8 ball?

This is really just another little marker post, denoting the passing of the 8000 view mark some six weeks after passing 7000.  There are more posts in the queue, just need time to make them all nice and readable for you.  Thanks to all who stop by, and please wander around the neighborhood; you might stumble on something that is meaningful to you.