Browsing: Medicine

Treatment for Minor Lacerations

Immediate treatment is necessary for all kinds of abrasions, cuts and lacerations. It is important to seek professional medical advice because if the wound is not properly rated, the person can become susceptible to various kinds of infections or have long-repeating scars. Certified clinicians often give you the quickest response so that you do not have to wait outside an emergency room for hours to get medical attention. Depending on the injury and how deep the wound has penetrated, the wound can be classified either as an abrasion, a cut or a laceration.

Difference between Abrasions, Cuts and Lacerations

An abrasion is the most minor of the three injuries. It is a wonderful wound that simply scrapes off the skin and does not penetrate deeper than the epidermis layer of the skin. A cut is an injury which goes deeeper than an abraction and usually causes bleeding from the wound. Major cuts which are more violent are called lacerations. A few points to keep in mind about the three include:

Abrasions can usually be treated at home by cleaning the wound and letting it heal. Major cuts and lacerations need medical attention .

All three must be cleaned and antibiotic must be applied immediately to prevent infection .

Medical professionals should be visited immediately to prevent infection and scarring .

Primary Treatment

The first thing to do when you get wounded is to clean the wound properly. First clean out all the mud or debris which is stuck to the wound. Do not use soap inside the wound since it may react. If the wound is still bleeding, use a clean piece of cloth and apply pressure on the wound to stop the bleeding. It is also advisable to keep the wound elevated so as to prevent further bleeding. Once the bleeding stops, clean the wound properly and apply an antiseptic or antibiotic cream to the wounded area in order to prevent any infection.

Further Treatment

If you suffer from a cut or laceration, ensure that you visit a doctor immediately. Even if the bleeding has stopped, it is necessary to get the wound cleaned professionally so that you do not suffer from any future scarring. A clinic or hospital will clean the wounded area completely and also use saline to irrigate the area so that there are no infections. Major cuts and lacerations may also need to be stitched up or closed with glue or tape. Since it is essential that these decisions are only taken by medical professionals, visit the certified establishment as soon as the person gets wounded.

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How to Heal a Meniscus Tear

Before the proper treatment of a meniscal tear can be recommended by a physician, a proper diagnosis must be made and confirmed. The symptoms of a meniscus tear include pain and swelling of the knee joint. These symptoms are also common in cases of arthritis and ligament and / or tendon tears. A physical examination in the clinical setting as well as diagnostic imaging will be the first step in determining if a meniscal tear is present. The most common clinical diagnostic tests to be administered by the physician or designated allied health care provider are the McMurrary test, Apley grind test, and the bounce home test. All three of the tests are accomplished by the physician manipulating the knee joint with flexion and extension of the leg. Positive meniscus tears will cause pain and possible “clicking” sounds while the movement occurs. Radiological imagining is the next step to a proper diagnosis. An MRI scan is the most accurate imaging when looking for soft tissue abnormalities. For patients that have some metal implants, pacemakers, or spinal cord or nerve stimulators, etc., a CT scan is the next best diagnostic imaging test that can be performed. Once a positive clinical diagnosis is made and the diagnostic images confirm the clinical findings, a treatment can be recommended.

What Are The Treatment Options For A Meniscus Tear ?:

The degree of aggressiveness when approaching the treatment options is based on the extensiveness of the meniscal tear. Meniscal tears are classified based on the anatomical region of the meniscus that is affected and how deep into the tissue the tear occurs. Medial meniscal tears occur on the inside of the knee. Lateral meniscal tears occur on the outside of the knee. Horizontal tears occurs in the front part of the knee and run parallel with the tibial plateau (knee end of the tibia). Radial tears occurs at the center of the “C” shaped structure and go across the middle dividing the meniscus. Oblique or meniscal flap tears can occur at any part of the meniscus but are most likely to be found in the ends of the “C” shaped structure. Complex or degenerative tears include more than one tear and are typically gradual over time as opposed to a specific event causing an acute tear. The degree as to the amount of the tear is classified by partial thickness (does not tear completely through the structure) and full thickness tears (completely tears through the entire thickness of the structure).

How to Treat a Meniscus Tear with Conservative Management:

In almost all cases of a meniscus tear conservative management (non-operative) is the first treatment option. This treatment involves steroid knee injections to reduce infection and swelling, physical therapy for six to nine weeks, and wearing a knee brace in everyday life to help take some of the load off of the joint while the body has a chance to repair the tear on its own. Patients that have symptomatic meniscus tears can expect a 50% chance of full resolution of pain and symptoms with conservative treatment. The steroid injections reduce the inflammation and swelling of the knee joint. Some of the pain can be reduced from these injections as well. This can allow for more productive physical therapy appointments. The physical therapy can assist with realigning the body mechanisms with respect to movement. This will also stop the knee joint from freezing up and will reduce soreness. Physical Therapy is administrated by a licensed Physical Therapist. A list of exercises are performed by the patient concentrating on stretching and moving the knee joint in a controlled fashion under the supervision of the physical therapist. Some of the exercises can evoke a pain response. Careful consideration must be acknowledged while performing physical therapy to avoid further damage to the meniscus tear. The knee brace will protect the joint and reduce load weight while the body repairs the meniscus lowering the chances of re-injuring the healing tear. The body repairs the meniscus by way of a collagen layer that is regenerated inside the tear.

How to Treat a Meniscus Tear with Surgery:

Patients that fail to respond to conservative treatment must consider surgical options to pursue achievement of a reduction in pain and symptoms associated with a meniscal tear. The majority of tears that need this next step are typically advanced in the severity of the tear or have an abundance of scar tissue around the tear that has preceded the proper collagen tissue from being deposited. Traditionally open knee surgery was the only option available for partial or full meniscalectomy (removal of the meniscus) surgeries. State of the art standards of care now include arthroscopic surgical intervention options. The goal of all surgical options is to relieve pain and symptoms associated with the meniscal tear. Choosing the correct surgical option is based on the severity and location of the meniscus tear.

How to Treat A Meniscus Tear With Arthroscopic Surgery:

Advances in arthroscopic procedures have allowed the meniscus to be surgically repaired by the use of a camera and endoscopic surgical instrumentation. These surgeries are typically performed outpatient at a surgery center. The most common surgery is an arthroscopic meniscal “shaving” technique. A scope is inserted into the knee joint and then the joint is filled with a saline solution. The scope is connected to an intra-operative television monitor allowing the surgeon to view the inside of the knee joint. Next a shaver is inserted into the knee to shave off scar tissue and the jagged edges of the tear. Again this will allow the body to heal the tear with collagen. More extensive surgery is needed for some full thickness and or broken pieces that are 'free floating.' For these extreme cases the use of a grasper is needed. The surgeon will insert the grasper into the knee joint in the same fashion as the shaver. Once the broken or floating piece of meniscus cartilage is identified the grasper can clinch it and the instrument is dropped from the knee removing the broken specimen. More extensive arthroscopic surgery techniques may include partial removal of the meniscus and / or arthroscopic suturing of the meniscal tear. These techniques are performed with the same set up and instrumentation. Closure is minimal only requiring a few sutures to close up in most cases only two or three small inclusions measuring 4 mm.

How to Treat a Meniscus Tear with Open Knee Surgery:

Open knee surgery is the most extensive and invasive form of meniscus surgery and is used as a last resort. Patients that fail to respond to arthroscopic surgery or have extremely damaged meniscus will require open knee surgery in hopes of achieving a reduction of pain and symptoms associated with meniscal tears. This surgery is usually performed inpatient requiring at least one night in the hospital.

To expose the knee joint an incision from an inch or so above the patella (knee cap) to an inch or so below the patella. The patella is moved to the side with retractors and then the surgeon will flex the knee exposing the interior of the joint. From this approach a significant portion of the meniscus can be visualized and removed. If the entire meniscus needs to be removed a meniscus transplant can be performed. A fresh meniscus is surgically recovered from a cadaveric (false) tissue donor. The donor is tested for communicable diseases such as HIV, HEP B, HEP C, Syphilis, etc. The transplant graft is pre-sized based on the recipient's needs. The new meniscus is anchored with metal screws and synthetic monofilament sutures. Infection and biorejection are the leading causes of failure for this surgery. The best results for this surgery have been reported on patients less than 40 years of age.

Lastly, for patients that fail to respond to open meniscus surgery or for elderly patients that have severe meniscal damage due to arthritic changes a total knee arthroplasty (knee joint replacement) is the final step. This surgery is performed with the same exposure technique. The ends of the tibia (shin bone) and the femur (thigh bone) are carefully reshaped with an oscillating and then fitted with metal implants that are cemented on. A synthetic plastic spacer is used to replace the meniscus. Closure of this incision that typically measures 6 inches will take several sutures.

How to Treat a Meniscus Tear Postoperatively:

Once surgery is completed rehabilitative physical therapy is required along with a knee brace. It is important for the knee joint to be rehabilitated with the proper movement so that normal body mechanics can be realigned. Returning to normal body mechanics will ensure that the joint will function in the normal capacity and re-injury is reduced.

For arthroscopic patients the postoperative physical therapy exercises are similar to conservative management physical therapy. Usually only a couple of appointments are needed with the physical therapist for training the patient. The patient is encouraged to perform the daily exercises at home once they have been trained how to perform them. Typically this regiment lasts for 6-9 weeks depending on how the patient responds to the post-operative treatment.

Patients that undergo open knee surgery can expect a more stringent form of postoperative physical therapy. In addition to general flexion and extension exercises, the patient must perform walking and mobility exercises as well. Although some of the exercises are performed at home the patient must go to multiple physical therapy appointments at the physical therapists facility. The physical therapist will closely monitor the progress and communicate the findings to the patient's physician. This postoperative physical therapy program can last from 12-16 weeks depending on the progress of the patient.

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Post Nasal Drip Bad Breath: Remedies and Best Medicine

Do you suffer from post-nasal drips? Have people around you already pod you about having bad breath? Post nasal drip is one of the major causes of bad breath. It often leads to Halitosis, a condition that occurs due to post-nasal drip. When a person suffers from post nasal drips, the glands in throat and nose start to produce thick white colored mucus. The accumulation of mucus leads to halitosis that can be pretty embarrassing for the sufferer. According to American Academy of Otolaryngology, there are a number of reasons for occurrence of post-nasal drip. These can include flu, breathing dry air, eating spicy foods, allergies, as well as bacterial infections. If you have been suffering from bad breath, there are specific ways that you can use to cure it. Follow the below tips to get relief from post nasal drip bad breath.

Drink Fluids

The first and most effective remedy is to keep your body dehydrated. Drink plenty of fluids like water, coconut water, fresh juices and smoothies to balance your body's pH levels. Fresh water serves as a natural cleanser that cleanses your mouth and mucus at the back of the throat. You should also indulge in 1-2 cups of green tea to get rid of accumulated mucus in your throat. Once your throat becomes clear, the halitosis will also disappear.

OTC Medications

Use over-the-counter medications like antihistamines or nasal congestion to reduce the production of mucus in your nose and throat. These medications should help you get relief from the symptoms of post nasal drip, also eliminating the incompetent-smelling breath.

Use Humidifier

Moisen the air using a humidifier. A good quality humidifier will add appropriate moisture to the air which brings you from having upper airway cough syndrome and bad breath. You can use them in different corners of your home, to ensure that you get fresh and moist air to breathe, as breathing dry air aggravates the problem.

Avoid Spicy Food

Since bad breath is related to post-nasal problem, it is important to eliminate the condition by focusing on food habits. Spicy food aggravates nasal secretions which lead to halitosis. Avoid eating spicy foods if you are too much sooner to upper airway cough syndromes.

Brush and Floss

Brush your teeth, along with tongue every day. Flossing should also be a part of your daily rule. This should help you clean out the mucus and bacteria causing unpleasant-smelling breath. Use good quality toothpaste and brush your tongue and teeth for about 2-3 minutes twice a day to clear the mucus.

Eat Mint or Refreshing Gums

Eating mint whenever you feel you have halitosis should give you temporary relief. Eating mint or refreshing gums stimulates saliva production that cleanses your mouth. You can also use OTC available saline nasal sprays to moisten the nasal passes. This will help break nasal secretions.

If the condition persists for a very long time, consult your doctor. He will prescribe you some quick relief antibiotics to resolve your post nasal drip bad breath condition. Follow the above tips and you should be able to live a free life without feeling embarrassed in your social circle.

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5 Tips to Improve the Physician/Patient Relationship

For doctors that have their own practice, the relationships with patients are everything because without them, there is no work. After all, it is a business, and if you have dissatisfied patients, then that's essentially the end of your career.

Creating a rapport with patients and improving your relationship with each of them can be a challenge for many doctors, especially in this age where the number of people seeking medical care is steadily increasing. Many doctors and medical professionals have grown weary of the workload, which has left them stressed out and overwhelmed. This can add even more tension to interactions between doctors and patients.

As a physician, what can you do to improve your relationship with patients? Here are 5 tips:

1. Manage expectations. Patients expect quality care from their medical providers, so it's your duty to provide that care to the best of your ability and maintain communication at all times. Create a culture of open communication between you, your staff, and patients so people know what to expect from each other. Each patient comes from different backgrounds and have their own idea of ​​what good patient care consists of.

2. Make sure you and your collections are on the same page each day. Stress to staff members the importance of prioritizing the patient relationship. Have regular meetings to discuss concerns or issues that need to be addressed. What things can be done to improve the experience of each patient?

3. Take a deep breath. In our busy culture you can easily get cooked up in a fast pace, but taking a deep breath is a great way to relax, plus it helps you be in the moment and gives you the ability to focus on the patient in front of you instead of worrying about what needs to be done next.

4. Build trust through transparency. Transparency means that every interaction flows from a belief of being open, honest, and truthful. Being honest with staff and patients can make a huge difference in preventing medical malpractice. Be truthful about the risks and benefits of providing medical procedures and what is happening through the process of care.

5. Be nice. One may assume that this is common sense, but you would have surprised how many doctors forget this simple rule. Remember why you went into the medical field in the first place. Have fun and enjoy the journey.

What tips would you add to improve the doctor / patient relationship?

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Enjoying The Health Benefits Of Medical Marijuana

Recreational marijuana and its legalization may be driving many people to try this treatment option, but the fact is that the medical use of cannabis is not something new. The use of this plant for treatment purposes can be traced to ancient times when marijuana was prescribed for digestive problems, pain relief and even psychological disorders, just to mention a few conditions. There are proven health benefits that can be traced to several of the active ingredients that are in marijuana.

The different forms

When you decide to try medical marijuana, you need to know that it is available in different forms. The product can be smoked, ateen in an edition version or ingested in pill form. You can get the product in any form that appeals to you. While to some people the pill makes the process feel more medical, others prefer to smoke it while many more prefer the marijuana added to cookies, brownies or chocolate bars. Marijuana in pill form is called nabilone or dronabinol.

The different ailments

Medical marijuana can be used to treat a wide range of ailments such as nausea, chronic pain, the effects of several progressive diseases as glaucoma and multiple scleroses. A medical marijuana investment is worth making if you are suffering from psychological disorders like PTSD or post-traumatic stress disorder. Medical marijuana is often used when treating patients going through chemotherapy as it helps to relieve nausea and vomiting.

Treating eye conditions

Medical cannabis has been used for several years in the treatment of glaucoma. This is an eye condition that causes elevated eyeball pressure, and it can lead to blindness. It is important to know that while marijuana may help to reduce the intraocular pressure, the fact that it needs to be consumed several times in a day can cause the mood-altering effects. Critics argument about the plants effectiveness, especially considering the impact on the user's ability to function effectively.

Stimulating appetite

One of the effects of marijuana use is appetite stimulation. Cannabis users find that they get a case of the “munchies” after smoking. This quality has made it the obvious solution for patients who have HIV or AIDS or other medical conditions that cause a suppressed appetite.

Marijuana can relax muscles that are tense, making it an effective treatment for patients with conditions like MS and other types of muscular disorders. Medical cannabis is thought to offer an effective treatment for people with neurological disorders like Parkinson's. It is also effective in reducing psychological stress by treating mood disorders, sleep disorders and post traumatic stress disorder.

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Using Medical Marijuana To Treat Different Conditions

The use of marijuana is becoming more acceptable in many medical circles as evidence shows that it helps in the treatment of different illnesses. After the legalization of cannabis in some locations, more and more people are beginning to give the plant a new look. The health benefits of Medical Marijuana have become evident. Many protinent medical experts have come out in support of the plant in the treatment of different conditions.

Slowing down Alzheimer's progression

According to studies, there has been an increase in the number of people suffering from Alzheimer's. This has led to renewed interest in looking for medical solutions. The legalization of marijuana is seen by many as providing hope for those who show signs of early afternoon Alzheimer's. Marijuana contains properties that can block the enzyme that is responsible for the progress of the disease. It also helps to prevent protein clumps, which can affect memory and cognition.

Stopping the spread of HIV through the body

People living with the virus can benefit from marijuana. Research carried out on monkeys has shown that the active ingredient present in cannabis was instrumental in stopping the spread of the HI- Virus. This THC ingredient, when received in daily doses, leads to more healthy cells in the body. This is good news especially considering the fact that the plant also helps to improve appetite. People living with the virus can reap from the medical benefits of the plant.

Slowing down spread of aggressive cancer cells

Studies have shown that a compound present in marijuana can stop cell metastasis in certain forms of cancer. Similar studies have also shown reductions in cell vitality when there is a presence of leukemia cells. The reductions occur at different cell cycle phases, and this means that people at different stages of the disease can receive the benefits. According to some reports, researchers have used compounds found in marijuana to kill the cancer cells, providing relief for leukemia patients.

The effective pain relieving qualities

The most common use of the product is as an effective pain reliever. The plant's anti-inflammatory and pain relief qualities have been effective in the treatment of a wide range of conditions and illnesses including migraines, multiple sclerosis and rheumatoid arthritis. The effects of cannabis are much more powerful than those of regular pain relievers such as aspirin. The medication can help to reduce dependence on most opiate-based drugs that tend to have highly addictive qualities.

Other benefits of marijuana include treating anxiety, depression and ADHD, and it can also help patients with other forms of neurological damage, including strokes and concussions.

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The Surgical Procedure, Reasons And Restrictions Of Liver Transplant

Liver transplant is a surgical procedure that involves the replacement of a diseased liver with a healthy one. Donated ones can be obtained from donors who have died recently and have not had organ injuries. These types of donors are called cadaver donors.

Alternately, donated livers can be obtained from healthy and willing persons. A healthy person can donate part of his / her liver. These types of donors are called living donors. The living donor's liver then grows again in time, with both the donor and recipient ending up with a working one after a successful transplant surgery.

  • Surgical procedure

Healthy livers should perform over 400 tasks daily, including making protein required for blood clotting; making bile that helps with digestion; storing fats, iron, sugars, vitamins and copper; and removing / changing medications, toxins & bacteria in the blood. A surgeon often removes a new one from the donor through surgical cuts in the upper part of the abdomen.

The donor liver is kept in a cooled saline (salt-water) solution that helps to preserve the organ for 8 hours. All the necessary tests are then performed to match donors with the recipients. The donation is then placed in the patient who requires the donation (ie the recipient). It is then attached to the bile ducts and blood vessels, with the operation taking about 12 hours. Recipients often require large amounts of blood through transfusion.

  • Reasons for liver transplant

Transplants are done for different ailments. Biliary atresia is a common reason the procedure is performed in children, while cirrhosis is a common a reason transplant is performed in adults. Cirrhosis involves the scarring of liver, which inhibits it from functioning right, leading to most organ failure.

Long-term alcohol abuse and long-term hepatitis B or C are the main causes of cirrhosis. Other conditions that can cause cirrhosis or liver failure include thrombosis (hepatic vein blood clot), medications or poisoning, autoimmune hepatitis, haemochromatosis, Wilson's disease which results from metabolic disorders of iron or copper and problems with the liver's binary tract.

  • Restrictions

This procedure is not recommended for people who have a history of cancer or patients with infections like osteomyelitis or tuberculosis. If you have a life-threatening disease, such as liver, lung, or heart disease, a transplant may not be recommended for you. Furthermore, people with various infections like hepatitis, or persons with risky lifestyle habits such as drug abuse, alcohol consumption, and smoking may not undergo a transplant.

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How to Master Human Anatomy and Physiology

Human anatomy and physiology are often the bane of the college or medical school student's existence. The sheer amount of details one must master can cause the head to spin. However, learning A & P is a must if you intend to go into the human sciences or the field of medicine.

This article is a review of a possible solution for serious students who are considering their learning options. The Human Anatomy and Physiology Course by Dr. James Ross, is a complete self-study course that leads college and medical students states it will give you everything you need to know to excel in this complicated subject, including secrets that are not typically taught in traditional classes.

Dr. Ross' course contains tremendous depths of learning, but presents the course material in a way that is easy to follow and to master in one's home or dorm room. The included study guide presents topics in a dynamic, highly memorable fashion. Ross' course description states that you even have fun while you learn.

The course takes you from the microscopic, chemical level of the human body, to the macro regions that make up human anatomy, giving the student a comprehensive education.

Dr. Ross claims that the study of the human body should be a joy rather than a drudgery, exciting rather than dreary. Many students dream of having a life of work in medicine or the sciences, only to find themselves struggling at the very beginning of their training.

There is no need for you to drop out, or to give up the rest of your life, in order to succeed in this area. Dr. James Ross has done the organizational and planning work for you. He is dedicated to helping students of all ages reach their career dreams by offering a dynamic, simple-to-use study course that will keep you on track to reach your goals.

The best way for you to know if this course is for you is to check it out and see. Good luck to you as you pursue your career goals.

The course is suitable for anyone with an interest in the subject, such as high school science students, medical students, university students, nurses, medical practitioners, and even attorneys who work leads them into the medical world.

The Human Anatomy and Physiology Course delivers more than 3,000 pages of illustrations, study sessions, classes, tests and answers. The course description states that you will receive everything you need to know to move ahead in your class, including “idiot proof coverage” of every region of the body. The lessons have been field tested to ensure that you are receiving top quality training.

Check out the course to see if it's for you. Good luck as you pursue your career dreams.

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Concierge Medicine In America

As our American population ages and the impact of healthcare reform continues to be felt, navigating the medical landscape is only getting more complex for employers and patients. There will be an even greater need for healthcare advisory services in the coming years as patient choices grow more complex and access to appropriate clinicians becomes increasingly difficult.

Now enter, Concierge Medicine and Direct-Pay healthcare options. Consumer and patient interest is also at an all-time high as more and more prosepective and curious patients are starting to enroll in concierge medicine and direct-pay practices. Baby Boomers and Generation X now represent more than half of the US consumer population utilizing such an old-fashioned delivery model of healthcare in modern America.

A mass-market variant of Concierge Medicine, distinguished by its low prices, Direct Primary Care (DPC) is also quite popular by many Gen Xers and the Boomer population. Due to much smaller patient panels than traditional primary care and insurance-based medical practices, DPC doctors say they spend more time with patients discussing treatments, procedures, prescription use and other healthcare options.

Similar to its older familial medical model, Concierge Medicine, Direct-Pay doctors frequently promote the fact that they can provide “unhurried appointments” and same-day access to a physician. Most Direct-Pay medical clinics and doctors with price points under $ 100 per person per month are slowly gaining traction in the highly competitive healthcare marketplace in the US Direct-Pay Medicine's strength has not been in the number of physicians signing up to change their business model but in the low monthly fee they charge their patients.

Initially, Concierge Medicine and Direct-Pay doctors were mostly operating in primary care and family practice. The latest data reported by the concierge medicine industry trade journal in 2014 reports that there are an estimated 12,000 Concierge Medicine and Direct-Pay practices nationwide in 2014. While these figures differ somewhat from analysis touted in the media and quoted by other organizations, their number representations primary care and family physicians plus a wide range of Concierge Medicine and Direct-Pay healthcare specialty practices in the US In 2011, there started to be a growing number that practice in secondary Concierge Medicine specialties including: pediatrics; general surgery; psychiatry; spinal surgery; gynecology; dentistry; cardiology; addiction medicine; dermatology; oncology and more. These specialty practices usually offer the same immediate access, longer appointments, and a proactive health focus similar to primary care concurgeon practices. Some also offer home visits. Specialists usually limit their practices to a smaller number of patients 150-300 compared to the more typical 300-750 patients for primary care. They also tend to have patients who have chronic conditions.

Recent industry changes along with the implementation of the Affordable Care Act bringing a sudden influx of recently insured lower-income patients to the doctor's offices. Primary care and family medicine doctors are listing their prices in menu-like fashion and offering affordable healthcare services and discounts on laboratory tests and examinations for a fraction of the cost seen in most traditional, insurance-based, managed care medical offices. The trade journal found that approximately two-thirds charge less than $ 135 a month on average . This figure includes primary care, family medicine, osteopath and various specialty clinical practices.

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Balancing a Caring Medical Philosophy With Business Realities of Running a Viable Physician Practice

We recently were asked to help a Podiatrist who ran his own practice to develop a business strategy to survive in our new healthcare world. This Podiatrist loves what he does for a living and enjoys spending time with his patients. He was very surprised to discover the new financial realities of practicing medicine and running a practice to generate enough income to pay himself, his staff, malpractice insurance, and other basic office expenses. Below are 4 lessons that helped to transform the practice to be financially sound as well as continue to practice medicine with a focus on the patient.

1. Seeing the Right number of patients. The Podiatrist, who enjoyed the personal contact he had with his patients, was seeing about 15 patients a day. He was surprised to learn that some of his competitors were seeing 50-60 patients per day in order to pay their bills. He agreed that he would need to see 25 patients each day in order to achieve his financial goals.

2. Understanding the CPT billing codes and reimbursements rules. The Podiatrist was very unhappy to find out that his average collected fee per procedure was only $ 37 (after large contracted discounts with insurance companies and Medicare). A large volume of his visits was toe nail trimmings for a diabetic population that only netted him $ 24 per visit. On the higher end of his fee schedule, the amputation of a toe netted him $ 248. He looked at the report and had a brief (and a little remorseful) reflection on the years he spent in medical school to be alerting these low fees per procedure. He realized that he needed to pay more attention to how much he was spending on each procedure and the mix of CPT coded procedures he was providing (while not amputating every toe he trimmed a nail on).

3. Selecting a good billing company. The billing company that the Doctor used was not meeting the needs of his practice. Sending over a chargeable procedure / visit was like shooting something into a black hole and hopping a few dollars coming out the other end. There was little transparency on what charges were made for the week / month, which ones were actually paid, and what the balances were. While the Podiatrist needed a Partner in a billing company who would coach him on the latest reimbursements policies and be an advocate for collections, he was instead being provided with sloppy service with very little transparency. He needed to make a change.

4. Organizing the staff to serve a higher volume of patient visits. The Podiatrist realized that in order to go from seeing 15 patients per day to seeing 25, he needed to get his two assistants on board with his Plan. They needed to adjust the scheduling of patient visits, carefully mange the patient flow through the 3 exam rooms, and maximize the effectiveness of the Doctor by doing anything that they can do so the Doctor did not have to. His time was at a premium and needed to be managed accordingly.

The result was that this 1-physician practice is now on a path to grow by more than 80% and allow the physician to earn a higher salary. The practice has an emerging air of efficiency while still practicing sound medicine in a caring environment.

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Heart Ablation

Basically, a partial heart removal includes utilizing a catheter that generally enters your thigh the distance up to your heart. In this catheter, a wire is embedded which sends electrical driving forces through the catheter to your heart, helping to control your heart's “mood”.

“Remove” intends to destroy. Subsequently, a partial heart removal would intend to destroy a piece of the heart. This is a bit of a misnomer, being that as it may, as in a heart removal method, none of the heart is crushed. Rather, a finer similarity is that it is rendered ineffectual, or deadened, by the electrical signs produced from the anodes set on the tissue shares of the heart.

Ablation is a somewhat new kind of system. It is superior to the conventional routines for treating arrhythmias which included to a greater degree a genuine pulverizing or uprooting bits of the heart that are in charge of the arrhythmia.

A few types of heart arrhythmia can be controlled through medicine. Nonetheless, different types of arrhythmia do not react to pharmaceuticals. In addition, drugs commonly do not cure the issue, and the measurement and the medicine must be changed intermittently in order to control the issue.

Catheters typically have no less than one terminal at the distal end of the catheter which is adjusted to convey vitality to the affected tissue. Different terminations could have been proximally located on the catheter and utilized for sensing endocardia indicators. Removal may be accomplished by the requirement of electrical vitality, for example, radio frequency (RF) or immediate current (DC) vitality, from a generator source, through a channel arranged inside the catheter, and to the distal terminal.

On the off chance that you must have a partial heart removal procedure, do not stress you are not alone. Numerous individuals experience the ill effects of this condition. Notwithstanding, if left untreated or treated inaccurately, the consequences could have been serious, including the likelihood of cardiovascular failure.

It is vital that you are endowed with the consideration of a quality group of people to evaluate you medication choices. Defer in looking for medication is the most obvious reason for death from heart removal.

Ablation is a methodology that can redress heart beat issues (arrhythmias). Removal typically uses long, adaptable tubes (catheters) embedded through a vein in your crotch and strung to your heart to redress structural issues in your heart that cause an arrhythmia.

The process works via scarring or obliterating tissue in your heart that triggers a strange heart cadence. In a few cases, removal keeps unusual electrical indicators from going through your heart and, strangely, stops the arrhythmia.

Cardiac ablation is frequently done through open-heart surgery, although its regularly done utilizing catheters, making the method less obtrusive and shortening recuperation times.

Heart removal is otherwise called cardiovascular removal.

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The Basic Functions of Ophthalmoscope and Otoscope

Ophthalmoscope is the instrument used by the doctors and ophthalmologists to examine the eye including its internal parts. Usually it is designed to examine the back of the eye-socket, which is known as fundus. Since it is the tool which is used to see the fundus it is also called fuduscope.

This instrument is of two types: Direct and indirect. A direct Ophthalmoscope is a device which you can hold with your hands and it is used to magnify the inside of an eye. It is the most common type available. Usually it is small. On the other hand, an indirect Ophthalmoscope is larger in size and is worn on head. It is connected with a lens to view the inside of an eye when a detail view of the inside is needed.

Function of Ophthalmoscope:

• At first, turn on the device and check the batteries.
• After that, bringing all the numbers of the instrument to zero position.
• While using Ophthalmoscope you need a very low power light, not necessarily a pitch black room.
• The patient who eye is to be tested can wear contact lenses but he / she have to remove glasses, if they have one.
• The patient should look at a particular point at your back.
• Now hold the Ophthalmoscope to your eye and look through the flat eyepiece of the device to the patient's eye. You are now able to see the red reflex of the back side of the eye.

The Ophthalmoscope magnifies an eye 15 times more than the normal size and makes it possible for you to view the detail of optic nerves, optical disc, retina and the crystal like eye lens. Doctors commonly use it to check the veins and eye nerves without performing surgery.

The instrument used by the doctors to check the small passes of ear, nostrils and upper part of throat with some change is known as Otoscope.

Function of Otoscope:

There are two main parts of the Otoscope. A handle and a head. A funnel-like speculum is attached to the head to examine the ear cavity. There is also a magnifying lens and light attached to the head to illuminate as well as magnify the small passage to examine.

For examination, the specific of the Otoscope is inserted inside the ear and the light and the attached lens enlarges the canal to check the eardrum. Otoscope is commonly used to examine tympanic membrane of the ear. There is also a bulb-like attachment which can used to puff air inside the ear to check the presence of any excess fluid or other related ear problem. The procedure to examine the nostril and upper throat is also same.

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What You Need To Know About Free and Low Cost Prescription Drugs

In these tough economic times, everyone is on the lookout for free and low cost prescription drugs. Although, drug stores are in business and want to make profits, it's common to find some of them offering the free and low cost medicines.

There are a number of reasons why the stores give these medications:

Good will

Most of the stores are usually well known and appreciated in their communities; therefore, they offer the free medications as a sign of giving back to the community.

Loss leaders

Loss leaders are items that are usually required in large numbers. For example, milk and ground beef. Since they are required in large amounts, the items tend to be cheap.

Although, the items are usually priced low, they tend to make up the difference by attracting customers who go to the stores and buy other things (that are usually highly priced).

Many drug stores tend to offer some of the most thought after medications at low prices so that the customers can go to the stores and buy other expensive drugs.


For you to benefit from the free medicines you have to give up a bit of your personal information. For example, you have to give up your name, address, phone number, email address, insurance information, and even your security number.

This information can be corrected from the pharmacy counter, or from an affinity card (such as an Rx discount card). The pharmacies tend to combine the corrected information and develop profiles. The information can also be used to generate mailing lists.

Although, you might see as if the stores do not benefit from their offers, the truth is that they benefit veryly.

Although, the free and low cost medications are very good, there are some things that you need to remember:

• You require a doctor's prescription for you to get the drugs

• Some stores offer over-the-counter medications which may require a prescription for you to qualify for the low pricing.

• Some stores offer limited quantities while others have end dates for their offers.

• You need to coordinate the drug's name with the doctor's office for you to be sure that the prescription is written for the appropriate drug.

Although, many stores may offer free and low priced antibiotics, you should avoid taking them anyhow. This is because antibiotics have been shown to be responsible for superbug infections and many deaths.

Before you go looking for the low-cost-drugs you should first check with your insurance company (if you have one). This is because it might be cheaper to get the medications through your insurance plan.

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Everything You Need To Learn About Creatine Research

Creatine is perhaps the most researched supplement of the decade. There have been a number of case studies and researches conducted on creatine monohydrate and its effects on the human body. Creatine research has proven that:

1. Creatine is safe to be used in healthy individuals who are above 18 years of age;

2. Creatine is used to enhance performance in athletes;

3. Normal individuals can benefit from taking 2 to 3 g doses of creatine daily.

Let us take a look at some of the researchers conducted on creatine.

Research based on creatine as a performance enhancing supplement

Research has shown that creatine is definitely effective in enhancing your overall performance. It works well on those who perform high intensity exercises like weight training, sprinting, etc. According to Paul Greenhaff, a professor at the University of Nottingham, take of creatine may cause you to gain weight. Initially, it will be water weight but later on, convert to lean mass because of the high intensity exercises which you will be performing due to take of creatine.

Creatine works by absorbing water from the body to form creatine phosphate, which in turn synthesizes ATP molecules, which are responsible for providing the human body with short bursts of energy. Hereby, research conducted on creatine as a performance enhancer is based on fact rather than fiction.

Creatine as a supplement for those suffering from muscular dystrophy

Since creatine increases the muscle mass of the body, research is being conducted on it being beneficial for those suffering from muscular degeneration. Creatine indeed has a therapeutic effect on such individuals. One study was conducted on people suffering from muscle problems; each individual was provided regular doses of creatine. It was seen that their muscle functions improved after some time.

Research on creatine as a supplement to prevent neurological disorders

Recent research has shown that insufficient energy levels may lead to degeneration of brain cells. People who body can not maintain active reserves of ATP may suffer from neurological disorders. Therefore proper dosage of creatine might help restore several impaired brain functions.

Creatine benefits people suffering from Parkinson disease

People who suffer from Parkinson's have reduced muscular coordination, decreased lean mass and generally suffered from bouts of fatigue. Creatine helps improve the body's muscle mass, provide energy and less fatigue, therefore it can be used as a health supplement for people suffering from Parkinson disease.

Creatine for people suffering from heart disease

It is assumed that creatine helps lower the level of triglycerides in the body, theby promoting general heart health. A study conducted on people suffering from heart failure was seen to have a marked improvement in individuals who combined regular medical care with proper creatine dosage. It was seen that these individuals had more energy to perform gentle exercises, which were beneficial for their heart. Creatine supplied them with enough energy to work out and improve their overall health.

With so many studies being conducted on creatine as a supplement which promotes general health, it can be assumed that creatine promotes health and regular small doses can help in maintaining a healthy body.

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Recurrent Episodes of Acute Kidney Injury in a Kidney Transplant Recipient

A 59-year-old man who had undergone orthotopic heart transplantation developed calcineurin inhibitor nephrotoxicity, which led to a false donor kidney transplantation. Five years later, he presented with an increase in serum creatinine level from 1.1 mg / dL (corresponding to an estimated glomerular filtration rate [eGFR] of 71 mL / min / 1.73 m2 calculated by the CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equation) to 3.2 mg / dL (eGFR, 19 mL / min / 1.73 m2). He had no urinary symptoms, but reported discomfort in the abdomen and back after working on his boat. On physical examination, his kidney transplant was not readily palpable, but a bruit was audible. Urinalysis showed proteinuria (3+) and hematuria (4+), as well as 3-5 granular casts, 2-3 white blood cells, and occasional tubular epithelial cells per high-power field. Kidney biopsy and ultrasonography were performed. Spontaneously, urine output increased with a marked improvement in serum creatinine level to 1.2 mg / dL (eGFR, 64 mL / min / 1.73 m2), and he was discharged. He was readmitted a month later with abdominal pain, vomiting, diarrhea, fevers, chills, and acute kid injury (AKI). Results of computed tomography (CT) of the abdomen and pelvis were consistent with transplant pyelonephritis. He was treated with intravenous fluids and antibiotics, although his urine culture remained negative. He was initially oliguric and his serum creatinine level peaked at 9 mg / dL (eGFR, 6 mL / min / 1.73 m2), but then improved upon resolution of his abdominal symptoms. Comparing the initial CT scan to a CT angiogram that was obtained 3 months later yielded the diagnosis.


1. What are the causes of late-sunset decreased transplant function?

Causes of late-sunset decreased transplant function (in which “late” is> 6 months after transplantation) can be grouped into prerenal, vascular, immunologic, infectious, and other intrinsic renal and urologic causes. Traditional causes of AKI, such as acute tubular necrosis, reduced kidney perfusion, and obstruction, remain important causes of late-adjusted decreased transplant function. Vascular causes include renal artery stenosis and thrombotic microangiopathy. Urologic causes include ureteric strictures, nephrolithiasis, and bladder outlet obstruction. Immunologic causes include late acute rejection and chronic transplant glomerulopathy. Common infectious causes of late-onset decreased transplant function include polyoma (BK) virus nephropathy and urinary tract infections. Intrinsic renal causes include calcineurin inhibitor nephrotoxicity and recurrent or de novo glomerular disease.

2. What were the biopsy and radiographic findings?

The biopsy specimen shown ischemic wrinkling of glomerular basement membranes, mild chronic interstitial fibrosis, and mild tubular atrophy. There was no evidence of tubulitis or tubular injury that would suggest interstitial nephritis, cellular rejection, or tubular necrosis. The spectral color Doppler ultrasound showed parvus tardus waveforms in the superior and inferior intrerenal sections. Ultrasound findings were concerned for renal artery stenosis, but this diagnosis did not fully explain the spontaneous improvement in symptoms and kidney function.

3. What is the diagnosis?

The patient has experienced torsion of the transplant kidney around her vascular pedicle. The CT angiogram shows the transplant kidney in the left pelvis, but in a different orientation than was observed in the CT performed during the second admission with AKI. The ultrasound findings of parvus tardus waveforms can be explained by kinking of the renal artery after the kidney had moved further into the pelvic cavity and away from the left external iliac vessels. It rotated 90 ° on its long axis to be oriented cephalad to caudad. This is an under-recognized vascular cause of late-adjusted decreased transplant function that to our knowledge has been described in only intraperitoneally placed transplanted kidneys. Review of the patient's surgical procedure showed that the kidney had been anastomosed to the left external iliac artery and then placed in an intraperitoneal position due to poor positioning when placed extraperitoneally.

4. What is the treatment of this condition?

Complete torsion warrants emergent surgical exploration and detorsion to salvage the kidney from total infarction. Episodic partial torsion with spontaneous detorsion (as in our case) should be managed by fixing the transplant to the anterior inferior wall (nephropexy), which eliminates the risk of recurrence of torsion of the kidney transplant.


Recurrent torsion of a transplanted kidney resulting in AKI.

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