How Emergency Medicine Physicians
Consumers’ Research Council of America has compiled a list of Top Emergency Medicine Physicians throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining Top Emergency Medicine Physicians.
Each year the EMP has been in practice
Education and Continuing Education
Member of Professional EMP Associations
Completing an approved residency program and passing a
Simply put, Emergency Medicine Physicians that have accumulated a certain amount of points qualified for the list. This does not mean that EMPs that did not accumulate enough points are not good health care professionals; they merely did not qualify for this list because of the points needed for qualification.
Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals whom they would recommend. We found this method to be more of a popularity contest, for instance: professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.
Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients from a particular physician on their satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.
We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, etc.
The Top Emergency Medicine Physicians list that we have compiled is current as of a certain date and other EMPs may have qualified since that date. Nonetheless, we feel that the list of Top Emergency Medicine Physicians is a good reference of qualified specialists.
No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, insuring an unbiased selection.
What is Emergency Medicine?
Emergency medicine is a specialty that diagnoses and treats conditions that require immediate attention. This may include accidents of any sort, illness, trauma, sports injuries, industrial and occupational accidents, poisoning, allergic reactions and heart failure.
Wikipedia states the following :
Emergency medicine is a branch of medicine that is practiced in a hospital emergency department, in the field (in a modified form – see EMS), and other locations where initial medical treatment of illness takes place. Emergency medicine focuses on diagnosis and treatment of acute illnesses and injuries that require immediate care. While not usually providing long-term care, EM physicians and pre-hospital personnel still provide care with the aim of improving long-term patient outcome. In the United States, some people use the emergency department for outpatient care that could be provided at a doctor’s office. As a result, much of emergency room care is general practice (coughs, colds, aches, pains).
A variant of an Emergency Department is an Urgent Care Center, often staffed by non-Emergency Medicine trained physicians and/or nurses, which treats patients who desire or require immediate care, but do not reach the acuity that requires care in an emergency department.
Emergency Medicine involves a large amount of general medicine but involves all fields of medicine including the surgical sub-specialties. Emergency Physicians are tasked with seeing a large number of patients, treating their illnesses and admitting them to the hospital as necessary. The field requires a broad field of knowledge and requires advance procedural skills often including surgical procedures, trauma resuscitation, advance cardiac life support and advanced airway management.
“Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”
Emergency Medicine as a standalone medical specialty is relatively young. Prior to the 1960’s and 70’s, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine and primary care. However, during this time period, groups of physicians mostly located in the Midwestern United States (notably Cincinnati, Ohio, and Denver, Colorado) recognized the need, and the niche, for physicians specifically trained to handle acute medical emergencies.
In the United States, the American College of Emergency Physicians (ACEP) is presently the largest member organization of emergency physicians (EPs), and is open to most physicians who practice in an Emergency Department. Originally founded in 1968, it was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP.
The American College of Osteopathic Emergency Physicians (ACOEP) was founded seven years later in 1975. Membership is open to both osteopathic (D.O.) and allopathic (M.D.) physicians who practice emergency medicine. Fellows use the designation FACOEP.
The American Academy of Emergency Medicine (AAEM) is another specialty society of Emergency Medicine. It was formed after ACEP and ACOEP and is considered a rival organization although both organizations have cooperated in the past. Members must be board certified in Emergency Medicine. Fellows use the designation FAAEM.
The American Board of Emergency Medicine (ABEM) provides board certification to allopathic (M.D.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional year of practice, passed a written exam, and then an oral exam.
The American Osteopathic Board of Emergency Medicine (AOBEM) provides board certification to osteopathic (D.O.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional two years of practice, passed a written exam, and passed an oral exam.
The American Board of Physician Specialties (ABPS) also offers Board Certification in Emergency Medicine (BCEM). This certification is offered to experienced physicians who have trained initially in other settings, and who have more than 5 years of emergency medicine experience and are certified in ACLS/ATLS courses, provide letters of recommendation and file case reports, as well as pass written and oral testing. The ABPS certification is controversial and not widely recognized as it allows non-emergency residency trained physicians to claim specialization in Emergency Medicine without going through a residency. The ‘grandfathering-in’ of other experienced non-residency trained physicians practicing emergency medicine was closed off from ABEM and AOBEM several years ago. Currently (as of 7/06), only the state of Florida has recognized “BCEM”, with the state of North Carolina affirmiatively rejecting the “BCEM” designation.
Board certification is maintained through annual testing over required reading lists and a more extensive written exam every 10 years (for ABEM).
Many types of physicians may practice in an Emergency Department; however, only those who have successfully passed the board certification process are considered “Emergency Medicine Specialists”. Currently the ABEM and AOBEM require a number of years of residency training after medical school, followed by comprehensive written and oral examinations. The BCEM requires (in addition to passing written and oral examinations) completion of an ACGME approved residency in an approved specialty such as Family Medicine or Internal Medicine, 5 years of the practice of emergency medicine, 10 Peer reviewed case reports, current ATLS/ACLS certification and 3 letters of recommendation from peers.
A sudden surge of interest in the specialty in the late 1990s was due to the popularity of the American TV series “ER”. Showcasing the function of a Chicago Emergency Department (loosely based on Cook County Hospital) and its many characters, the show introduced a large number of people to the specialty.
In the US, Emergency Medicine is one of the more competitive specialties to get into, and residency programs generally select physicians from the top of their medical school class. There are usually many physicians competing for each residency spot.
Allopathic (M.D.) emergency medicine residencies can be 3 or 4 years in length, combining both the internship and residency into one program or “1+3,” utilizing a separate internship followed by 3 years of Emergency Medicine. Osteopathic (D.O.) residencies are four years in length, requiring a one year traditional rotating internship followed by a three-year emergency medicine residency. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. By the end of their training, EPs are expected to handle a vast field of medical, surgical, and psychiatric emergencies. EPs are therefore both clinical generalists and well-rounded diagnosticians. EPs are considered specialists in advance cardiac life support protocols (‘codes’) and airway management.
The employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), or corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments).
Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department.
The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and requiring immediate attention. Emergency departments developed during the 20th century in response to an increased need for rapid assessment and management of critical illnesses. In some countries, emergency departments have become important entry points for those without other means of access to medical care.
Upon arrival in the ED, people typically undergo a brief triage, or sorting, interview to help determine the nature and severity of their illness. Individuals with serious illnesses are then seen by a physician more rapidly than those with less severe symptoms or injuries. Depending on resources, if the anticipated waiting time is particularly long, patients with minor symptoms may be directed to visit a primary care physician or outpatient clinic instead. After initial assessment and treatment, patients are either admitted to the hospital, transferred to a specialty hospital, or discharged. The staff in emergency departments often includes doctors and nurses with specialized training in emergency medicine. The emergency departments of large hospitals operate continuously and accept after-hours cases not seen by smaller hospitals.
Since a diagnosis must be made by an attending physician, the patient is initially assigned a chief complaint rather than a diagnosis. This is usually a symtom: headache, nausea, loss of consciousness. The chief complaint remains a primary fact until the attending physician makes a diagnosis.
A typical emergency department has several different areas, each specialized for patients with particular severities or types of illness.
In the triage area, patients are seen by a triage nurse who completes a preliminary evaluation, before transferring care to another area of the ED or a different department in the hospital. Patients with life or limb-threatening conditions may bypass triage and to be seen directly by a physician.
The resuscitation area is a key area of an emergency department. It usually contains several individual resuscitation bays, usually with one specially equipped for pediatric resuscitation. Each bay is equipped with a defibrillator, airway equipment, oxygen, intravenous lines and fluids, and emergency drugs. Resuscitation areas also have ECG machines, and often limited X-ray facilities to perform chest and pelvis films. Other equipment may include non-invasive ventilation (NIV) and portable ultrasound devices.
The majors, or general medical area is for stable patients who still need treatment that requires a gurney (trolley). This area is often very busy, filled with many patients with a wide range of medical and surgical problems. Many will require further investigation and possible admission. Patients who are not in need of immediate treatment are sent to the minors area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing.
A pediatric area for the treatment of children has recently become standard, to dedicate separate waiting areas and facilities for children. Some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.
The obstetrics area, for women before, during and after pregnancy, is usually a separate part of an emergency department and/or a separate part of a hospital. Women are often primarily seen by obstetricians in an environment where equipment is available for specialized care.
Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and psychiatry-trained nurses and psychiatric social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal). Emergency departments may also have a separately streamed service for minor and rapidly treatable conditions, such as minor injuries. The fast track may be staffed by emergency nurse practitioners and/or physicians, and special consultation rooms are specifically designated for this purpose. This system allows for quicker treatment of patients who may otherwise be forced to wait for more pressing cases to resolve. This part of the department may be called by several names e.g. Urgent Care Center or Primary Care Suite depending on the local emphasis. Where this type of service is provided on a separate site from the local ED it is called a Minor Injuries Unit.
In the United States an emergency department is often referred to as an emergency room (ER). Emergency rooms are actually departments of a hospital with many rooms. The ER interacts with every other department in the hospital and often represents a significant percentage of the hospital’s work load and finances. It is common for emergency department doctors to work for a company hired by the hospital to provide emergency services.
During the 1990s, an effort was made to change to the more accurate term emergency department (ED), which is a term increasingly used by members of the specialty internationally. The effort failed and ED never caught on among the U.S. public, perhaps because of the popularity of the TV show, “ER”, and the heavy marketing of the euphemism “ED” for erectile dysfunction by pharmaceutical companies. However, the term does have some circulation among emergency medicine physicians.
A smaller facility that may provide assistance in medical emergencies is known as a clinic. Larger communities often provide a drop-in clinic where people with medical problems that would not be considered serious enough to warrant an emergency department visit can be seen. These clinics often do not operate on a 24 hour basis, and visiting them is sometimes less expensive than going to the ED.
Patients arrive at emergency departments in two main ways: by emergency ambulance or independently. Ambulance paramedics or technicians notify the hospital beforehand if they are transporting a severely-ill patient. These patients are rushed to the emergency department’s resuscitation area, where they are met by a team with the expertise to deal with the patients’ conditions. For example, patients with major trauma are seen by a trauma team consisting of emergency physicians and nurses, a surgeon, and an anesthesiologist (anesthetist).
Patients arriving independently or by ambulance are typically triaged by a nurse with training in emergency medicine. Patients are seen in order of medical urgency, not in order of arrival. Patients are triaged to the resuscitation area, majors area, or minors area. Emergency/Accident and Emergency departments usually have one entrance with a lobby and a waiting room for patients with less-urgent conditions, and another entrance reserved for ambulances.
Critical Conditions Handled
Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic and advanced life support as taught in the Advanced Life Support and Advanced Cardiac Life Support courses. This is an immediately life-threatening condition which requires immediate action in salvageable cases.
Patients arriving to the emergency department with a myocardial infarction (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG; aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sublingual (under the tongue) or buccal (between cheek and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given.
If the ECG confirms an ST elevation myocardial infarction or there is onset of left bundle branch block this indicates complete blockage of one of the main cardiac blood vessels. These patients require reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolysis (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction. Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolysis if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty.
Major trauma, the term for patients with multiple injuries, often from a road traffic accident or a fall, is treated by a trauma team who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. Some other international training bodies have started to run similar courses based on the same principles.
The services that are provided in an emergency department can range from simple x-rays and the setting of broken bones to those of a full-scale trauma center. Emergency medical technicians often work as support staff in emergency departments under the supervision of nurses and doctors. A patient’s chances of survival are greatly improved if emergency care begins within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the “golden hour.”
Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma center. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport.
Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many U.S. states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. From the emergency department, patients thought to be mentally ill may be transferred to a psychiatric unit (in many cases involuntarily).
Asthma and COPD
Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD) are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have an urgent chest X-ray and arterial blood gases and are referred for intensive care if necessary. Non invasive ventilation in the ED has reduced the requirement for intubation in many cases of severe exacerbations of COPD.
Special facilities, training, and equipment
An ED requires different equipment and different approaches than most other hospital divisions. Patients frequently arrive with unstable conditions, and so must be treated quickly. They may be unconscious, and information such as their medical history, allergies, and blood type may be unavailable. ED staff are trained to work quickly and effectively even with minimal information. ED staff must also interact efficiently with pre-hospital care providers such as EMTs, paramedics, and others who are occasionally based in an ED. The pre-hospital providers may use equipment unfamiliar to the average physician, but ED physicians must be expert in using (and safely removing) specialized equipment, since devices such as Military Anti-Shock Trousers (“MAST”) and traction splints require special procedures. Among other reasons, given that they must be able to handle specialized equipment, physicians can now specialize in emergency medicine, and EDs employ many such specialists.
ED staff have much in common with ambulance and fire crews, combat medics, search and rescue teams, and disaster response teams. Often, joint training and practice drills are organized to improve the coordination of this complex response system. Busy EDs exchange a great deal of equipment with ambulance crews, and both must provide for replacing, returning, or reimbursing for costly items.
Cardiac arrest and major trauma are relatively common in EDs, so defibrillators, automatic ventilation and CPR machines, and bleeding control dressings are used heavily. Survival in such cases is greatly enhanced by shortening the wait for key interventions, and in recent years some of this specialized equipment has spread to pre-hospital settings. The best-known example is defibrillators, which spread first to ambulances, then in an automatic version to police cars, and most recently to public spaces such as airports and office buildings.
EDs usually have their own surgical facilities. They also require very fast laboratory work for blood-typing, measurements of drug levels in overdose, and so on, so they may have separate lab facilities, or first priority when using shared labs.
Emergency departments around the world are increasingly being used for non-emergency care because of overburdened healthcare systems. Many people, afflicted by minor injuries or illnesses late at night or at times when their doctor’s surgery is closed, are forced to resort to attending the ED. This is especially true for conditions with severe symptoms, such as a child’s ear infection. People in lower socioeconomic classes are more likely to require treatment for primary care ailments from EDs.
Poison is any type of substance that can cause harmful effects in the body. It has be estimated that millions of people are poisoned each year with the greatest at risk being children six years of age and younger. Each year poison control centers report over one million children under the age of six are exposed to potentially poisonous medicines and household chemicals.
Children will eat or drink just about anything regardless of taste. Children tend to be curious by nature and investigate and explore things by putting all sorts of items in their mouths. They can be attracted to items with colorful packaging, good smells and bottles or packaging in interesting shapes and sizes.
We suggest in being pro-active and take preventative measures to avoid any possibility of your child being poisoned. We have listed some tips for you:
The Most Dangerous Poisons for Children:
Ear infections include a wide range of diseases that can affect any of the ear structures. A middle ear infection— known as otitis media —is an inflammation or infection of the middle ear. This condition is most common in young children, because their Eustachian tubes—the tubes that connect the throat and the middle ear—are shorter, more horizontal, and more easily blocked than those in older children and adults. A middle ear infection commonly occurs along with or after a cold or other upper respiratory infection.
The space in the middle ear, behind the eardrum, is normally filled with air. Any buildup of fluid in the middle ear space is called an effusion. This fluid provides an environment that allows infection to develop.
This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. They can either be viral or bacterial infections. Seventy-five percent of children experience at least one occurrence of otitis media by the time they are three-years-old. Almost half of these children will have three or more ear infections during their first 3 years of life. Although otitis media is primarily a disease of infants and young children, it can also affect adults.
What if an ear infection is left untreated?
Not only will otitis media cause severe pain, but also, in rare cases, it may result in serious complications. An untreated infection can travel from the middle ear to the nearby parts of the head, including the brain. Any hearing loss caused by otitis media is usually temporary, but if left untreated, otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear and chronic otitis media can reduce a child’s hearing at a time that is critical for speech and language development. Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.
For an ear infection, treating the symptoms at home may be all that it is needed. Up to eighty percent of ear infections get better without treatment. If your child is under 2 years old and you think your child has an ear infection, take your child to a doctor. Antibiotics, however, are often prescribed to treat middle ear infections that don’t get better at home. Some doctors prescribe antibiotics to treat all ear infections, while others ask parents of otherwise healthy children older than 2 years to watch their child for a couple of days. And if the child begins to feel better within a couple of days, antibiotics may not be needed. If a child has not improved, antibiotics can then be started, and the infection usually clears. Children who are 3 years old or younger should have a follow-up visit in about 4 weeks—even if they seem well. If fluid behind the eardrum persists for 3 months, the child should have his or her hearing tested.
Flu Shots A-Z
The flu shot is an inactivated vaccine, containing killed virus, which is given with a needle, usually in the arm. It contains three influenza viruses. The three vaccine strains—one H3N2 virus, one A H1N1 virus, and one B virus—are representative of the influenza vaccine strains recommended for that year. Two weeks after receiving the shot, antibodies in your body will form and protect you from the virus.
When to get vaccinated
October or November is the best time to get vaccinated, but you can still get vaccinated in December and later. Flu season can begin as early as October and last as late as May.
Who should get the flu shot?
Basically, anyone who wants to cut their chances of getting the flu can be vaccinated. Certain people, however, should get vaccinated each year. They include:
|All children ages 6-23 months.|
|Adults and children 6 months and older with chronic heart or lung conditions, including asthma.|
|Parents with children with children older than 6 months.|
|People who are 65 or older.|
Who should not get the flu shot?
Some people should not get the flu shot without talking to a doctor first. These people include:
|People who have had Guillain-Barre syndrome.|
|People who have had a severe reaction to the vaccine before.|
|People who are allergic to chicken eggs.|
|The flu shot is not approved for people who are younger than six months.|
The ability of flu vaccine to protect a person depends on the health status and the age of the person getting the vaccine, and the similarity or “match” between the virus strains in the vaccine and those in circulation. Studies have shown that the flu shot is effective at preventing the flu.
What to expect
The virus in the flu shot is killed, so you cannot get the flu from it. Some minor side effects are:
|Soreness, redness, or swelling where the shot was given|
If these problems should appear, they will occur within one to two days after receiving the flu shot. Although most people who receive the flu shot have no serious problems, on rare occasions, people can experience severe allergic reactions.
Meningitis is an infection of the meninges—tissues that that offer protection for the brain and spinal cord. Microorganisms can invade the meninges and produce this life-threatening illness. Meningitis is a deadly illness that can produce long-term disabilities for those who survive. Meningitis results in swelling of the brain tissue and in some cases the spinal tissue. When brain tissue swells, it puts pressure on brain cells, which can kill the neurons and result in brain damage.
The infection occurs most often in infants, young adults between the ages of 15 and 24, and people who have a long-standing health condition, such as a weakened immune system.
Viruses, bacteria and fungi can cause meningitis. The seriousness of the infection and the best treatment depend on the cause of the infection. Bacterial meningitis is generally much more serious than viral meningitis, and quick treatment is necessary. The causes of most cases of meningitis are viruses.
The effects of meningitis can be severe. The longer you have the disease without treatment, the greater the risk of permanent neurological damage, including hearing loss, loss of speech, learning disabilities, behavior problems and brain damage, even paralysis.
What are the symptoms of meningitis?
High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. The onset of this illness is very rapid: It can take over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. As the disease progresses, patients of any age may have seizures. In small infants, symptoms may be hard to detect; however, some signs include: being inactive, very irritable, vomiting, or poor appetite.
Can meningitis be treated?
Bacterial meningitis can be treated with a number of effective antibiotics. However, it is important that treatment be started early in the course of the disease. Antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.
Viral meningitis cannot be cured with antibiotics, but most cases resolve on their own in a week or so without therapy. Mild cases of viral meningitis are usually treated with bed rest, plenty of fluids and over-the-counter pain medications to help reduce fever and relieve body aches.
Vaccination may prevent some types of meningitis. Vaccines help protect against the most common causes of bacterial meningitis—Streptococcus pneumoniae and Neisseria meningitides. Vaccines are recommended for people at high risk of infection. These include older adults and children and adults who have a weakened immune system, such as those who have an underlying serious illness.
Some types of meningitis are contagious. You may be exposed to the bacteria when someone with meningitis coughs or sneezes. The bacteria can also spread through kissing or sharing eating utensils, a toothbrush, or a cigarette. You increase your risk if you live or work with someone with the disease.
Washing your hands may be one of the best ways to stay well. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Try to boost your immune system by exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables, and whole grains.
A migraine (modification of late Latin hemicrania– “pain in one side of the head”) is a very bad headache that tends to recur. Migraine headaches typically last from 4-72 hours and vary in frequency from daily to less than 1 per year. Migraines seem to develop from overactive electrical impulses in the brain that increase blood flow and cause widening of blood vessels and inflammation. This activates pain signals and other symptoms, such as nausea. The more inflammation there is, the more intense the migraine. Migraine affects about 15% of the population. Migraine pain can be excruciating, and may incapacitate you for hours—even days.
Two to three times as many women as men have migraine, perhaps because the fluctuation of hormone levels is a key migraine trigger. The pattern of a woman’s migraines may be affected by her menstrual cycle and is often altered when she undergoes menopause. In addition, pregnancy or the use of oral contraceptives may change a woman’s migraine symptoms or frequency. More than 80% of people with migraines have other members in the family who have them, too.
What causes migraines?
A rapid widening and narrowing of blood vessel walls in the brain and head cause migraine headaches. This causes the blood vessel walls to become irritated and cause pain. Blood vessels in the scalp are often involved. Some of events that have been reported to causes migraine headaches include: hunger, changes in weather, nuts, fatigue, avocados, chocolate, menstrual periods, emotional stress, monosodium glutamate (MSG), and alcoholic beverages.
The use of other prescription anti-inflammatory drugs may be effective for some migraines. Migraine-specific therapies are designed specifically to treat migraine attacks.
Alternatively, there are a host of choices for patients whose headaches do not respond to the first line medications. These include calcium channel blockers, a variety of antidepressants and several other medications.
Taking a combination of drugs to prevent and treat migraine attacks when they happen helps most people with migraine to limit the disabling effects of these headaches. Women whose migraines attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.
Avoiding triggers—something that activates a migraine—may be an effective way to stop a migraine before it starts. Though they will not totally stop migraines, avoiding triggers will lessen the frequency of migraines. Migraines may be triggered by food, stress, and changes in your daily routine.
Some common triggers of migraines include:
|Consuming certain substances such as chocolate, monosodium glutamate (MSG), red wine, and caffeine.|
|Getting too much or not enough sleep.|
|Fasting or skipping meals.|
|Stress or intense emotions.|
|Strong odors or cigarette smoke.|
|Bright lights or reflected sunlight.|
All About Diabetes
Diabetes is a set of diseases in which the body cannot regulate the amount of glucose, or sugar, in the blood. Glucose in the blood gives your body energy. The pancreas is an organ that creates a hormone called insulin. Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel. When a person has diabetes, their body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in your blood.
There are approximately 20 million people in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, 6.2 million people, or nearly one-third, are unaware that they have the disease.
Type 1 diabetes is an autoimmune disease in which the immune system attacks the beta cells in the pancreas that make insulin. This makes the pancreas make less amount of make insulin, a hormone which helps turn blood sugar into energy. The cells become starved of energy and there is an excess of glucose in the blood. People with Type 1 diabetes must have daily injections of insulin to live. Proper diet, exercise and home blood sugar monitoring is essential to manage the disease. If your blood sugar level becomes very high, a life-threatening chemical imbalance called diabetic ketoacidosis can develop.
Type 1 diabetes can develop at any age. However, it usually develops in children and young adults, which is why it used to be called juvenile diabetes. About 5-10% of people with diabetes have type 1.
Treatment for type 1 diabetes focuses on keeping blood sugar levels within a target range.
Usual treatments are:
|Taking daily insulin injections.|
|Maintaining a healthy diet.|
|Monitoring blood sugar levels at home.|
|Getting regular exercise.|
People with type 1 diabetes can live long, healthy lives if they keep their blood sugar levels as close to normal as possible.
Type 2 diabetes is a lifelong disease that develops when the pancreas cannot produce enough insulin or when the body’s tissues become resistant to insulin. Insulin helps sugar glucose enter cells, where it is used for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.
When insulin is not available or is not used properly, blood sugar rises above a safe level. If blood sugar remains high for years, blood vessels and nerves throughout the body may be damaged. This puts you at increased risk for eye, heart, blood vessel, nerve, and kidney disease. Type 2 diabetes can develop at any age, although it usually develops in adults. Between 90-95% of people with diabetes have type 2.
Type 2 diabetes is caused by insulin resistance, which occurs when the body’s cells and tissues do not respond properly to insulin. An individual’s weight, level of physical activity, and family history affect how your body responds to insulin. People who are overweight, get little or no exercise, or have diabetes in their family have an increased risk of developing type 2 diabetes.
Risk factors for type 2 diabetes include older age, obesity, family history, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Pacific Islanders are at particularly high risk for type 2 diabetes.
What other complications can diabetes lead to?
|Heart disease and stroke: Heart disease and stroke account for about 65% of deaths in people with diabetes.|
|High blood pressure: About 73% of adults with diabetes have high blood pressure.|
|Blindness: Diabetes is the leading cause of new cases of blindness among adults aged 20–74years.|
|Kidney disease: Diabetes is the leading cause of kidney failure, accounting for 40% of new cases.|
|Nervous system disease: About 60-70% of people with diabetes have mild to severe forms of nervous system damage.|
|Amputations: More than 60% of non-traumatic leg amputations occur in people with diabetes.|
|Dental disease: Almost 30% of people with diabetes have severe gum disease.|
What is an Allergy?
An allergy is a reaction of the body to foreign substances such as dust, pollen, insect bites, drugs, animal fur, animal excretions, smoke, plants, feathers, cosmetics, chemical pollutants, and various kinds of foods. It is estimated that over 40 million Americans suffer from some type of allergies. It is common for people to think that they have a cold or flu, only to find out that they have an allergy. Many times the symptoms are very similar.
Symptoms generally include, watery eyes, sneezing, nasal congestion, itchy skin, rash and upset stomach. Most allergies are reactions to substances that are generally harmless. When your immune system reacts to an allergen that has been absorbed into the body, the body now treats the allergen as a harmful invader and causes the white blood cells to produce antibody molecules called Immunoglobulin E (IgE). When this series of events happens it causes the body to release Histamine, which can cause allergic symptoms such as watery eyes, sneezing and itching.
Diagnosis of Allergies
Allergies are diagnosed from the patient’s medical history, skin and patch tests to help identify the allergen. Physicians inject common allergens just below the skin in separate sections to see which substance is causing redness and swelling. This test determines which allergens the person is sensitive to.
Mold allergies are very common. The sources of mold in the home are found where there is moisture. Common places are in damp basements, closets, refrigerator drip pans, house plants, air conditioners, humidifiers, garbage pails, shower stalls, toilets, old foam rubber pillows, and plumbing leaks. Humidity promotes the growth of various molds.
Common Emergency Surgeries
Angioplasty is a procedure performed during a heart catheterization. The atherosclerotic blockages in the coronary arteries are compressed against the vessel wall by expanding a balloon from within the artery.The angioplasty procedure is an invasive method of opening blocked arteries that are restricting and impeding blood flow. When the balloon is inflated, the plaque blocking the interior arterial wall is compressed and remains compressed, clearing space so the blood flow volume can increase.
The angioplasty method is a less invasive procedure as compared to a bypass surgery. Angioplasty has less risk and the recovery period is much quicker. Your cardiologist will tell you if you are a good candidate for this procedure. The cardiologist will take into consideration your age, severity of the blockage and your overall physical condition.
Angioplasty procedures have been performed for the past 25 years. Results show that patients are doing better today because of advanced drug therapies and new advanced techniques that are better able to detect the exact locations of the blockages.
In the early 1990’s Surgeons started using stents. Stents are tiny wire mesh tubes which are inserted permanently at the location of the blockage. The use of stents have been highly successful in reducing the possibility of arterial collapse and the renarrowing of the artery which is called restenosis. Seasoned doctors who perform this procedure are able to install stents in one or more arteries with a high degree of success.
Coronary Artery Bypass Graft Surgery
Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patients legs, stomach or chest and grafting them to the front and back of the blocked arteries.
During a bypass procedure the heart-lung machine takes over the functions of the heart and lungs. This is done so the heart can be carefully stopped and the Surgeon can work in a blood-free environment. The heart-lung machine keeps oxygen-rich blood flowing through the body. It receives the blood and removes the carbon dioxide and other waste products, warms and/or cools the blood and adds oxygen as it pumps the blood through the patient’s body. At the conclusion of the bypass surgery, the heart is restarted and the heart-lung machine is disconnected.
New advances in bypass surgery are continuing. A minimally invasive bypass surgery technique is being tested with promising results. This new procedure requires the Surgeon to work on the front of the heart through a four inch incision while it is beating slowly. Another type is that the heart is stopped and a Surgeon uses a fiberoptic scope that is passed through a 4 ˝ inch incision and the Surgeon works on all sides of the heart by viewing a video image. This less invasive procedure would be less expensive and requires a much shorter hospital stay.
Each year over 500,000 Americans have gallbladder surgery. One type of gallbladder surgery is called a laproscopic cholecystectomy. It is used in 95% of gallbladder removal surgeries. The Surgeon inserts a miniature video camera and surgical instruments through tiny incisions in the abdomen. The video camera transmits images to a video monitor, giving the Surgeons a close up and detailed view of the various organs and tissue. While using the camera as his eyes, the Surgeon separates the gallbladder from the liver, ducts and other tissue. The cystic duct is cut and the gallbladder is removed through one of the small incisions.
Laparoscopic surgery is preferred since abdominal muscles are not cut. This results in a much quicker recovery and sometimes requires only one night in the hospital. However, an open surgery is sometimes required due to complications. They call this an open surgery because it requires an incision that is 5 to 9 inches long in the abdomen. This is considered a major surgery with up to a one-week stay at a medical facility.
Minimally Invasive Heart Surgery
Recent advances in surgical techniques and equipment allow surgeons to perform Coronary Artery Bypass Surgery in a less traumatic way. Minimally Invasive Coronary Artery Surgery is also called Limited Access Coronary Artery Surgery. It is as an alternative to the standard methods of Coronary Artery Bypass Graft Surgery. Unlike conventional surgery, which utilizes a 10-12″ incision and requires the patient to be placed on the heart-lung machine, new minimally invasive surgery may avoid placing the patient on the machine, and can be performed through a 3-5″ incision placed between the ribs, or may be done with several small incisions. Like conventional surgery, the surgery is done to reroute, or bypass, blood around coronary arteries clogged by fatty buildups of plaque and improve the supply of blood and oxygen to the heart.
Minimally Invasive Coronary Artery Bypass—also called MIDCAB—is used to avoid the heart-lung machine. It’s done while your heart is still beating and is intended for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes, or ports, in your chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision.
Benefits of Minimally Invasive Bypass Surgery
Minimally Invasive Bypass Surgery has the same beneficial results as conventional bypass surgery. It restores adequate blood flow and normal delivery of oxygen and nutrients to the heart. This type of surgery has additional advantages, including the ability of the surgeon to work on a beating heart or through smaller incisions.
|The procedure is performed in only two to three hours, compared to three to six hours for a traditional bypass.|
|The recovery time is dramatically reduced from months to days or a week. Complications associated with the heart-lung machine are avoided.|
|Due to less time under anesthesia, patients are moved out of intensive care more quickly.|
|Patients tend to experience less pain and discomfort.|
|There is a 25-40% savings of the cost of conventional surgery.|
|Lower infection rate: A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.|
|This surgery is available to more patients. Many patients are poor candidates for traditional bypass surgery because their illness is too widespread or their heart is too weak. Some patients are able to receive this life-saving surgery through minimally invasive techniques.|
Performing surgery on a beating heart is more difficult than working on a heart that has been stopped with the help of the heart-lung machine. In addition, the stress on the heart during the procedure may lead to more heart muscle damage, lower blood pressure, irregular heartbeat and potential brain injury if blood flow to the brain is reduced for too long during surgery. In some cases—usually less than 10 percent—it is necessary to convert to conventional methods on an emergency basis.
CT (CAT) Scan
Computerized Axial Tomography
A CAT-scan uses x-rays to create images of the body. The primary difference between an x-ray and a CAT-scan is that an x-ray is a two-dimensional image, as opposed to the three-dimensional CAT-scan image. The CAT-scan imaging technology and expertise of the radiologist can study several three-dimensional slices of the body. The images represent slices of the body and are approximately one centimeter per slice. The benefit of this is that a radiologist can not only see if there is a tumor in the body, but can also determine the depth and size of the tumor.
Another benefit of a CAT-scan is that the information generated is sent to a computer, as opposed to a standard x-ray on a flat piece of film. The data collected and sent to the computer can then be enhanced and viewed three-dimensionally.
CAT is an acronym for Computerized Axial Tomography. The term computerized indicates a series of various images that is combined into one three dimensional image by means of a sophisticated computer. The term axial indicates a series of cross-sectional x-ray images made along a specified body axis. The term tomography refers to a method for obtaining sectional views of the body that eliminate the x-ray shadows of the body structures before and behind the desired section.
When a patient is having a CAT-scan, they are placed on a table where the large coil of an x-ray tube is then rotated around the desired body part of the patient. Electrical sensors record the emerging rays as a pattern of electrical impulses that are fed into a computer and processed into a final single image. The image is stored in the computer and can be put on disc and viewed on a monitor.
A CAT-scan takes anywhere from fifteen minutes to one hour to perform. There is no pain and very little discomfort. CAT-scans have a reputation of being a simple and safe way to see inside the body.
Magnetic Resonance Imaging
MRI stands for Magnetic Resonance Imaging, a technology developed after CT scanning. This technology incorporates computer-controlled radio waves and very big magnets. These large magnets create a magnetic field so strong that it is over 25,000 times stronger than the earth’s magnetic field. Once operating, the machine creates the magnetic field, sends radio waves into the body, and measures the response of its cells. This measurement determines how much energy is being released from the cells. The data from these responses is routed to the computer where a three dimensional picture of the body is created.
Electron Beam Tomography
Electron Beam Tomography is different than a CT scan or MRI. This type of technology uses an electron beam that is focused on a tungsten target located beneath the body. EBT scans are very fast and can be taken in a 100 millisecond exposure time. The advantage of this is that no body motion such as a heart beat can interfere with the clarity of the image in a CT scan or MRI. This type of technology uses an electron beam that is focused on a tungsten target located beneath the body. EBT scans are very fast and can be taken in a 100 millisecond exposure time. The advantage of this is that no body motion such as a heart beat can interfere with the clarity of the image.
EBT scans can detect blockages of blood flow by looking for the amount of calcium in the blood vessels. This technology can detect lung cancer, tumors and other medical disorders.
Positron Emission Tomography
Positron Emission Tomography is yet another technology utilizing electronic detection of short-lived positron emitting radiopharmeceuticals. It is a non-invasive procedure that can quantitatively measure metabolic, biochemical and functional activity in living tissue. PET can measure chemical changes that occur before visible signs can be detected on other imaging techniques.
PET is a nuclear medicine technique that uses a radioactive tracer and hundreds of radiation detectors, with the assistance of a powerful computer to identify the biochemistry of internal organs. Patients are injected with minuscule amounts of radioactive tracers. The patient receives approximately the same amount of radiation as the would with a standard x-ray. The patient is then scanned with a special camera called the PET Scanner. The images are created three-dimensionally for viewing. These images are used to determine tissue function, rapidly growing tumors and to determine if prescribed treatments such as chemotherapy are working.
PET imaging is also used for the detection of colon cancer, lung cancer, heart disease, and even neurological disorders such as Alzheimer’s disease.