Herpes Zoster in the Elderly

Everyone fears shingles. We all know of patients who develop shingles and many of whom continue to live with pain, often for years and years. The elderly are particularly vulnerable to this disabling disease and bare the burden of developing the neuralgia.

A vaccine is now available and recommended for patients over the age of 60 years of age. Reported in JAMA (Journal of the American Medical Association), Dr. Tseng and associates reported in January of 2011 (Volume 305, Number 2, ...

Continue Reading →

The Fish Oil Controversy


As we all know, fish oils have been met with great acceptance and encouragement. But, what do we know so far about their benefits? And what about the controversy surrounding their usage?


Fish oils have been praised for their ability to reduce heart events in patients known to have coronary artery disease, according to the American Heart Association. What is less clear is whether or not there is a benefit to individuals ...

Continue Reading →

Homocysteine and heart disease

homocysteineElevated levels of homocysteine (a breakdown product of an amino acid, methionine) can lead to inflammation of blood vessels, including coronary arteries. As a result, atherosclerosis (hardening of the arteries) may develop leading to heart disease. In addition, hyperhomocysteinemia is also associated with excessive blood clotting issues in veins. This can lead to other health issues such as deep venous thrombosis (DVT) and secondarily, to blood clots to the lungs (pulmonary ...

Continue Reading →

Lowering of LDL can impact coronary artery disease

ldl-levelsFrom Oxford University, published in online The Lancetthis November 8, 2010 is now reporting the following:
“Researchers say that each 1-mmol/L LDL cholesterol reduction reduces the risk of occlusive vascular events by about one-fifth, irrespective of baseline cholesterol concentration, which implies that a 2- to 3-mmol/L reduction would reduce risk by about 40% to 50%. The findings suggest that the primary goal for patients at high risk of occlusive vascular events should ...

Continue Reading →

Nasal Irrigation

Often patients of mine will hear of the benefits of nasal sinus irrigation in the management of chronic allergic sinus conditions. This post is to provide my patients with a link to a product often discussed in the office, called the NeilMed device, which may be a supplement to management of various sinobronchial conditions. An interested reader may wish to look at NeilMed website for further information.

In the November 15, 2009 edition of the American Family Physician by Rabago et al, ...

Continue Reading →

Prognosis in pulmonary hypertension

This graph is again used in my office to sit with patients who have pulmonary hypertension and discuss their own individual situation. This is not meant to be extrapolated to all patients and any discussion must be take into consideration the individual patient’s medical issues.


Continue Reading →

Loss of lung function

While chatting to my patients I find it helpful to refer to the graph shown below to help educating individuals about the decline in lung function in normal patients, cigarette smokers and in those people who quit smoking.

The purpose of this graph is to visually explain what may be predicted on the basis for those individuals who qualify for one or the other categories.




Continue Reading →

The cough that won’t go away

During the winter season one of the most common reasons to see a patient for a consultation is a cough that seems to last forever. In the past few years attention has focused on the resurgence of pertussis (Bordetella pertussis) in the adult population. Famous for the “whooping” cough association, this is not as common in the adult population compared to the younger people.

Pertussis is highly communicable between people and is most commonly seen in the late spring and early ...

Continue Reading →

Devices to help with mucous clearance

Several devices abound for helping patients with chronic bronchitis and productive coughing of mucous. Patients may experience difficulty expectorating the phlegm in their chest. While I am not endorsing any particular device, the following are devices that can be considered:
1. Lung Flute (by Medical Acoustics). medicalacoustics
2. Flutter (by Axcan Scandipharm, Inc) axcan.
3. Acapella (by Smiths-Medical).acapella

For more severe problems there are VESTS that can be used to strap onto a patient’s chest to provide percussive therapy ...

Continue Reading →

Sleep apnea: an opportunity to improve mental function

Patients who suffer obstructive sleep apnea (OSA) can go unappreciated and undiagnosed for many years. As a result there are consequences that these individuals may suffer: impaired brain function, cardiovascular disease such as hypertension, and many other problems as well.

The loss of brain function is particularly disturbing but news now suggests that this may be reversible with the use of nCPAP masks!

In an article published online on October 29, 2010 in the Journal of Respiratory and Critical Care Medicine the ...

Continue Reading →
Page 3 of 4 1234