Doc Talk

Autism

Monday, March 19, 2012

Autism spectrum disorders (ASDs) are a group of developmental disorders that cause lifelong difficulties with socializing, communicating and behavior. The term "spectrum" refers to the fact that some people have a few mild symptoms while others have severe symptoms. It affects 1 in 110 children.

How does autism develop?
It is not clear how or why autism develops. The general consensus is that autism spectrum disorders are a genetic disorder that affects brain development and impairs the development of social and communication skills.
There have been concerns within the general public about the safety of vaccination for children. These concerns include a relationship between vaccines and autism. Despite this concern, there is no scientific evidence that receiving these vaccines causes or increases the risk of developing autism. Studies that raised this possibility had significant weaknesses in their design.
Environmental factors such as toxic exposures before or after birth, complications during delivery and infections before birth may be responsible for a small percentage of cases. In children with a genetic predisposition, environmental factors may further increase the child's risk of developing autism. It is not currently possible to test a child's genes to determine if he or she is at risk for ASD.

Symptoms
Symptoms begin before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or older.
A person with an ASD might

• Not respond to their name by 12 months
• Not point at objects to show interest (point at an airplane flying over) by 14 months
• Not play "pretend" games by 18 months
• Avoid eye contact and want to be alone
• Have trouble understanding other people's feelings or talking about their own feelings
• Have delayed speech and language skills
• Repeat words or phrases over and over
• Give unrelated answers to questions
• Get upset by minor changes
• Have obsessive interests
• Flap their hands, rock their body or spin in circles
• Have unusual reactions to the way things sound, smell, taste, look or feel

Diagnosis
Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child's behavior and development to make a diagnosis.

Treatment
Currently there is no cure. Research shows that early intervention treatment services can greatly improve a child's development. Early intervention services help children from birth to 3 years learn important skills.

If you think your child might have an ASD or you think there could be a problem with the way your child plays, learns, speaks, or acts, contact your child's doctor and share your concerns.

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Cardiovascular Risk

Monday, March 12, 2012

Cardiovascular Disease is very common in Western Societies and affects the majority of adults past the age of 60 years old. Cardiovascular Disease can be divided into four major areas or diagnostic categories:
1. Coronary Disease – may cause heart attacks, angina or heart pain, heart failure, and sudden death.
2. Cerebrovascular Disease – manifests as strokes or mini strokes called TIA's.
3. Aortic Atherosclerosis – may cause aneurysms or a weakening of the walls of the thoracic and abdominal aorta.
4. Peripheral Arterial Disease – manifests by leg cramps with exertion and poor leg circulation.

The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults has determined the following to be the risk factors for Cardiovascular Disease:

Positive Risk:
Age – males 45 and over and females 55 and over and also females with premature menopause without estrogen replacement.
Family history of premature coronary heart disease – heart attack or sudden death before 55 years old in a male 1st degree relative or before 65 years old in a female 1st degree relative.
Current cigarette smoking.
High Blood Pressure: >140/90 (current recommendations state this should be <120/80.
HDL cholesterol < 40mg/dl. Negative Risk: HDL cholesterol >60mg/dl.

Many other factors are involved such as elevated LDL cholesterol, lifestyle factors such as exercise, diet, alcohol, and stress. Talk to your doctor to better determine your risk and formulate a plan to correct as many risk factors as possible.

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Diabetes Monitoring

Monday, March 5, 2012

Diabetes is very common. The estimated prevalence in the USA is about 7.5% of the population, and this is rising with the increased prevalence of obesity in the Baby Boomers and younger populations. Diabetes, if not managed, is associated with severe multi-system complications such as heart attack, stroke, end-stage kidney disease requiring dialysis, retinopathy, , blindness, foot ulcers and amputations. These complications alone currently account or about 14% of the US health care expenditures.

Diabetes is a disease that simply needs to be controlled. With tight control, most if not all of the complications can be avoided. The following are the recommended "tune ups":

Ophthalmologic Exam - This should be done at the time of diagnosis and then yearly. For Type I Diabetes which may be diagnosed in childhood, within 5 years of the diagnosis or age 10 (which ever comes first), then yearly.

Foot Examination – This should be done yearly. Advice about prophylactic foot care includes avoiding going barefoot - even at home. Test water temperature prior to stepping into a hot bath. Trim toe nails to the shape of the toe and do not cut the cuticles. Wash and check feet daily. Shoes should be snug and not too tight and customized for misshapen feet or if ulcers are noted. Socks should fit and be changed daily.

Fasting lipid profile – Yearly, unless there are abnormalities. If abnormal and/or on medication, labs are done as often as every 3 months.

HgbA1C – Every 3-6months, depending on how well controlled the Diabetes is. In general the goal is an AIC of <7%.

Urine Microalbumin – Yearly

Serum Creatinine – This kidney function test should be done initially and as often as every 3 months depending on medications and renal function.

Blood pressure should be checked on every visit and should be kept below 130/80 and below 120/75 if there is kidney impairment.

There is a lot of great information on a web site made for docs and parts of this may be accessed without joining - check it out @ http://www.uptodate.com/patients

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Bariatric Medicine

Thursday, March 1, 2012

Programs promising overnight results in weight loss can be very tempting! However, if it sounds too good to be true, it usually is. Weight loss takes effort, support and determination. Once you’ve lost weight, support for weight maintenance is just as important as losing it in the first place.

SBFMG’s Internist, Dr Tanya Arvan, is a member of the American Society of Bariatric Physicians

• Bariatric medicine is the art and science of medical weight management. The term is derived from the Greek word barros, meaning heavy.
• Bariatric physicians, or bariatricians, practice weight loss management by reducing body fat using an individualized approach designed specifically for the patient.
• If appropriate for the patient, bariatricians will work closely with surgeons who perform weight reduction surgeries.
• Physicians perform an initial patient consultation to determine treatment based on each patient’s history, physical examination, laboratory work and other appropriate testing, as needed. Other associated medical conditions are evaluated, and physicians determine if patients are ready to lose weight.
• Bariatricians use medical (non-surgical) methods for weight loss including dietary modification, activity/exercise prescription, psychological support, and medication (when appropriate).
• A variety of prescribed diets are designed to reduce hunger while you lose weight.
• Physicians review the potential benefits and risks of any medications that may be used during treatment.
• In many cases, with appropriate weight loss, previous medications used for other related conditions can be decreased or eliminated.
• Bariatricians are dedicated to supporting your weight management efforts by providing an ongoing maintenance program to suit your needs.
• The goals of becoming healthier and looking better are definitely achievable when a program designed by a skilled professional is implemented