Vertigo

Vertigo is the sensation of feeling like you or the place where you are of spinning around. The more intense the feeling the more it may cause you to also have nausea or even vomiting. In many instances vertigo occurs when you make a change in your position as from laying down to sitting up and then it subsides if you remain motionless. However, vertigo can occur with other conditions such as an infection in your ear or sinuses. If the vertigo is continuous, then it is likely due to a brain rather than an ear condition. It is important to see your medical provider or go to the closest Emergency Department to sort out the cause and get treatment. Often times this could result in receiving medication to relieve the symptoms or treat the cause until it ends.http://bit.ly/7O0d1R
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Vitamin D

Vitamin D has recently been recognized as an important co factor in maintaining bone health and preventing osteoporosis and possibly avoiding other health conditions. The primary sources of vitamin D include sunlight, foods that are fortified with it and vitamin D supplements.Some locations like Western Washington have as high as an 80 % incidence of vitamin D deficient residents due to lack of sufficient sunlight. Physicians can easily measure vitamin D levels with a nonfasting blood test and compare that to accepted norms. Treatments for this include getting as little as 15 minutes daily of sunlight, taking vitamin D fortified foods like milk, orange juice or egg yokes, liver,and oily fish. Unfortunately these same foods in the amounts needed to achieve sufficient vitamin D levels can increase the risks of cholesterol related heart disease. Similarly sufficient sunlight exposure without sunscreen can also increase the risk of skin cancer. The safest method to boost vitamin D levels is to take Vitamin D3 which is available over the counter at a minimum dose for adults of 1000 IU (International Units) daily and remeasure the level in the blood 8 weeks later. Your physician can then advise you if you need more vitamin D based on the new level in your blood until you achieve a therapeutic dose.Other health conditions linked to vitamin D deficiency may include hypertension, heart disease, some cancers, possibly multiple sclerosis, and inflammatory arthritis. http://bit.ly/9QWP6e
Simply seeing your doctor and measuring a vitamin d level and then taking that vitamin if needed can go a long way to helping you stay healthy.
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Preventing strokes

Strokes can be a devastating or even fatal event in anyone's life. Fortunately there exists strategies that can minimize or prevent that risk. Potential signs of a stroke such as unexplained or sudden onset of weakness involving the face, arm or speech or visual difficulties or severe headaches require an urgent visit to a stroke ready  Emergency Department. Threatened strokes or transient ischemic attacks can be treated urgently today in the same manner as chest pain due to a threatened heart attack if managed in a stroke ready Emergency Department that exists in most large cities such as Seattle http://bit.ly/bkQnuW

Treating hypertension, diabetes, taking an aspirin daily if safe, losing weight if obese, stopping smoking, exercising regularly and eating healthy can all markedly reduce the risks of having a stroke but require a long term relationship with a physician to assist people in managing these chronic problems. Focusing on strategies like these can help people live a better quality of life and enjoy the years ahead.
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Elective Surgery Decisions

Elective surgery decisions are important to get the intended benefit while minimizing risk. Before surgery write down and ask questions from your surgeon about the problem needing surgery and the anticipated result with specific information. Asking how many of the operation your surgeon has done, how long your recovery may take, what complications or risks could occur will make your decision easier. It can also help to make an appointment at least one week in advance of surgery with your primary care physician to learn about your fitness for surgery and update your health in general. Getting a second opinion from another provider who may approach your problem differently or who has more experience doing the operation will give you more information. It may be helpful to ask the surgeon, a medical subspecialist, or your primary physician about your health without doing surgery and medical or other alternatives.
Asking your primary physician about what medicines that you should stop prior to surgery and when to resume them will improve your outcome. Planning your surgery when you can get more help at home can speed your recovery.
Making an appointment to see your primary physician one month or more after leaving the hospital will enable you to get other problems that could occur after surgery addressed as well.

Surgery decisions coupled with preparations like this can help get you the best possible result.
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Travel Advice

Traveling can be exciting and fun but preparing for travel is important to avoid having medical problems interfering with your trip. The CDC is an excellent and very detailed source for advice wwwnc.cdc.gov/travel/

It is helpful to see your physician or a travel clinic at least 2 weeks prior to leaving the US to update your immunizations and get prescribed medications specific to places you are visiting. Asking your physician for sleep medication may help you to adjust faster to time zone changes and long travel routes. When you are packing for travel, bringing a carry on bag with all your medications in their labeled bottles will give you ready access to them. Consider packing powdered gatorade or another electrolyte substitute and peptobismol for a possible diarrheal illness which can shorten your sickness. Include Deet containing repellent for destinations where there are insect borne illnesses.

While abroad paying attention to avoid certain types of food such as raw vegetables, unpasteurized dairy products and inadequately cooked fish or meat can lessen illness. Try to give yourself adequate time to sleep and as the Italians suggest "La Dolce Vita"
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Getting more from your medical visit

When someone sees their physician there are things that can be done to get more from the visit. Write down the 3 most important things that you want to discuss and bring that list with you. Ask for written information about the answers that you receive. Bring someone with you if you need help understanding what the physician might say.Make another appointment to discuss any questions or results of tests done after the appointment. If you are seeing a Primary Care Physician, it helps to see that physician at least once yearly for a preventative examination. Ask that physician or their Medical Assistant if you can do lab tests fasting prior to your appointment so the results can also be discussed at your appointment. Bring other records with you to any appointments that you would like to discuss with your physician. Ask if you can make an appointment that lasts longer than the standard duration for 30 instead of 15 minutes for example.

Hopefully some of these preparatory things will allow you and your physician to get more accomplished with your next visit. http://bit.ly/dJbMwx

Lilacs

Spring brings many things to me in Seattle. Its harbinger is my birthday on March 6, then field lacrosse and shots at my backyard goal, more yardwork and now lilacs.
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Medical practice musings

I created this blog at the urging of my wife and children who are all ahead of me in using the web to learn from and communicate with the world around them.

I am a physician in private practice doing General Internal Medicine at The Polyclinic in Seattle. I have learned many things from my colleagues, family, friends but most of all the people in my practice that I serve. They are not only my patients but some of them have become dear friends.

The friendship part of the relationship has taken much longer for me to develop than for them. I feel many of them have wanted to become more than a patient to me but I have been slow to become a friend as well to them.

If any of this interests you, then I hope we can start to share more ideas about the many topics that medicine and my friends have taught me.

JohnMD
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