March 26, 2012 – What's Going Around ???

Case Cluster #1: Pancreatitis

Presentation: We saw a few cases of Pancreatitis this week. These cases presented with pain in the upper mid abdomen with a gnawing quality and soreness that radiated through to the back. All cases were associated with severe nausea, vomiting and anorexia.

Course and treatment: Pancreatitis is a serious medical disorder that on initial presentation often requires hospitalization. Patients are monitored closely for complications of Pancreatitis including metabolic abnormalities among others and are held NPO (nothing by mouth) to rest the organ. Pancreatitis can become a chronic condition that recurs particularly if the doctor orders are not followed.

Epidemiology: Pancreatitis is caused by a long list of things but most commonly alcohol abuse, lodged gallstones, and very high triglyceride levels. It is also associated with scorpion stings, something relevant to this area.

Prevention: The best way to prevent Pancreatitis is to limit or eliminate alcohol intake, see your doctor and have your triglyceride levels controlled so they are well under 500, and be evaluated for right upper quadrant abdominal pain especially after eating fatty food before a gallstone gets lodged. Dr. Arian recommends if you must drink alcohol, drink an 8oz glass of water for every alcoholic beverage that you have. Of course don’t play with scorpions or walk barefoot in the desert, and always empty your shoes well before inserting your feet especially when camping.



Case Cluster #2: Vitamin D deficiency

Presentation: Vitamin D deficiency can present with pathologic fracture following little or no trauma but is more often found on routine laboratory screening or bone density scan.

Course and treatment: Vitamin D is usually easily replaced by increasing sun exposure, increasing dairy foods in diet, or supplementing with a pill.

Epidemiology: Vitamin D is an important fat soluble vitamin. It serves to conserve calcium by decreasing renal loss and GI loss and by influencing the hormone in charge of the bone calcium pool, allowing calcium to be stored in the bone pool. If there is insufficient Vitamin D, then rather than get a net influx of calcium to bone, there is a net efflux of calcium from bone. What results is reduced bone density and pathologic fractures. A fractured hip has a high rate of mortality in the older population due to pneumonia and blood clots from inactivity. Vitamin D deficiency is seen in vegans who don’t consume dairy, those who don’t get enough sun exposure as in cloudy climes, lactose intolerant folks who avoid dairy, some GI diseases and some renal diseases.

Prevention: It is easy to prevent vitamin d deficiency. Sunlight catalyzes the reaction that forms vitamin d in the skin but of course raises the rate of premature aging of the skin, wrinkles and the risk of skin cancer. Increasing dairy products in the diet can help replace Vitamin D but those with high cholesterols beware. The easiest way is to replace it via an oral supplement. Vitamin D is dosed in the range of 200IU per day to over 800IU per day. BE careful because you can become toxic with too much so your doctor should recommend an amount to supplement.



Case Cluster #3: Anxiety

Presentation: We are seeing a very large number of patients who are reporting extreme anxiety, feeling overwhelmed, under enormous stress, poorly performing at work due to strain, trouble managing personal relationships, coming apart at the seams, and around the clock worry, some with panic attacks.

Course and treatment: Anxiety is usually first treated with conservative measures including elimination of all caffeine from diet, regular vigorous cardiovascular exercise if cleared by a doctor to do so, regular recreational activities and hobbies that make a person happy and content, limitation or elimination of alcohol and simple sugars from diet, a healthy nutritional balanced diet, and reduction of stressors. IT can be treated with medications but usually when acute and debilitating or as a last resort. See your doctor for an evaluation. Blood tests are sometimes indicated such as thyroid.

Epidemiology: Dr. Arian believes the bump in case numbers is due to the current economic and social milieu. These include: economic downturn and instability, unemployment rates, decreased compensation, reduced job security, foreclosures, loss or reduction of retirement accounts, troubled stock market, the high cost of gas, 24 hour news cycles and an election year.

Prevention: To prevent anxiety eliminate all caffeine and alcohol from diet. Alcohol does not treat anxiety; it merely hides it for another day. Maintain a healthy balanced diet and do vigorous cardiovascular exercise at least 45 minutes a day 5 days a week if cleared by a doctor to do so. Avoid simple sugars. Talk to friends, relatives or therapists about what’s worrying you. And most importantly, make a list. Make a list of all things that are stressors and separate them out into three categories, those you can change, those you can’t change, and those you need more info or time to decide if you can change them. Then, don’t worry about what you can’t change. That’s a waste of energy. Focus your efforts on trying to eliminate or reduce stressors you have control over and on the others that need to be decided if they can be controlled. Confronting a list of all your stressors is the first step in treating anxiety. This helps reduce a feeling of being overwhelmed.



Case Cluster #4: Nonspecific upper respiratory viral illness with secondary bacterial infections

We are treating a number of viral illnesses of the upper respiratory tract with sore throats and coughs productive to clear sputum that have then become secondarily infected with bacteria resulting in prolonged courses up to 3 weeks requiring antibiotics to finally quell the disease process.

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I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

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