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Rahm Emanuel and reducing health care costs.

Posted on December 21, 2010 - 6:56pm

Rahm Emanuel said today city workers should take better care of themselves -- with City Hall's help -- as one way to  save taxpayers money by reducing health care costs.

Reducing Your Health Care Costs

To Kristen Mack, The Chicago Tribune, December 20, 2010

(The Chicago Tribune today released a Rahm Emanuel statement in which he promises to reduce City workers' health care costs by $500M, or 20%, with "... just 4 percent of the city’s workforce accounting for roughly 65 percent of the city’s health care costs...")

Iron deficiency anemia and clumping Platelets

Question: 
Iron deficiency anemia can cause a high platelet count but can it also cause platelets to clump?My Lab work said my platelets were clumped on my blood smear but appeared to be increased in number so  a manual differential in 8 weeks.  This is the second sample in two months to show clumping.

An increase in platelets is a reaction to the anemia. When the anemia is corrected, the platelet count then returns to its normal range. Complications (thrombosis and thrombo-embolisation)of "reactive thrombocytosis" are extremely rare, and require very high counts (>1 million).

What do my cardiac ECHO results mean?

Question: 
Can you tell me in layman term the findings of my 2D echo result showed as follows: Concentric left ventricular hypertrophy with segmental wall hypokinesia Adequate overall systolic function Doppler evidence of decreased left ventricular compliance Mildly dilated left atrium Compared to the study done last January 2010, the current 2d echo now showed segmental wall hypokinesia. the reset are essentially the same. What is the significance of this findings? Does it mean I am at high risk of stroke or coronary heart attack?

Please explain to me why you don't ask those questions of your doctor. The ECHO suggests the effects of a high blood pressure and likely coronary
artery disease. Why your left atrium is enlarged I cannot judge from here.

Improper and unnecessary procedures

It has been a while since I have written about improper and unnecessary stenting. Articles in response to a US Senate Finance Committee statement earlier this week have re-activated my concerns about both these activities and the growing industry efforts to influence medical care. The case involves a Maryland hospital, a local cardiologist and a stent manufacturing firm. Other cases against cardiologists in other parts of Maryland as well as in other states are in progress. Charges include stenting in patients without significant coronary artery disease, as well as industry kickbacks.

Do I need the supplement CoQ10 if I use a statin

Question: 
If my doctor prescribes a statin for me, do I need to take the supplement, CoQ10 also?

Coenzyme Q10 (CoQ10) is similar to a vitamin. It also functions as an antioxidant, and has been used (w/o) success) in the treatment of heart failure. The use of statins may reduce the CoQ10 in your blood and some recommend CoQ10 as adjunct therapy to statins, reasoning a likely benefit against very small risk.
I am reluctant to recommend more medications to treat the potential side effects of another. I echo the Mayo Clinic, "CoQ10 has been used, recommended, or studied for numerous conditions, but remains controversial as a treatment in many areas."
Hope this helps,
Dr T

Cardiac ECHO measurements

Question: 
We have some Cardiologists who dictate E:A ratio and some who also in the same report say E:A and later E:a, or E/A and E/a.  I've searched but don't find anything conclusive as to why anything else would be correct other than E:A or E/A.  Could I get some feedback please?  Thank you.

You must work in an ECHO lab! The E/A ratio is a cardiac ECHO measurement for the presence of "diastolic heart failure (DHF)":

What are the Top U.S. Hospitals for Heart Care

Question: 
If I decide to have an operation for my aortic valve problems what are the top hospitals for this type of surgery in the US?  

Your recovery depends on the type of surgery that most likely involves dividing your breast bone (sternum) to get to your heart. After the surgery, what needs healing is your sternum, about six weeks to three months, just like any other broken bone. If you lift weights in moderation, not to break the next world record, I see no reason why you should have any restriction.

Long Term Survival of Adenocarcinoma of the Esophagus

Posted on December 5, 2010 - 7:52pm

Carcinoma of the esophagus is a relatively rare but very lethal disease. 50% of all patients diagnosed will have adeno carcinoma, which has been associated with a very poor long term survival.

How dangerous is it to have Cancer of the esophagus?

This weekend I learned that in January one of my patients, Bill G, had passed away.  When I first saw him in 1983, he was referred to me as a last ditch treatment effort of what was thought to be an incurable disease: Carcinoma of the esophagus. At the time, very few surgeons in Northern New England were involved with this type of surgery; the operation had a high complication rate and even if successful, the survival afterwards was estimated at less than six months to a year. In fact, most physicians were so pessimistic about the survival chances that one of my colleagues recommended to my first patient to buy a gun, take one last walk on the beach at sunset and do himself in! He saw me with that one question, should he?

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