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Dr. Lloyd's blog has now been retired. We appreciate all the wisdom and support Dr. Lloyd has brought to the WebMD community throughout the years.

Monday, October 27, 2008

Med School: What’s in a Name?

There are 126 medical school in the United States and every one of them has a name. Most of the time the medical school name name is derived from the parent university. The medical school is just one of several ‘tenant colleges’ within the larger institution: business school, law school, veterinary school, etc. The Ohio State University College of Medicine is one such example.

There are 19 USA medical schools which have been named (or renamed) as the result of a gift, such at the Feinberg School of Medicine at Northwestern University. In 2002 a $75M donation made it all happen. Back in 1941 Wake Forest University cut the ribbon on Bowman Gray School of Medicine after a $750,000 act of philanthropy. 58 years later it was redubbed Wake Forest University School of Medicine to distance Wake Forest from Bowman Gray, the former president of R.J. Reynolds Tobacco Company. Change happens!

In the past decade alone there have been 10 renamed medical schools. The two largest transactions were for $200M each: UCLA’s David Geffen School of Medicine and New York’s Weill Cornell Medical College. I imagine the family members of these namesakes enjoy prompt appointments and convenient parking. Not jealous, mind you, just an observation.

Not every proposed cash branding deal makes it to the sign shop. The School of Public Health at the University of Iowa politely declined a $15M offer from for-profit health insurer Wellmark because of perceived ethical conflicts. Child advocates successfully blocked provocative teen apparel retailer Abercrombie & Fitch from staking out the emergency center at the Children’s Hospital in Columbus, Ohio. Their angry protest lamented, “Given the company’s appalling history of targeting children with sexualized marketing and clothing, no public health institution should be advertising Abercrombie & Fitch.” You know something? I’ve seen the A&F; ads in the magazines and those buff models wear practically nothing…where’s the merchandise anyway?

Authors commenting in a recent JAMA editorial worry that corporate branding of medical institutions may confuse health consumers and lead to misinformed choices. Probably so – I don’t think I could force myself to visit a doctor at the Coors Light Medical Center because I’m a Budweiser kind of guy. All kidding aside, state legislatures and taxpayers may revolt if they discover that public corporations are willing to fund highly visible health resources. Right now medical schools don’t need any new reasons to discourage critical government support for research and patient care.

Do any of these practices bother you? I would like to know.

SOURCE: JAMA, October 22, 2008, pages 1937-1938.

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Posted by: Bill Lloyd MD at 11:14 am

Sunday, October 19, 2008

Don’t Give Me the Flu

Here’s a sincere plea: Don’t give me the flu!

You see, if I contract viral influenza I will very likely give it to many other people. For up to five days before I develop fever and realize that I’m sick, I will shed highly-infectious virus particles to everyone with whom I come in contact. Earlier this week I was in a very crowded lecture hall with over 200 people who came to hear me speak. Did you know that I roam all over the room when I lecture? Hopefully they departed with some useful information, a few laughs and nothing more.

Here’s the deal: You can protect me if you get your flu vaccination.

Are you worried about availability? There are over 135,000,000 vaccine doses available today.

Are you worried about Thimerosal? You shouldn’t be worried because there is no valid scientific evidence that links Thimerosal to neurodevlopmental disorders. But lets say that you are still skeptical. Many flu vaccines are Thimeosal-free… all you have to do is ask. Single-dose syringes and the nasal FluMist influenza vaccine contain no Thimerosal.

Thank you for protecting me from getting influenza.

Be sure to get your healthy children over 6-months-old vaccinated, too. Children love me and they flock to me. School-age children are also very powerful vectors for influenza. They can shed live virus for 10 days because of their younger immune systems. Remember, I asked for your help.

[youtube=http://www.youtube.com/watch?v=Kh_6X6C2Icc]

Worried about needles? By now I hope you would be willing to take one for me, but even the squeamish can still be heroes. The FluMist nasal influenza vaccine is inhaled through each nostril and works just as well as the injectable form. In some aspects FluMist is superior to the traditional injection.

Finally, if I get the flu, I will likely miss work and be unavailable to help all those who are counting on me. This will really mess things up. So, please keep your promise and go get your flu vaccine.

On second thought, I’m not sure you’ll keep your word. I’m going to go get myself vaccinated. That way I can help protect you and your family from seasonal flu.

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Posted by: Bill Lloyd MD at 12:55 pm

Monday, October 13, 2008

Consider Yourself a Gym Rat?

Photo Credit: Thang Nguyen

How often do you workout?

Daily? Weekly? Seasonally?

Folks who head to the fitness club frequently are called gym rats. These athletes feel the burn every day – sometimes twice a day, yikes! I consider myself a gym mouse…maybe a gym gerbil. I try to find 45 minutes every every day for some exercise, alternating between running outdoors and moderate weight training.

A recent visitor to our WebMD Vision & Eye Disorder message board asked about eye irritation that was only experienced while exercising at the gym. I mentioned some possible culprits, but it got me thinking about how potentially hazardous fitness centers can be to the eyes. The more I thought about it the longer my list grew.

This blog was not posted to generate alarm or to discourage readers who want to become gym rats (or gym gerbils!). I just want to share some practical ideas regarding vision protection when exercising at a fitness facility.

  • Protective goggles + racquet sports: ‘Nuff said. Choose a durable polycarbonate product. Stay away from the ‘lensless’ goggles because the deformable, high-speed ball can still strike the eyeball.
  • Protective goggles + tanning booths: ‘Nuff said again. Tanning booths are unsafe but it’s hard to get some people to turn away. At the least they should shield their eyeballs.
  • Extreme weightlifting: Do not strain when handling barbells – keep breathing. The blood pressure skyrockets during heavy lifting…systolic readings often exceed 400mmHg (more than 3 times normal). Delicate retinal blood vessels can burst and wipe out your eyesight for months.
  • Swimming pools: Chlorine can make eyes red, but abnormal pool water pH is more likely to cause discomfort and blurriness due to superficial corneal edema.
  • Spas/Hot tubs: Stay away if you have had LASIK or if you are wearing contact lenses. Your cornea is like a culture plate just waiting for some germ to visit…like Acanthamoeba.
  • Stretch cords/PT straps and other elastic devices have a bad reputation for snapping back at your face. Also, put some space between you and other customers.
  • Physical contact: Don’t share towels and always wipe down apparatus before and after use. Other athletes are continuously coating the health clubs with their own germs. Protect yourself from unwanted colds and pinkeye.

What about yoga? I don’t know any eye hazards with yoga. How could you hurt your eyes in a Happy Baby pose?

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Posted by: Bill Lloyd MD at 12:01 pm

Thursday, October 9, 2008

Financial Jitters?

It’s hard to write about healthy vision when I’m distracted. All that I can see these days is red ink!

I’m getting queasy feelings.

Check this out. I just got done talking to my financial advisor about the current economic crisis. Most of the time this guy is a crackerjack, confidently recommending surefire investments that usually do well. Just as often he’ll call to advise me when to make adjustments to my IRA. Simply stated, the fellow always had a quick answer.

Today he had no answers…not even predictions. I’ve never heard him equivocate before and this made me very concerned. ‘Hey! If my financial advisor has run out of ideas what are the rest of us supposed to do?’

Are you having queasy feelings, too?

As of today the stock market has lost 35% of its value from its peak a year ago. Guess what? It’s not as bad as you may think. During the 2001-2003 Internet bubble collapse stocks tanked 50%! Of course, the circumstances and the market dynamics are very different – tech stock speculators back then versus decimation of the national housing market today. There’s no guarantee we will experience a similar rebound over the next 4 years, but I hope we do.

Fear can be misinterpreted as apathy. I haven’t changed anything in my portfolio yet because I’m guessing that the future will be better than the present. Most of my stock investments involve blue chip companies that will still be around after the dust has settled. If I sell-off the stock I’ll take a loss and have to pay a commission before I can reinvest the funds. Oh, reinvestment isn’t free either. Then after everything improves I’ll pay more commissions to get back into stocks. Ouch!

Some folks are totally cashing-out, buying insured CDs or US Treasury bonds. Nobody seems interested in the interest rates, they just want a safe haven. I hope they find it. A neighbor of mine has a big safe in his house and he has been hoarding cash over the past few months. Would you consider that wise planning?

I’d like to hear from others with their reactions to the national (er, global!) financial mess. Maybe with some smart advice I would become less distracted and feel a little less queasy.

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Photo credit: ©iStockphoto.com/LilliDay

Posted by: Bill Lloyd MD at 4:20 pm

Tuesday, October 7, 2008

One Eyedrop Worth Asking For

Most folks with healthy eyes who undergo cataract surgery usually sail through the procedure. Within weeks the patient enjoys crisp, colorful vision that they haven’t experienced in years.

However, some folks have a more rocky course. One big boulder along the road to full vision recovery is something called cystoid macular edema (CME). This is a leading cause of delayed vision recovery after cataract surgery and, for a minority of patients, permanent vision loss. It is very frustrating to the patient and surgeon because the cataract surgery and the intraocular lens implantation may have been flawless yet the patient still can’t see well enough to drive safely.

The macula is that small region of the retina used for reading and precise focusing. How small, you ask? It’s a circular area approximately one-third inch in diameter… roughly the diameter of the eraser at the end of a new pencil. Any changes to the macula can have profound visual changes: trauma, bleeding, inflammation, swelling (edema).

Here’s what happens during CME: Leaky retinal capillaries in the vicinity of the macula lead to pockets of accumulated fluid that cause the macula to thicken – just like a recently sprained ankle. It can be quickly diagnosed with the doctor’s ophthalmoscope and confirmed with a simple OCT scan performed in the clinic.

Lots of factors contribute to the development of CME after cataract surgery and many are preventable. Ophthalmologists know it is far better for the eye to prevent CME than have to treat CME.

New clinical research offers evidence that the daily application of nonsteroidal eyedrops for 3 days prior to cataract surgery significantly reduces the incidence of CME. Now, here’s the good part. Nearly every cataract surgery patient will be taking those identical eyedrops after surgery anyway, so it won’t cost any extra money. Simply begin taking the nonsteroidal eyedrops before the operation.

If you know someone anticipating cataract surgery be sure to pass along this valuable nugget: Ask the surgeon about using the post-op nonsteroidal eyedrops prior to surgery. Get a head start on CME; it could make all the difference in the world!

REFERENCE: American Journal of Ophthalmology, October 2008, pages: 554-560.

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Posted by: Bill Lloyd MD at 4:16 pm

Wednesday, October 1, 2008

SPOOKY: Do Ghosts Really Perform Surgery?

Ever heard the phrase ‘ghost surgery’? It can be a very scary topic.

Ghost surgery exists whenever an individual performing an operation is not the same person that the patient expected to be wielding the scapel.

In some busy practices the patient is led to believe (let’s simply say ‘underinformed’) that their hotshot superstar surgeon will perform the procedure. Hotshots often charge more than what is covered by insurance and patients are willing to pay the difference in order to benefit from Dr. Hotshot’s advanced skills and experience. Sadly, Dr. Nobody may actually operate on the unknowing (asleep) patient. This is a deeply unethical medical practice.

Ghost surgery can also arise in the training environment. Young surgeons in need of experience sometimes develop their techniques on unsuspecting patients who believed that the attending staff surgeon was in charge. This, too, is unethical. It does not involve reimbursement revenues but it corrodes the trust patients put in their doctors.

Now, let’s be realistic. Residents have to learn how to perform surgery somewhere, right?!? A well-structured clinical residency program is the ideal environment for senior surgeons to train their successors. Standing side-by-side the staff and resident surgeons collaborate to get the best results for their patients. If portions of a case are too precarious or too unfamiliar to the young protegé the more experienced attending surgeon typically takes over. The patient is protected every step of the way.

It is the responsibility of the attending surgeon to approach the patient and ask this important question. If a patient declines to have a surgeon-in-training scrub-in the choice needs to be respected. Fortunately, this is a rare occurrence.

Here’s a neat secret: If you are ever brought to the hospital in the middle of the night needing surgery, and they offer you two options: Surgery Chief Resident (cub) or Chief of Surgery (lion) go with the Chief Resident! As a general rule, that young doctor has recently performed an enormous volume of surgical procedures and knows the latest and greatest ways to fix you up. The Chief of Surgery spends a lot of time going to meetings and performs far less surgery.

So, how do most folks feel about a resident serving as primary surgeon with staff supervision? A recently published study collected patients’ feelings on the subject with the use of an anonymous survey distributed to 106 preoperative patients needing cataract surgery. Here’s what they found:

  • 96% felt that they should always be asked (no ghost surgery)
  • 83% claimed that they would agree to let the resident assist the attending surgeon perform the eye operation
  • 55% felt that the standard pre-op consent form was adequate disclosure (who reads those anyway?!?)
  • 49% claimed that they would allow the resident to be the primary surgeon

If you or a loved one is anticipating surgery make sure you clearly understand all options. Make sure that ghost surgery is not tolerated in your hospital. Specifically ask who will serve as primary surgeon and their level of proficiency. Do not abdicate that decision to anyone!

REFERENCE: Archives of Ophthalmology, September 2008, pages 1235-1239.

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Posted by: Bill Lloyd MD at 11:13 pm

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