Incidentalomas are more common than we would like to think. They can be found most anywhere incidentally. As medical scanning tests have become more sophisticated, they have been able to detect more things. These incidental findings are known as incidentalomas. What do you do when a test your doctor has ordered detects an incidentaloma or multiple incidentalomas?
A thyroid nodule was innocently detected on a stress thallium heart test I had done four years ago. When I discussed this with my cardiologist, I was told no further testing was needed. Fortunately my primary care doctor felt otherwise (like I did) and ordered more tests. The thyroid uptake scan detected a cold nodule which can be consistent with cancer. An ultrasound guided needle biopsy was negative for cancer. My thyroid blood tests have remained normal over the years. In addition, the nodule cannot be seen or felt. Yearly sonograms have been stable and unchanged until this year.
I am waiting for the official report from my doctor for this year's sonogram done this week. The technician that did the ultrasound of the thyroid confirmed what I saw as I lay on the table and watched the screen. There were changes showing up. After four years of following this incidental finding, it turns out it is not so incidental.
Many physicians feel that incidentalomas should be left alone. There is much controversy over what to do about them because it is feared that unnecessary procedures, surgeries, and treatments may lead to increase morbidity and mortality. They are becoming more frequent as tests get better. As you can see ignoring them is far from the answer. It gave me a "free" ticket for a thyroid biopsy then kept showing up normal for a few years.
At least yearly surveillance is warranted for incidental findings. Depending on what is found, medical invasive intervention such as biopsy or surgery may be necessary. Additional testing as it relates to the incidentaloma is also indicated. Each person's case must be individualized. The more you know about it helps you and your doctors decide what is best for you.
It turns out that I found out about my incidentaloma incidentally - when I requested a copy of my stress test report.
by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.
www.mypatienthandbook.com
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd
viernes, 19 de octubre de 2007
martes, 16 de octubre de 2007
Children's Medication Safety Alert
Our children's health and well being is so important. Last week cold drugs for children under two were being pulled off the counter for safety issues. What surprises me most about this is that the actual harmful ingredients have been unnamed "antihistamines and decongestants" with brand names. Many of these are combination of two or more medications.
One of the several brands recalled lists the actual name of the drug causing the deaths. All the brands should have the offending drugs listed. When parents know the actual medication, they can check other medicines they may still have in their medicine cabinet, and on the drugstore counter. Though a "voluntary" recall the New York Post states, "...some small companies may continue selling the product". Safety reviewers in the FDA "considered" the ban on this cold medication two weeks ago.
The reasoning behind this decision surprises me, also. They are safe when taken as directed , but "rare patterns of misuse" can lead to death. Misuse of just about anything will lead to an adverse outcome. Does that warrant removing the items in question? With almost a thousand products that fit this description (some maybe under other names not on the list), it should be known what the actual medication are that are causing the problem. My research on the Internet yielded the following.
For instance, Dimetapp contains Brompheniramine (the antihistamine) and pseudoephedrine (the decongestant). Active ingredients in Robitussin include dextromethorphan (cough suppressant) and guaifenisin (mucolytic). These are made by Wyeth. Clicking on the medicines at their respective websites, reveals the active ingredients. The press release on JNJ's (Johnson & Johnson) website leaves the ingredients out. The Tylenol website lists some of the Pediacare formulas' ingredients, and omits those for Tylenol products. Novartis manufactures Triaminic. The press release section at it's web site fails to mention the recall. Further navigation to Triaminic home page yields front page notification of the recall. Clicking on the product reveals the ingredients. Prestige Brands division, Medtech, makes the Little Colds line. The warning is found under "Investor Relations" in the press section of Prestige's home page. The product home page lists no warning, or product ingredients. Again, clicking on the medication informs you about phenylephrine and dextromethorphan. Pediacare, made by Johnson and Johnson, lists its active ingredients as phenylephrine and pseudoepedrine in 4 of its 5 products on the CHPA, Consumer Healthcare Products Association, website (www.otcsafety.org). This organization represents the country's over the counter drug manufacturers and distributors. CHPA voiced its initial concern in a press release 8/16/07, and the voluntary recall was 10/11/07. That is almost two months ago.
The FDA meets this week with "outside" experts to decide if a ban or "voluntary" recall is necessary. In the meantime, parents are responsible for making sure that the 14 products listed are not used in children under two. They must also check other medication not on the list. It appears that pseudoephedrine, phenylephrine, and brompheniramine are the drugs causing the problems. Pseudoepedrine for adults went from over the counter to a "sign for" medication last year.
The websites of the drug manufacturers shows the medications being recalled; however, the actual ingredients in the medication were likely to be missing. It was rather inconsistent. Other drugs, with the ingredients, and some of the listed drugs advised for this age group were still listed here, and for sale on the web. It was somewhat reassuring to see that the companies gave phone numbers to contact for further information.
Hopefully, the FDA meeting will clarify the issue this week. Maybe you will see a press release that lists the drug ingredients, and more readily visibility on the web pages as well as television screens. TV stations now tend to pass this information off these days by telling you to check their website instead of listing it on TV (like they used to do). Everyone does not have access to the Internet. For our children, give us some type of continuity in reporting this type of information across the news wires. The biggest task is to get accurate, detailed information to every parent's mailbox in a timely manner.
by J.L. Richardson. MD, family medicine doctor, patient advocate, and author of Patient Handbook to Medical Care; Your Personal Health Guide, a Writer's Digest 14th International Self-Published Book Award winner in reference books.
http://www.mypatienthandbook.com/
www.blogtalkradio.com/drjfpmd
www.twitter.com/MD4U
Actual book excerpts on Google Books http://dld.bz/bZ39
One of the several brands recalled lists the actual name of the drug causing the deaths. All the brands should have the offending drugs listed. When parents know the actual medication, they can check other medicines they may still have in their medicine cabinet, and on the drugstore counter. Though a "voluntary" recall the New York Post states, "...some small companies may continue selling the product". Safety reviewers in the FDA "considered" the ban on this cold medication two weeks ago.
The reasoning behind this decision surprises me, also. They are safe when taken as directed , but "rare patterns of misuse" can lead to death. Misuse of just about anything will lead to an adverse outcome. Does that warrant removing the items in question? With almost a thousand products that fit this description (some maybe under other names not on the list), it should be known what the actual medication are that are causing the problem. My research on the Internet yielded the following.
For instance, Dimetapp contains Brompheniramine (the antihistamine) and pseudoephedrine (the decongestant). Active ingredients in Robitussin include dextromethorphan (cough suppressant) and guaifenisin (mucolytic). These are made by Wyeth. Clicking on the medicines at their respective websites, reveals the active ingredients. The press release on JNJ's (Johnson & Johnson) website leaves the ingredients out. The Tylenol website lists some of the Pediacare formulas' ingredients, and omits those for Tylenol products. Novartis manufactures Triaminic. The press release section at it's web site fails to mention the recall. Further navigation to Triaminic home page yields front page notification of the recall. Clicking on the product reveals the ingredients. Prestige Brands division, Medtech, makes the Little Colds line. The warning is found under "Investor Relations" in the press section of Prestige's home page. The product home page lists no warning, or product ingredients. Again, clicking on the medication informs you about phenylephrine and dextromethorphan. Pediacare, made by Johnson and Johnson, lists its active ingredients as phenylephrine and pseudoepedrine in 4 of its 5 products on the CHPA, Consumer Healthcare Products Association, website (www.otcsafety.org). This organization represents the country's over the counter drug manufacturers and distributors. CHPA voiced its initial concern in a press release 8/16/07, and the voluntary recall was 10/11/07. That is almost two months ago.
The FDA meets this week with "outside" experts to decide if a ban or "voluntary" recall is necessary. In the meantime, parents are responsible for making sure that the 14 products listed are not used in children under two. They must also check other medication not on the list. It appears that pseudoephedrine, phenylephrine, and brompheniramine are the drugs causing the problems. Pseudoepedrine for adults went from over the counter to a "sign for" medication last year.
The websites of the drug manufacturers shows the medications being recalled; however, the actual ingredients in the medication were likely to be missing. It was rather inconsistent. Other drugs, with the ingredients, and some of the listed drugs advised for this age group were still listed here, and for sale on the web. It was somewhat reassuring to see that the companies gave phone numbers to contact for further information.
Hopefully, the FDA meeting will clarify the issue this week. Maybe you will see a press release that lists the drug ingredients, and more readily visibility on the web pages as well as television screens. TV stations now tend to pass this information off these days by telling you to check their website instead of listing it on TV (like they used to do). Everyone does not have access to the Internet. For our children, give us some type of continuity in reporting this type of information across the news wires. The biggest task is to get accurate, detailed information to every parent's mailbox in a timely manner.
by J.L. Richardson. MD, family medicine doctor, patient advocate, and author of Patient Handbook to Medical Care; Your Personal Health Guide, a Writer's Digest 14th International Self-Published Book Award winner in reference books.
http://www.mypatienthandbook.com/
www.blogtalkradio.com/drjfpmd
www.twitter.com/MD4U
Actual book excerpts on Google Books http://dld.bz/bZ39
miércoles, 3 de octubre de 2007
Inflated Insurance Premiums
In response to the most recent 11% increase in my health insurance premium, I say please tell me how to decrease this humongous, hefty payment. After about seven years of stable prices and reasonable increases that were not higher than the average 3% cost of living per year, the last four years have been double digit increases.
My premium has gone from one of my smallest monthly bills, not even in the top ten, to the second. It follows my monthly mortgage (and interest, homeowners insurance, and windstorm
insurance in one bill). There is also flood and auto insurance. Together with the other home insurance protection mentioned, the total is about half of what my yearly health insurance will be. It used to be the other way around.
What is one to do? My initial thought was...well, my second and third thoughts were to call and write the insurance company, and to see what else I could trim from the monthly budget. My hundred dollar medication (not covered by insurance)? My weekly physical therapy treatment (not covered by insurance, but prescribed by my doctor)? My visits to the doctor? My grocery bill? My gas for the car? My windstorm (if you have a mortgage they say this can't be done),homeowners, and flood insurances? Postpone my new roof or keep the leaky one? At least I will get a discount on my windstorm and homeowners insurance premium for a new roof because of the preventive hurricane code application. For all the medical prevention I have done, it seems as if my insurance company could follow suit. I have saved them a lot of money, and continue to do so.
Well, I am considering all options. I wrote a letter to my insurance company via email last week. I am still waiting for a reply. I will call them if there is no response by tomorrow. Sometimes calling and getting a response can take just as long.
It makes me wonder what other patients are doing in response to increasing inflated insurance premiums. What price is too much for your most important asset - YOU?
My premium has gone from one of my smallest monthly bills, not even in the top ten, to the second. It follows my monthly mortgage (and interest, homeowners insurance, and windstorm
insurance in one bill). There is also flood and auto insurance. Together with the other home insurance protection mentioned, the total is about half of what my yearly health insurance will be. It used to be the other way around.
What is one to do? My initial thought was...well, my second and third thoughts were to call and write the insurance company, and to see what else I could trim from the monthly budget. My hundred dollar medication (not covered by insurance)? My weekly physical therapy treatment (not covered by insurance, but prescribed by my doctor)? My visits to the doctor? My grocery bill? My gas for the car? My windstorm (if you have a mortgage they say this can't be done),homeowners, and flood insurances? Postpone my new roof or keep the leaky one? At least I will get a discount on my windstorm and homeowners insurance premium for a new roof because of the preventive hurricane code application. For all the medical prevention I have done, it seems as if my insurance company could follow suit. I have saved them a lot of money, and continue to do so.
Well, I am considering all options. I wrote a letter to my insurance company via email last week. I am still waiting for a reply. I will call them if there is no response by tomorrow. Sometimes calling and getting a response can take just as long.
It makes me wonder what other patients are doing in response to increasing inflated insurance premiums. What price is too much for your most important asset - YOU?
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