TFM Blog

How to stop accelerating car

Sun, 25 Jul 2010 18:04:04 -0500

This video has been circulating the internet. It’s a great review of how to control a car that is accelerating out of control. This has been an issue on some new Toyota cars on the market. It is surprising to some that the solution is not as expected. Braking or turning off the car will only cause more trouble on most cars.

Watch the video for more information.
Consumer reports did a great job demonstrating the problem and promoting the fix.

Video Link

FDA warns of more trouble with PPI’s

Sat, 5 Jun 2010 18:26:45 -0500

The FDA has added another warning about proton pump inhibitors ( Prilosec, omeprazole, prevacid, nexium, protonix, aciphex, zegerid, etc..). They are being used more often and are now available over the counter so as use increases, more troubles arise.
The latest concern points to increased risk of osteoporosis, or loss of bone density which increases the risk of fractures. If you are at risk and have been having yearly physical exams ( Complete Physicals ) then this has been monitored for you and hopefully addressed.
The latest risk included a review of 7 studies. Six of the seven studies show increased risk of fractures to the hip, wrist and / or spine. Postmenopausal women ( after menopause ) that used PPI medications had 26% increased risk of wrist fractures and forearm fractures. They also had 47% increased risk of spine fractures, and overall 25% increased risk of total fractures.
Other bad news, increased risk of Clostridium difficile infections ( sometimes called C. Diff) which is a very dangerous gastrointestinal infection.
Using PPI medications while on plavix reduces the effect of the blood thinner which increases risk for those with high risk of heart attack or stroke.
Some studies show increased risk of pneumonia, which makes sense as the acid barrier is shot off while on these medications and bacteria is not as easily killed in the stomach before it is potentially refluxed into the lungs.

I try to limit the use of these medications as much as possible but it’s not easy to stop them. Most important thing that can be done is lifestyle modification, please read the blog posting in April for more information when I tried to warn of the risks:

Heartburn and Reflux or GERD April 25, 2009

Be careful and be sure to discuss this with your physician, clinic or specialist before stopping your medication. There are conditions that are high risk without the use of these medications as well. NEVER just stop the medication as you’ll likely have a severe rebound of acid production and symptoms that can be very dangerous and sometimes even worse than the original problem!

More information is available online:

AAFP NEWS - Studies show link between PPI use, increased fractures risk, other adverse effects 6/1/2010

US News and World Report - Not the best medical journal but good information and advice.

Arch Intern Med 2010 May

Frequent Questions: Hormone Therapy Safety and What to do for Leg Cramps.

Sun, 30 May 2010 22:06:15 -0500

Lots of recent questions about hormone therapy. This used to be called Hormone Replacement Therapy, but these treatments don’t replace hormones to their previous level. They are useful to treat menopausal symptoms, reduce osteoporosis and fractures. The problem is the growing list of dangers associated with these hormones. Lung Cancer is the newest cancer linked with hormone therapy. Estrogen and progestin might increase risk of developing lung cancer, especially when used for 10 or more years. It might also stimulate growth of existing lung tumors, more in older women especially smokers. Some lung cancer tumors have hormone receptors that respond to the stimulation by hormone therapy.
Breast cancer risk increases after 3 years on estrogen plus progestins, much sooner than originally thought at 5 years based on previous studies. This risk increases 8 cases of breast cancer per 10,000, but the risk declines after 2-3 years of stopping hormone therapy. Risk also increases for drinking alcohol, sedentary lifestyle,
Endometrial cancer risk is 5 times higher for women on estrogen alone for more than 3 years.
Colon cancer risk was initially thought to be better on hormone therapy, but longer term studies show show it does not prevent colon cancer and the risk is the same.
Ovarian cancer risk is not changed or very small if any risk.
Because of these risks, use for the shortest possible time and only for severe menopausal symptoms is suggested.

LEG CRAMPS
I also get a lot of questions about leg cramps, especially night cramps. These are very difficult to manage. First looking or restless leg syndrome which is an irresistible urge to move the legs. It usually is worse at night, resting, and can be associated with a creepy, itchy or pulling sensation. Short of this diagnosis, simple leg cramps are more difficult to manage. Some medications like fluid pills, asthma or copd treatments can worsen. Low potassium, magnesium and calcium can be associated with worsening. What works best is variable. Try calf stretches often and before bed, hot or cold packs depending on which helps more. Drink some gatorade early evening to rehydrate and replace electrolytes. Vitamin B-complex, magnesium can help and are worth a try. There are some medications that are helpful but are muscle relaxers, anti-anxiety or anti-convulsant medications so they carry the risk of significant side effects.
Quinine was popular treatment for many years but recent evidence shows the risk of the quinine is greater than the risk of the cramps. It’s no longer available for prescription except for one approved version but its’s expensive at about $5 per capsule and would be an off-label use due to high risk side effects possible.

Sumner County Federal Disaster Area

Tue, 11 May 2010 17:12:12 -0500

Copy of email detailing how to get help if you had flood related damages.

“Sumner County has now been declared a federal disaster declaration area, making federal assistance available to individuals, businesses and communities affected by the recent devastating floods. This includes loans and assistance for home repairs, property damage, funding for temporary housing and other major flood-related expenses.

I encourage home owner, renters and business owners to document any property damage and be in touch with FEMA promptly to find out what kinds of assistance might be available to you, even if you are insured. If you find out months from now that your insurance covers only a portion of necessary repairs to your property, it may be too late at that time to register for Individual Assistance from FEMA. Taking time to register damage with FEMA now may save hundreds of dollars and more heartache down the road. You can register online at www.fema.gov or by phone at 1-800-621-FEMA. The deadline for registering for Individual Assistance is July 6.

If you are a small business owner, the Small Business Administration is working with FEMA to make low-interest loans available to affected businesses. In order to be eligible, you must register your damage with FEMA. Assistance from SBA includes loans for physical property damage, as well as Economic Injury Disaster Loans to cover loss of revenue even if a business did not sustain physical damage.

I will continue working with officials in Tennessee and Washington to help our communities recover and rebuild as quickly as possible. My staff in Cookeville (931-528-5907), Gallatin (615-451-5174) and Murfreesboro (615-896-1986) is standing by to help anyone who has questions about how to apply for assistance.

Detailed information about the ongoing recovery and information about deadlines to apply for different types of assistance will be available at www.house.gov/bart.

Stay in touch,
BART GORDON
Member of Congress”

Other helpful links:
www.facebook.com/TNDisasterInfo

Humane Society

Thu, 29 Apr 2010 10:34:46 -0500

Heard about people having financial trouble dumping their pets today. They humane society finds them tied up outside or dropped off because they cannot afford to feed their pets.
Really interesting program the Humane society has to provide food to feed your pets for free. Thanks to donations from local grocery stores, if you cannot afford to care for your pet or cannot afford to spay or neuter your pet they will provide the service and food for free, just pick it up!
Spread the word if you can.

In these hard times, if you find great tips like this, please send them in to askdrjohn@comcast.net

For more information be sure to check out their web site.
http://www.sumnerhumane.org/

Interesting perspective on Family Medicine

Sun, 11 Apr 2010 16:38:13 -0500

The Tennessean had an interesting article on Family Medicine and the upside-down insurance industry and Medicare changes. The current healthcare system rewards excessive procedures and lawyers more than the patient. Hopefully soon we’ll start getting things right one day soon.

The article helps highlight the challenges faced.
Establish with a good Family Medicine physician as soon as possible. Hint, hint.

Link to article.