Most Recent Blog Posts

• Stand Tall: Preventing Osteopo Stand Tall: Preventing Osteoporosis

  • From: MervilleCMarshallMD
  • Description:

    “My mother lost four inches of height and can no longer stand up straight,” a patient of mine bemoaned. Clearly, her mother suffered several compression fractures of the spine, resulting in the typical stooped over appearance of a woman with osteoporosis.

    The National Osteoporosis Foundation (NOF) will join with other bone health organizations from around the world to celebrate World Osteoporosis Day on October 20, 2009. This year’s theme is “Stand Tall -- Speak Out for Your Bones.” According to the NOF, more than 10 million Americans have overt osteoporosis and another 30 million have low bone density (osteopenia) of the hip. The NOF estimates that approximately 50% of all Caucasian women will suffer an osteoporosis-related fracture during their lifetime. Spine, hip and wrist fractures are most common, but hip fractures are the most dangerous. Hip fractures require hip replacement surgery and are associated with increased morbidity and mortality. Compression fractures of the spine occur when the weakened bones of the spine collapse upon one another. This can cause severe back pain.  In addition, the postural changes of spine fractures not only cause lost of height, but also adversely affect the lungs and the abdomen because of the distorted anatomy.

    Bone is living tissue. It is constantly being regenerated. There is a continuous process of breaking down bone tissue and building up bone tissue. When the rate of breakdown exceeds the rate of buildup, bone becomes weak and prone to fracture. Like a bank account, if withdrawals exceed deposits, the account has a net loss.

    My patient, who is approaching menopause, is determined to avoid the fate of her mother. She is being proactive: she has had Bone Mineral Density testing; she gets her 1200 mg of calcium and 800 to 1000 IU of vitamin D daily; and she does weight-bearing exercise. We have already discussed the pharmacological interventions that are available if necessary. She wants to stand tall today and tomorrow.

  • Blog post
  • 9 months ago
  • Views: 106
  • Not yet rated

• Judge Sonia Sotomayor: Diabete Judge Sonia Sotomayor: Diabetes and "Justice"

  • From: MervilleCMarshallMD
  • Description:

    The nomination of Judge Sonia Sotomayor to the Supreme Court is one more crack in yet another glass ceiling -- not because she is Hispanic or a woman, but because she has type 1 diabetes.

    I can recall a time when the diagnosis of diabetes had a profoundly negative effect on a person's socio-economic status. Diabetics often had trouble getting life insurance, health insurance, and a job (almost any job). In fact, the term 'pre-diabetes,' which is commonly used these days, was expunged from the lexicon of medicine in the 1970's to protect people. Why? Because any mention of the word diabetes in a patient's medical record could cost the patient his or her employment. The thought was 'why subject a patient to all the adverse economic consequences of being labeled a diabetic before diabetes was confirmed?'

    Judge Sotomayor would be the first Supreme Court Justice known to have type 1 diabetes. This has already generated extensive discussion about how healthy a Justice needs to be and whether Sotomayor's diabetes should disqualify her from consideration for the Supreme Court. Even R. Paul Robertson of the American Diabetes Association has muddied the waters with his published statements. The Associated Press and the Wall Street Journal quote Dr. Robertson as saying, 'The advancements in the management of type 1 diabetes have been just amazing over the last two decades and the ability of people to manage their diabetes successfully has been proven. People with diabetes can function and live a long and healthy life.' However, the New York Times reported, 'Still, Dr. R. Paul Robertson...said that given the seriousness of the disease and of the proposed job, the public had a right to know how the judge was controlling her diabetes -- and how well.'

    If, as it has been reported, Sotomayor's diabetes is well controlled, the public does not need to know whether she is using an insulin pump, how many insulin injections she takes, or how often she checks her blood sugar level. Sotomayor has been a federal judge for 17 years without her diabetes being an issue. On the other hand, Paul D. Carrington, professor of law at the Duke University Law School, wrote an op-ed article in the New York Times last month entitled 'When to Retire a Justice.' He points out that the Constitution never meant for justices to have a life-long appointment, but that justices have a duty to retire when they are no longer fit to work full time. Carrington notes that this concept was clearly ignored when Chief Justice William Rehnquist continued to work on cases while he was dying of cancer.

    The American Diabetes Association released a statement yesterday, which begins: 'President Obama's nomination of Federal Appeals Court Judge Sonia Sotomayor to the Supreme Court of the United States affirms that people with diabetes should not be discriminated against and each person with diabetes should be judged based on his or her merits, not on stereotypes or misinformation about diabetes.' I agree.

  • Blog post
  • 1 year ago
  • Views: 134
  • Not yet rated

• A Mother's Love A Mother's Love

  • From: MervilleCMarshallMD
  • Description:

    When I eulogized my mother several years ago, one of the stories I told was the following: My mother had a habit of saying how happy she was for me whenever I had an accomplishment of note. One day she was bragging to a neighbor about something I had done. The neighbor commented on the fact that my mother, as usual, said she was happy for me, but did not say she was proud of what I had done. My mother explained to her neighbor, as she had explained many times to me, that she was always proud of me. Her pride in me was not contingent upon what I did. So if I did do something, she was happy for me. Motherhood is unconditional love, unconditional sacrifice, and unconditional pride.

    Wishing all of you a happy Mother's Day!

  • Blog post
  • 1 year ago
  • Views: 140
  • Not yet rated

• Lessons from Kitty Hawk and Re Lessons from Kitty Hawk and Responses to Questions

  • From: MervilleCMarshallMD
  • Description:

    The Wright Brothers are known for their successful flights of a powered aircraft.  But that success was preceded by several glider (non-powered) flights that barely got off the ground.  Such is often the history of new launches.

    BeWell was newly launched in December 2008.  Several questions have been posted at my Blog since then, but not answered. I'm glad to announce that the website has advanced beyond the gliding stage and is now fully powered and airborne.

    So, below is a short review of thyroid physiology that addresses many issues raised in the questions posted to my very first blog post.  And, continue to get on board, join the community, enjoy the flight, and be well.

    The thyroid gland produces the thyroid hormones commonly abbreviated as T4 and T3.  The thyroid gland is regulated by TSH (thyroid stimulating hormone), which is secreted by the pituitary gland in the brain.  Think of the pituitary as the thermostat of the endocrine system.  Just like a thermostat will turn on or turn off the furnace if a room is too cold or too hot, the pituitary will secrete more or secrete less TSH, if there is too little or too much T4 and T3 in the blood.  The TSH test is a very sensitive gauge of a patient's thyroid status.

    When a patient needs to take thyroid hormone (Synthroid is one brand name, but not the only one), the goal is to generate a normal TSH level, indicating that the dose is optimal.  Regardless of the starting dose (such as 1 microgram per pound), blood tests should be monitored, and the dose altered as necessary to maintain a normal TSH.  The risks of taking too much thyroid hormone, with a 'near zero' TSH, include osteoporosis and atrial fibrillation (an abnormal heart beat).  One important exception to the rule of keeping TSH normal is thyroid cancer.  In the case of thyroid cancer, standard practice is to intentionally keep TSH lower than normal to help prevent recurrence of the cancer. 

    If the TSH level is wildly fluctuating in the high range, several possibilities come to mind. The common scenarios include poor absorption, incomplete compliance with the medication, changes from one brand to another or to generic thyroid hormone, and use of other medications that may interfere with thyroid hormone metabolism.  An uncommon scenario is the presence of substances in the blood that can cause artifacts in the laboratory test for TSH. Often, doctors and patients have to join forces to play detective when there are unusual and unexpected tests results.

    Hashimoto's thyroiditis refers to an 'autoimmune' disorder of the thyroid gland.  The immune system is set up to defend the body against outside invaders by the use of antibodies.  But if antibodies are directed against normal body parts, then there is an 'auto'-immune disorder.  Thyroid antibodies, such as the thyroglobulin antibody and others, are associated with both an overactive gland (hyperthyroidism or Graves' disease) and an under active gland (hypothyroidism or Hashimoto's thyroiditis).  Anyone who has one autoimmune disease has a greater risk of getting another autoimmune disease, such as pernicious anemia, Addison's disease (low adrenal function), and a long list of rheumatologic disorders, such as rheumatoid arthritis. 

    Although there are sporadic cases of Hashimoto's thyroiditis and thyroid cancer occurring simultaneously, it is controversial whether Hashimoto's increases the risk for the typical thyroid cancer.  There is an association between Hashimoto's and a very rare form of thyroid cancer, lymphoma of the thyroid gland.  However, the vast majority of patients with Hashimoto's thyroiditis do not have thyroid cancer.

    If one or more thyroid antibodies are present, but T4, T3, and TSH levels are normal, then no therapy is necessary.  But, because the presence of thyroid antibodies raises the chances of developing either an overactive or under active thyroid at any time, it is important to continue to monitor thyroid status.

    Finally, don't forget you have a right to speak to your physician if you have a question about the cause or course of your specific thyroid disorder.

  • Blog post
  • 1 year ago
  • Views: 95
  • Not yet rated

• Come With Your Questions! Come With Your Questions!

  • From: MervilleCMarshallMD
  • Description:

    Welcome to BeWell. I’m excited about this new health education Web site because I consider myself to be first and foremost an educator. And I have always believed that an educated patient is a healthier patient. When I speak to lay groups, I often give this advice regarding the doctor-patient encounter: “Come with your questions; leave with your answers.” This Web site community is an opportunity for you to come with your questions. Too often these days, the doctor-patient encounter is rushed, with little time for a real conversation. At BeWell, there is no time limit. I can converse with you and you can converse with one another. Ultimately, our hope is that you will be better educated about health issues that concern you. So, welcome; stay awhile; and be well.

  • Blog post
  • 2 years ago
  • Views: 104
  • Not yet rated