|Posted by Margaret Donohue on January 1, 2016 at 9:10 AM||comments (0)|
Headaches are a common phenomena. It's one of the most common problem I treat in clinical practice with exceptionally good outcomes. The first step in treatment involves identifying the type of headache somone has.
There are multiple types of headaches.
|Posted by Margaret Donohue on December 24, 2015 at 1:30 PM||comments (0)|
Autoimmune disorders and viral infections are strongly linked together. There are more than 80 identified autoimmune diseases. Viruses, bacteria and other types of infections are recognized as major environmental triggers for the body starting to attack itself.
Chronic cytomegalovirus (CMV) one of a type of herpes virus that causes mild flu-like symptoms has been linked to the development of Sjogren’s syndrome. Sjogren’s syndrome is the second most common autoimmune disease in humans impacting more than 4 million people in the United States. Sjogren's syndrome causes dry eyes, a dry mouth, and can cause joint pain, increased dental decay, swollen salivary glands, vaginal dryness, persistent cough and fatigue.
The research showing some of the mechanisms for the linkage may help with future treatments.
Research: Anne Halenius and Hartmut Hengel, “Human Cytomegalovirus and Autoimmune Disease,” BioMed Research International, vol. 2014, Article ID 472978, 15 pages, 2014. doi:10.1155/2014/472978
|Posted by Margaret Donohue on December 20, 2015 at 11:15 AM||comments (0)|
You don't know me and as a result my medical history will not be believed until it is. My tests tend to come back normal in spite of obvious symptoms of illness. I have a number of unusual medical conditions going back to birth, literally. Many of these are genetic and rare. They run in my family so I'm familiar with some of them, but the presentations never seem to match text book descriptions. So I'm not believed. I know that. I understand that. That doesn't make it correct. I'm part of a large number of patients with unusual, rare or atypical medical conditions. I am not alone.
So let me explain some things.
There are millions of people with rare or unusual medical conditions. I'm not alone. Women with these conditions are more likely to seek treatment than men with these conditions. Women report more trauma as a result of these interactions. Men tend to be more avoidant of treatment and there is a resulting higher mortality rate.
|Posted by Margaret Donohue on December 13, 2015 at 11:55 PM||comments (0)|
Migraines are a type of vascular headache causing a variety of responses to inflammatory pain in and around the lining of the brain with symptoms of acute nausea, vomiting and severe pain. They are different from tension headaches, cluster headaches, rebound headaches, post-concussive headaches, sinus headaches, headaches from hypertension, headaches based on changes in blood sugar, abdominal migraines, hormone related headaches, chronic progressive headaches, and mixed headaches in addition to rarer forms of headaches.
Migraines cause the hands and feet to be cold. They may cause a wide variety of neurological symptoms such as loss of speech, problems with vision, visual and auditory hallucinations including hearing music, and olfactory hallucinations. They can be triggered from a variety of foods, medications, hormonal conditions, stress, genetic predisposition, and environmental conditions. It's important to differentiate migraines from other types of headaches and other medical conditions.
There are a wide variety of treatments for migraines. These include lifestyle changes to reduce stress, adding meditation or yoga, physical therapy, massage and ensuring adequate sleep and exercise. There are lifestyle changes to eliminate triggers for migraine such as eliminating caffiene or other migraine triggering foods or drinks, changing diet to a less inflammatory diet, and changing sleep and wake patterns. There are medications taken at the start of a migraine to lessen the intensity and severity of migraine, and medications taken to prevent migraines from occurring. In chronic migraine botox can be used.
If you are having chronic headaches feel free to contact me for evaluation. 818-389-8384.
|Posted by Margaret Donohue on November 19, 2015 at 7:55 PM||comments (0)|
Many people think their insurance covers psychological or neuropsychological testing. Insurance will stipulate that psychological or neuropsychological testing if it meets criteria for medical necessity. That doesn't mean that a physician or a school or a teacher thought the testing would be necessary. It means that psychological or neuropsychological testing meets the strict criteria set forth by the insurance company.
Medical necessity means that there is no other agency or organization that can provide testing at state or federal expense. So that eliminates testing for:
It means that psychological or neuropsychological testing will produce a change in diagnosis or treatment plan and is the most cost efficient method of obtaining that information. So an MRI or CT scan may be able to rule out memory problems related to brain disease or defect.
If you are interested in obtaining insurance benefits to cover psychological or neuropsychological testing GET AN AUTHORIZATION NUMBER from the insurance company.
If you are interested in having psychological or neuropsychological testing feel free to contact our office. We have access to a large number of psychological and neuropsychological tests at reasonable fees. If you are eligible to use a free service we will advise you of that. Feel free to contact us. Our main office number is 818-223-4116. My cell phone is 818-389-8384 Margaret Donohue, PhD.
|Posted by Margaret Donohue on October 25, 2015 at 11:15 AM||comments (0)|
I listened carefully as psychologist Anthony Zamudio, Ph.D. spoke at the 27th annual Convention of the Los Angeles County Psychological Association about his clinical practice within a primary care clinic. He sees 30 to 50 patients a week in 30 minute intervals. Not what I do. He has patients he treats for psychological factors that impact physical conditions. I see no more than 15 people a week. I spend 50 minutes to 2.5 hours getting a history.
When I first started in practice in a medical office, my clients were depressed and anxious with some weird medical symptom that defied diagnosis. They were frustrated as was the physician. It was my job to assit the patient in describing their symptoms adequately so the medical condition could be illuminated. Cancer, endocrine disiorders, rare medical conditions, and heart disease were the commonly missed diagnoses. The idea was that by taking an adequate history in addition to noting physical symptoms the physician could cut down on unneeded tests and avoid litigation for failure to diagnose. Most people talk about medical symptoms in non-medical terms. There is then a problem with the translation of patient language to doctor language. So a woman comes in saying her neck hurts. The physician gives her a prescription for ibuprophen. She comes back saying her neck is worse. I would then see her. She's been cleaning her shower on her hands and knees. She's been moving furniture. Her son is coming for a visit. She cleans the shower for a bit then her neck hurts. She can no longer clean her shower. After 20 to 30 minutes of lying down covered in sweat, the pain subsides. When she goes back to clean the shower it starts back up. She's nausous from the pain. I tell the physician she needs an EKG a way to check the electrical activity of her heart. The heart attack has already occurred and she's at risk for another one. She has an 99% occluded blood vessel found on angiography at the hospital. At the end of the day I review the case with the physician. So he can see what I saw for the future. Her coloring is ashen. There's some mild bluing as an undertone. She's laboring to breathe. Her jaw is tight. She never mentioned sweating or nausea so the physician wasn't cued to look for heart problems. She talks about neck pain, but holds her hand up to her throat first before reaching around to the back of her neck. She arches her neck slightly to take a deep breath. Physician's still think of chest pain, which is a common presentation in men with heart attacks. Women are more likely to complain of feeling sick and maybe having the flu, or neck pain, or feeling weak or tired. But symptoms increase on exertion and lessen on rest. If the information isn't provided the physician can't know what's going on.
If you are having a problem getting diagnosed for your recurrent symptoms, contact our office. 818-223-4116.
|Posted by Margaret Donohue on October 21, 2015 at 9:00 AM||comments (0)|
Breast cancer in women has a population spike between the ages of 30 and 70.
Percent of U.S. Women Who Develop Breast Cancer over 10-, 20-, and 30-Year Intervals According to Their Current Age, 2009–2011
Current Age 10 Years 20 Years 30 Years
30 0.44 1.88 4.07
40 1.45 3.67 6.83
50 2.29 5.56 8.76
60 3.48 6.89 8.90
70 3.88 6.16 N/A
Source: Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/browse_csr.php?sectionSEL=23&pageSEL=sect_23_table.10.html, based on November 2013 SEER data submission, posted to the SEER Web site, April 2014.
So the American Cancer Society has recommended that cancer screenings should start at age 45. That breast exams not be done by physicians due to time constraints, and that women over 50 with a negative screening should get evaluated every two years.
If these recommendations are followed, the rate of cancer in African American women between age 30 and 45 will increase and cancers will be found at later stages when they are harder to treat. This is a population most at risk for breat cancer between age 30 and 45.
Global statistics to inform health policy should be a thing of the past. More individualized treatment recommendations should be being made based on a woman's history, genetics, racial background and life expectancy. The more someone knows about their history, the better they can be informed about health care decisions.
A young woman with a history of breast cancer in her family who is positive for the BCRA (breast cancer gene muttion) may want to be screened early. A Caucasian woman with no family history can wait to age 45 for an initial screening. An African American woman with a family history of breast cancer may want to get an initial screening at 30 depending on the age at which relatives developed the disease.
If you want help with health related decision making, assistance in developing a medical genogram to evaluate risk factors, or assistance with treatment planning, feel free to contact us. 818-223-4116 our main office is in Glendale.
|Posted by Margaret Donohue on October 15, 2015 at 10:30 AM||comments (0)|
According to the Academy of Medical Psychology (AMP), there are two educational paths to becoming a medical psychologist. One is to complete medical school and earn a license to practice medicine in the United States. The other is to complete an American Psychological Association-accredited Doctor of Philosophy (Ph.D.) in Psychology or Doctor of Psychology (Psy.D.) program, followed by a post-doctoral master's degree or certificate program in clinical psychopharmacology (www.amphome.org).
I have my Ph.D. in clinical psychology and spent 23 years working in a pharmacy as a pharmacy technician. I then spent two years working with a general medical practitioner in his office with his patients. In the process of all that I learned clinical medicine: the ability to evaluate and diagnose medical disorders based on clinical symptoms and physical signs. The "art" of clinical medicine is being lost. It requires considerable time and, in essence, a mentorship with a physician to notice and understand what is being observed. Unfortunately that training in clinical medicine is becoming rare. Instead of clinical medicine leading laboratory medicine, laboratory medicine has ineffectively replaced clinical medicine. The physicians who know clinical medicine are older. The impact of managed care on the ability of a physician to take a history has led to nurse practitioners and medical assistants getting that information as a more cost effective method. But it’s more costly to the patients and adds to the level of misdiagnosis being significantly high. It’s also led to concierge medical services outside of managed care.
Medical psychology effectively bridges the gap for a physician in providing medical education, ensuring compliance with treatment plans and getting that needed history. Unfortunately, there are few medical psychology practitioners and fewer still know what we do. I have to explain my role to physicians and psychologists alike. Most equate what I do to “Dr. House” from the television series. I just think of it as saving people’s lives.
|Posted by Margaret Donohue on October 12, 2015 at 9:30 AM||comments (0)|
Some of you know I used to work with and train cats. This infomation is put out by the International Veterinary Academy of Pain Management http:https://ivapm.org/for-the-public/animals-and-pain-articles/how-we-assess-your-felines-pain-level/" target="_blank">//ivapm.org/for-the-public/animals-and-pain-articles/how-we-assess-your-felines-pain-level/
|Posted by Margaret Donohue on October 4, 2015 at 11:50 AM||comments (0)|
I remember being in Kindergarten when I figured out that the other children in my class were different from me. By age five I had already had two surgeries for unusual medical problems and I was being routinely followed by six treating physicians. So when I walked up to Nadine and asked her how many doctors she had, she looked at me like I was crazy. She explained she didn't have any doctors. She only got shots for immunizations.
That was when I realized my condition was likely genetic. My kindergarten class had a garden and we planted vegetables. We were also told about how plants grew from seeds. I don't know how many students in my class figured out that the same process also applied to people, but I did. So it was just a matter of waiting for science to identify all the genes to be able to figure out all the genetic anomolies I have.
Not every person or their parents want to know. "I just want my son to be normal." The mother told me. I told her that genetic disorders tend to result in syndromes. Many of the syndromes have complications that can be addressed early or monitored for so the person can stay healthy. I've been able to avoid many of the complications of my syndromes because I know what to do to lessen my risk factors. My siblings haven't been as fortunate.
A large percentage of individuals with genetic anomolies have something called facial or cranial dysmorphism. In less medical language it means there's something unusual about the shape or size of their head or the size and structure of their facial features. In other cases the genetic anomilies are more noticable on the hands or feet. In other cases medical problems crop up early and are unusual. At age 6 months I weighed a pound less than I did at birth. My head size is slightly smaller than normal. It makes it hard to buy a hat. But it's just enough to know it's a likely genetic disorder. Tracking down my biological family was difficult but I was able to trace my line back two to three generations. that allowed me to do a medical genogram and document all the medical conditions that people were known to have. It also documents any genetic predispositions to types of illness.
If you think you or your child has an unusul medical condition, we can help you connect to the right people to determine what is wrong and help you avoid possible preventable complications. Feel free to contact us. 818-223-4116.