|Posted by Margaret Donohue on February 2, 2016 at 10:35 PM||comments (0)|
The new information on the Zika virus is that there is a confirmed case of sexual transmission of the virus in Texas. This means that anyone, male or female, traveling to an area where the virus is epidemic, or anyone who has flu like symptoms following being bitten by a mosquito should:
|Posted by Margaret Donohue on January 27, 2016 at 9:25 AM||comments (0)|
For most people the Zika virus is a mild case of flu like symptoms if they notice anything at all. For others, like pregnant women it can result in their children having abnormally small heads and brains, known as microcephally. For others it may produce joint pain, or progressive symptoms of paralysis known as guillain barre syndrome. Fever, rash and runny eyes are common.
Zika virus is a viral infection of the blood carried by mosquitos. Aedes aegypti, the mosquito that carries the virus, lives in tropical and subtropical areas throughout the world. The mosquito strain is in the United States but their aren't enough infected people living in the United States to serve as hosts. It originated in Uganda Africa and was found in a rhesus monkey in 1947. In 2013 it caused significant human outbreaks in French Polynesia. It is likely also able to be sexually transmitted. I say likely because blood borne viruses are usually also sexually transmitted and the virus has been isolated in semen. The disease is most prevalent in South America, but it's also present in other countries. If it's not already in the United States, it will likely be here soon. There is no cure. Prevention measures are to avoid pregnancy in countries where the infection is in epidemic proportions and to avoid mosquitos. Treatment with antiviral medications have limited impact. Several pharmaceutical companies are working on a treatment or preventative medication.
In the meantime, if you can avoid traveling to tropical areas, especially if you are pregnant, then do that. Preventative treatment will likely be available within the next 2 to 5 years.
If you ever have any questions about illness, disability or clinical trials, feel free to contact me. 818-389-8384.
|Posted by Margaret Donohue on January 1, 2016 at 9:10 AM||comments (631)|
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 15, 2015 at 12:05 PM||comments (0)|
Kidney disease is generally not detected until it is quite advanced. A new protein marker in the blood can detect kidney disease while in the very early and more easily treatable stages. That marker is suPAR.
suPAR is the soluble form of the urokinase-type plasminogen activator receptor (uPAR), a three domain receptor  mainly expressed on immune cells, including neutrophils, activated T-cells, and macrophages. It correlates with cancer, cardiac disease, autoimmune disorders, infections, diabetes, and overall mortality levels.
To evaluate risk the levels of suPAR was divided into 4 groups.
The very high levels had an 80% likelihood of developing the disease.
At your next check-up your physician may want to measure this level of protein.
If you have any questions about illness, lab tests, or want to know more about medical research, feel free to contact me. Donohuema1@me.com or 818-223-4116.
|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.