All posts by Andy Smith, MD

Well The Weather Outside is Frightful

            “Hey Dad, there’s no shelter here.”  This was the report of my oldest daughter, Hannah, after checking out the area where we had planned to camp for the night after an eleven mile hike with three of my children and two of their friends (some 15 years ago).  The temperature was in the low 40’s, a light rain was beginning to fall and it was starting to get dark.  This was not a happy moment.  As it turned out, we had an outdated map which showed shelters at Birch Spring Gap which had in fact been torn down.  Now there were only tent platforms and, you guessed it, we had no tents since we were counting on the shelters.

Soooo, we started hiking on the double trying to get over to Fontana to find some warmth and dryness.  We eventually made it but found only a shelterless parking lot and more rain, dark, and cold.  We had four of the teens huddle for warmth while Hannah and I hiked off into the rain looking for shelter.  Along the way (the eleven mile hike turned into a twenty mile hike for the two of us), Hannah began to shiver uncontrollably with chattering teeth.  Fortunately, she was still able to function, walk and talk fine.  But hours of cold and wetness were taking their toll.  Thankfully we finally came upon a public phone and got ahold of a hiker shuttle that picked us up and got us all to a warm, dry place.  It took a while, but Hannah slowly re-warmed and was none the worse for the wear.

Hannah had started down the path toward hypothermia.  Having spent some years in Vermont and upstate New York, the threat of hypothermia while spending hours or days out of doors was familiar to me.  Here in east Tennessee we are less exposed to this threat.  Still, for the outdoorsy among us, this time of year still deserves a bit of caution in terms of proper dressing and planning.  And, if fact, more people die of hypothermia indoors than outdoors as inadequate household heating is an experience not well tolerated by the elderly.  Over a thousand people die yearly in the U.S. from hypothermia.

Hypothermia is a condition in which the body’s core temperature drops due to prolonged exposure to cold and/or wet conditions.  Initial symptoms can include shivering, tiredness and difficulty with talking and coordination.  If hypothermia progresses, shivering may cease and the person develops very slurred speech, difficulty walking, exhaustion, and apathy or lack of concern.  This can end with confusion, combativeness and eventually, loss of consciousness and death.  During the state of confusion a person will often want to just stop and sleep, which can be deadly.  The confusion will paradoxically sometimes also cause them to want to take off layers of clothing.  Hypothermia is particularly a risk for infants as they lose body heat more rapidly and are unable to shiver.

Heat is lost more rapidly in water than in air, so exposure to cool or cold water can cause hypothermia more quickly.  Likewise, sleeping outdoors in the cold carries risk if inadequate equipment isn’t used and getting stranded in a car in the cold is yet another hazardous situation.

So, what if you notice signs of hypothermia in yourself or someone you are with?  Until medical help arrives, the following can help:

  • Move the person to a warm, dry place if possible, or shelter them from the elements
  • Removing wet clothing if dry alternatives are available
  • Cover the whole body and head with blankets
  • If outdoors, start a warming fire if possible
  • CPR if breathing stops
  • Provide skin-to-skin contact, if possible, by removing clothing and wrapping yourself and the individual in the blanket to transfer heat
  • Provide warm drinks, if the individual is conscious, but no alcohol as this gives a sensation of heat but actually causes more heat loss.

So let’s enjoy the relatively mild Tennessee winter, but take precautions when you’re in the cold, and, yah, if you’re hiking, get a map that’s up to date.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835





Thankful for Our Bodies

Thankful for Our Bodies

Some sixteen centuries ago, Augustine observed, “People travel to wonder at the height of mountains, at the huge waves of the sea, at the long courses of rivers, at the vast compass of the ocean, at the circular motion of the stars; and they pass by themselves without wondering… Now, let us acknowledge the wonder of our physical incarnation- that we are here, in these particular bodies, at this particular time, in these particular circumstances.”  It’s a good reminder as we approach Thanksgiving.  Let’s take a moment to wonder.

It’s a natural tendency we have to notice what’s not working right in our bodies rather than to give thanks for the huge number of processes that are working wondrously well.  Consider a few wonders of the bodies our Creator has given us: There are a trillion nerves powering our memory. These can send and receive messages at up to 200 miles per hour.  A study showed that after viewing 2,500 images for 3 seconds people can recall if they’ve seen the images with 92% accuracy.  Speaking of viewing, our eyes can distinguish nearly 10 million shades of color.  Those eyes are protected by the fastest muscles in the body, those that cause us to blink, in about a hundredth of a second.  And even more staggering than the eyes’ color discernment is the less glorious nose that can differentiate between 1 trillion smells.

            Of course all our cells and tissues need nutrition and oxygen delivered to them.  This occurs as blood travels through our blood vessels, which if laid end to end would stretch nearly 100,000 miles.  The heart makes this happen by pumping about 100,000 times per day.  This then adds up to about 3 million quarts of blood pumped by your heart every year.   

            How does the blood keep picking up a new load of oxygen and getting rid of the waste gas carbon dioxide?  You take about 23,000 breaths a day, or about 672,768,000 breaths in a lifetime, usually without even thinking about it.  And the oxygen and carbon dioxide are diffused over the surface area of the lungs, which if it were flattened out would be equal to the surface area of a tennis court.

            And talk about strength, the femur (upper leg bone) of an average-sized man can withstand 30 times our weight – ounce-for-ounce that is stronger than steel.

            Even some of the lowliest bodily functions are impressive.  For example, the average human produces 25,000 quarts of saliva in a lifetime, enough to fill two swimming pools; try swallowing or speaking normally without saliva.

            So, how did we get the information for the construction process of our beyond-ingenious bodies?  It’s encoded in our DNA which, if uncoiled, would stretch 10 billion miles.  And its encoding of information is so efficient that just one tiny DNA molecule contains 40 times the information in a set of Encyclopedia Britannica. 

It’s a rough world out there, and it wears on our body.  Fortunately, much of the human body is self-regenerating.  For example, the stomach lining is replaced every 4-5 days so that it doesn’t digest itself, since stomach acid can dissolve metal.  Meanwhile, skin is replaced about every 2-4 weeks and our bones are fully replaced about every 10 years.  In fact, 50,000 cells in your body died and were replaced by new ones while you were reading this sentence.

We could go on, but hopefully you get the idea, and it’s not a new one – some three thousand years ago, King David wrote (in Psalm 139) to his Creator, “I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.”

Since among so many other gifts, we have been given the ability to remember, let’s remember on this Thanksgiving to give thanks to our Creator for the truly amazing bodies He has given us.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835





Polymyalgia Rheumatica

             “Wow, I guess I’m just getting old.  Everything hurts and I’m tired even doing little things.” Mrs. Jennings, in her early sixties, was normally one of my more energetic patients.  On further questioning it turned out it really wasn’t “everything” that hurt, but particularly the muscles of her thighs and shoulders, not so much her joints.  Her tiredness was notable particularly when she would exert herself, like walking up her back hill.  She would get back into her house from coming up the hill and feel totally out of breath, achy and exhausted.  All this was a rather striking change from just a couple weeks ago when none of this gave her much trouble at all.            Was she right that age had finally caught up with her?  Or maybe she had some hidden cancer, or late-onset rheumatologic disease, or any number of other problems.  Most of the tests came back pretty normal, but an old, simple blood test, the sedimentation rate, was very high.  It’s a non-specific test, but together with her other symptoms and the normalcy of most of the rest of her tests, it pointed to a diagnosis we see only occasionally: polymyalgia rheumatica (PMR).  The clincher would be how she responded to a course of oral steroids.  They tend to work like magic with PMR and that helps confirm the diagnosis.  Sure enough, a week or so after starting the steroids, we had the younger, energetic version of Mrs. Jennings back.  She was again motoring up her back hill like it was nothing.

As with Mrs. Jennings’ episode, PMR involves the rapid onset of soreness in the large muscles of the thigh and shoulders with a sense of weakness and fatigue.  Sufferers are almost always over age 50 and more than twice as many women as men get it.  The cause is not known and is thought to possibly be autoimmune.  As noted, steroids work wonders for PMR and can then be slowly tapered over many months.  The entire course of PMR averages about three years.  It’s one of those diagnoses you don’t want to miss since it’s so debilitating to have, but so very treatable.

Importantly, about 15% of people with PMR also have a condition called giant cell arteritis (GCA), which has also been called temporal arteritis.  GCA involves inflammation of arteries, most commonly the temporal arteries on either side of the forehead.  GCA causes a substantial temporal headache, and if untreated (with higher dose steroids), can even cause sudden blindness.  Mrs. Jennings actually had some temporal pain that came and went.  In the end we had her get a temporal artery biopsy but happily it was normal.

It is always very satisfying, to doctor and patient alike, to see the debilitating fatigue, weakness and achiness of PMT quickly melt away with treatment.  And unlike almost 50% of individuals with PMR, Mrs. Jennings did not experience a relapse.  Several years later, she’s still going strong, motoring up her back hill like its nothing.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835



The lowly prostate – in a young adult it’s a walnut-sized gland that forms part of the male reproductive system.  It sits below the bladder and wraps around the urethra, the tube through which urine exits the body.  Generally it grows with age… and there’s the problem.  Most middle-aged and elderly men come to know the prostate as a source of troublesome urinary symptoms.  They may have experiences such as standing at a public urinal slowly emptying while three teens come and go taking care of their business with firehose-like efficiency.

This common condition of non-cancerous enlargement of the prostate is called benign prostate hyperplasia or hypertrophy (BPH).  It is considered essentially a normal part of the aging process in men and is hormonally dependent on testosterone. An estimated 50% of men demonstrate BPH by age 60 and the number increases to 90% by age 85 years.  About half of these men with enlarged prostates have moderate-to-severe symptoms including urinary frequency, urgency, nocturia (awakening at night to urinate), weak urine stream, or a sensation of incomplete emptying.  The other half escape with minor versions of these symptoms.

Eventually the chronic partial obstruction of the bladder outflow can lead to complications such as urinary retention.  Here, a person may routinely fail to fully empty the bladder or may completely obstruct at some point and have to go to the ER for catheterization to get relief.  Additionally, renal insufficiency (loss of kidney function), recurrent urinary tract infections, blood in the urine and bladder stones may occur.

So the question becomes, if this is so common, when does one need to do something about it?  The answer to this is somewhat subjective – basically, when the symptoms are bothersome enough for it to be worth it to you to take a daily medicine to treat it.  There are a variety of types of BPH meds from ones that relax the grip of the prostate on the urethra to those that slowly shrink the prostate over 3-6 months to others that partially relax an overly twitchy bladder.  If meds are unsuccessful then a urologist may suggest any of a variety of procedures, with the trans-urethral resection of the prostate (TURP) being the best known.  It is not-so-affectionately known as the roto-rooter procedure by some.

It is important to realize that BPH doesn’t make you any more prone to cancer than the next person your age.  The two conditions (BPH and prostate cancer) are separate.  However they can produce some of the same symptoms, and they can both cause an elevation of the prostate blood test, PSA, which is often used for cancer screening.  Thirdly, the prostate can also become infected, often causing more of a sudden onset of urinary symptoms such as frequency and burning with urination.  This condition is called prostatitis.

All-in-all BPH is an inconvenient reminder of aging for the typical male.  But if the level of symptoms is really putting a crimp in your day (and night) and your walnut seems to have become a small orange, it may be time to talk things over with your doctor.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835