All posts in Medical Diseases

The end comes from the beginning

Being board certified in Internal Medicine and Pediatrics and working in a full spectrum primary care practice I get to see all types of people every day. Yesterday, for instance, I took care of a two week old and then went across the hall to care for a 99 year old. I absolutely love that part of my job.

That age difference also allows for me to gain a unique perspective on the choices we all have to make. I literally will walk out of one room having told a middle aged woman she has lung cancer to the next room only to find out a teenage girl had her first cigarette recently. I’ll counsel a diabetic on starting insulin then go meet a sixth grader who is 85lbs overweight.

When you can see the end of every new beginning it impresses upon me the urgent need to change our destiny. We must learn to choose differently and to choose wiser.

Watch this video and see what I mean. I warn you though it doesn’t pull any punches. I have seen a patient at every stage portrayed in that man’s life even the last one. At each stage we can choose differently and avoid the ending.

Come see us and learn about our wellness program and our nutritional counseling. This doesn’t have to be your destiny or the destiny of your child.

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Check out this piece on getting to work helping patients instead is sitting around acting like no one knows what to do.

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Remember that simple isn’t always easy and hard isn’t always complicated.

Come see our Nutrition and Wellness Counselors if you want to know the simple and not complicated way to get your health back.

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Vertigo

Over twenty years ago, my receptionist at the time was occasionally plagued with bouts of vertigo. During these bouts, when she had to move around the office she’d move ever so carefully, trying to turn her head as little as possible and as slowly as possible. The wrong move or turn of the head would send her world spinning and she’d have to grab onto something to keep from falling. Just as miserable, the spinning sensation would leave her nauseated, or occasionally even trigger vomiting. Obviously, at its worst, the vertigo would necessitate her staying home to ride it out.

We had diagnosed her with a type of vertigo called benign paroxysmal positional vertigo (BPPV) and would treat her with medicines such as meclizine. This would dampen the spinning sensation and reduce the nausea, but certainly didn’t cure the problem. So she would tough it out until the vertigo faded away again.

I had been hearing about something called the Epley maneuver which was claimed to almost instantly cure the problem by just putting the patient through a specific series of movements. I remember telling my receptionist that it sounded a little too good to be true but still seemed worth a try given the success I had heard about it. So off she headed, looking unsteady and nauseated. An hour or so later she was back grinning from ear to ear and practically shouting, “I’m cured!” That was my first experience with the Epley maneuver and it left a lasting impression.

So let’s back up a little and explain a few things. When people say they’re dizzy, we first need to sort out a couple of things. Dizzy is used for two rather different sensations. There is lightheadedness, where a person feels woozy or faint, like they might pass out. Then there is vertigo, which is a sensation of whirling or loss of balance. The two very often have quite different causes.

The next important point is to realize that vertigo is just the name of a symptom; it’s not a diagnosis. So if a patient says to me, “Whenever I turn my head a certain way, the room starts to spin for several seconds and I feel really nauseated,” and I respond, “I think you have vertigo,” I really haven’t told them anything other than to put a name on their symptom – kind of like responding to someone who tells me their temperature is 103 by informing them, “I think you have a fever.” Fine, but what’s causing it?

So, once we know we have true vertigo, and not just lightheadedness, the next question is what is the specific cause of the vertigo? We don’t have space to go through the list, which includes entities such as Meniere’s disease and labyrinthitis, but the most common of all is the one my receptionist had, BPPV.

The onset of BPPV is usually sudden. A person may wake up with it, first noticing it when they go to sit up from bed. Then each time they turn their head or move in a certain way, it triggers a sometimes violent sensation of spinning which lasts some 20-30 seconds. At its worst this may cause vomiting. The eyes tend to beat spasmodically during the vertigo, a phenomenon called, nystagmus.

There is quite a list of causes of vertigo, even once we distinguish it from lightheadedness. Happily, there are treatments for many of them, and for BPPV, there is often a rather quick cure. So if you’re waking up dizzy these days, don’t just tough it out – get it checked out and see if it’s one that can be fixed.

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

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Bell’s Palsy

​What are you supposed to think when you wake up and half of your face isn’t working? That was the question one of my patients recently had to ask herself. When she smiled in the mirror, only the left side of her mouth went up. When she tried to close her eyes, only the left eye closed. And when she tried to lift her eyebrows, only the left eyebrow worked, and only the left forehead wrinkled. She brushed her teeth and tried to swish out her mouth and the water went spilling out of the weak side of her mouth. Stroke? Fortunately not, although when in doubt it’s always best to get immediately to the ER.

​One clue that this was Bell’s palsy and not stroke was the lack of movement of the right forehead. When a stroke is the cause, the forehead is usually spared and still moves (wrinkles) on both sides – we won’t get into the whole reason for that – but with Bell’s palsy it doesn’t.

​So what is this stroke-mimicker that affects only the face? Bell’s palsy is an acute affliction of the facial nerve. It results in rapid paralysis or weakness of the facial muscles on one side of the face, usually progressing over up to 48 hours. The cause still isn’t definitively known. It can happen at any age, but its peak prevalence is in 40-49 year olds.

​Along with the one-sided facial paralysis, there may be altered taste and loss of tear production on the affected side. There also may be pain around the ear and sometimes vision is blurred on the affected side.

​Treatment involves first making sure it’s Bell’s palsy and not a stroke. If the symptoms aren’t clear-cut, a cat scan or MRI of the head is sometimes done to rule out tumor or stroke. Steroids are the preferred treatment and antiviral agents may sometimes improve outcomes slightly as well. ​

​The good news is that in 80-90% of cases, the symptoms slowly clear over a few months’ time. In the meantime, the affected eye needs to be protected with frequent lubrication, and sometimes taped shut overnight to avoid drying out and damaging the cornea. Facial physical therapy is sometimes used but hasn’t really proved to make a notable difference in the rate of recovery. Various surgical procedures are used only rarely to aid eye closure in those cases where the paralysis proves permanent.

​So, while Bell’s palsy certainly beats a stroke, it’s no picnic and can be very slow to resolve, or rarely, may not resolve fully. And as we said at the beginning, always best to get to the ER immediately with any sudden paralysis or loss of function.

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

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