Wednesday, October 12, 2011

Family Medicine: Trends in My Office

1.  Immunization Discussions:  Getting longer. Parents (Usually Moms) who had delayed initiating immunizations for a child are signing their child up for vaccines, building into the required immunization schedule starting with one or two combination immunizations, with sensitivity to family history and context issues (who is on chemotherapy, pregnant or otherwise vulnerable?).  None ever mentioned any concern about the British publication about MMR.  Many don't agree with the varicella vaccine mandate (chicken pox shot) due to their personal and family history of a benign experience with the chicken pox.  Well child visits are expanding in time needed for education about vaccine preventable diseases.

2.  Increased Numbers of Thyroid Abnormalities:  More men with elevated Thyroid Stimulating Hormone (TSH) than usual and increased numbers of women.  They were experiencing fatigue, hair loss, dry skin, swollen neck and fluid retention.  It seems that they reduced their salt intake leading to decreased iodine ingestion.  Recent surveys of salt products found lower levels of iodine than expected.  This is a key ingredient in thyroid hormone production.  Many patients had shifted to use of sea salt for cooking.  Sea salt typically doesn't contain iodine.  Sea salt and iodine advised the patients who had decreased iodine intake to take kelp tablets which are loaded with iodine.  An excellent article from Life Extension magazine October, 2011 issue just happens to discuss this problem.
The Silent Epidemic of Iodine Deficiency

3.  Unusual diseases:  About 9% of patients in a family physicians practice have unusual or rare diseases.  These are interesting and often challenging.  One interesting site to use for reading about rare diseases that have a genetic basis is OMIM, listing over 12,000 single gene disorders. Online Mendelian Inheritance in Man.

More later.

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