Winter 2019
ASPIRIN IN HEALTHY OLDER ADULTS: DISAPPOINTING
Aspirin helps to save lives and prevent problems in people with established cardiovascular disease. But people who have no cardiovascular disease and have never had a heart attack or stroke are a much larger population. Should they take aspirin as part of a healthy approach to maturity? The United States Preventive Services Task Force has long recommended balancing of risk and benefit in this healthy group. Aspirin reduces the risk of heart attack and stroke (ischemic events) but also increases the risk of serious problems, such as GI bleeding.
Allan R. Kelly, MD, FACP
Robert H. Kelly, MD, FACP
FECAL TRANSPLANTATION CONTINUES TO SURPRISE
We continue to explore the ways in which our body’s ecology, or biome, affects our health. These terms refer to the bacteria and viruses inside or on our body. The microorganisms in question are fecal microorganisms. Drugs or events that change the microorganisms inside the colon can cause illness. Changing the fecal ecology can have positive or negative effects on health.
Allan R. Kelly, MD, FACP
REDUCING FALLS, IMPROVING HEALTH
As we age, falling becomes common. Most falls do not result in serious injury. But advancing age creates fragility in our bones and muscles and skin: falls are more likely to be injurious.
Allan R. Kelly, MD, FACP
NURSE PRACTITIONERS
An emerging model of care is independent nurse practitioners. They have become particularly important in long-term care and hospital care. Nurse practitioners serve as subspecialty clinicians in pulmonary medicine, intensive care, cardiology, and the emergency room, to name a few.
Robert H. Kelly, MD, FACP
SURGICAL RISKS
Surgery may lead to complications. Fortunately, the risk of death from surgical procedures is extremely low – 1 in 10,000 or less depending on the procedure done. Complications following surgery range from 2%, (minor procedures) to nearly 20% (major procedures). Complications may include pneumonia, infections, confusion (delirium), anemia, kidney impairment, and heart failure.
Robert H. Kelly, MD, FACP
SELF-SAMPLING FOR HPV INFECTION
Human papillomavirus (HPV) infection is the cause of cervical cancer. Testing for HPV measures the risk of cervical cancer. Detection of this virus is the best way to screen for this cancer. In the absence of HPV, cervical cancer is highly unlikely and the pap smear is unnecessary. For women known to have high-risk HPV, a traditional pap smear is needed. The question is whether or not home HPV sampling can be used in place of doctor visits.
Robert H. Kelly, MD, FACP
Allan R. Kelly, MD, FACP
PMH QUOTATIONS
“Developing expertise does not negate the need to retain and nurture the humanity that drove us to medicine in the first place.”
Anna Goshua, MD 2019
“For the sake of our profession, get out of the current EHR rut, and enjoy the balance of the rest of your life as a doctor.”
Andrew Alexander, M.D., (2018)
“When my resolve faltered, I reminded myself that my suffering was trivial compared to that of my patients.”