PLE stands for protein losing enteropathy and was the subject of a review article in a recent issue of The New England Journal of Medicine. PLE is a syndrome not a specific disease and can occur for a wide variety of reasons. The problem is caused by the loss of plasma proteins through the intestines (they “leak” out). In general terms it is caused by illnesses that damage the intestinal lining or that block the intestinal lymphatic drainage. The resultant…
A recent issue of the New England Journal of Medicine had an editorial (not a research paper) titled “Strategic Masking to Protect Patients from all Respiratory Viral Infections”. It was written by four Harvard physicians whose specialty is epidemiology and public health. The authors preamble alludes to the understandable mask wearing pushback/mask use fatigue in both the general population and in healthcare workers. That’s very understandable. We are all sick of constraints. But the focus of the article is with…
Finally, a medical therapy I can relate to. I love ice cream. Actually, it’s not a medical therapy, but a safe mechanism to “test the waters” in alpha-gal syndrome. This newsletter has previously discussed this uncommon condition that unfortunately is becoming more common. By way of reminder the syndrome is the new onset of anaphylaxis due to eating meat. It is a strange condition in that the allergic symptoms occur suddenly (hives, swelling, throat constriction) but are delayed 3 to…
The Florida Department of Health has issued a statewide mosquito advisory. In the past two months there has been an increasing number of malaria cases in the state. Malaria is transmitted by infected Anopheles mosquitos. The Florida cases have all been due to these mosquitos transmitting Plasmodium vivax. So far, there have been no deaths but several people required hospitalization. The health department recommends reducing the chance for bites by wearing long pants and sleeves and using repellant (either on…
I’ve been privileged to be in the medical field since the discovery of Lyme disease and witness the ongoing research to understand it and to treat it. I happened to be an intern at Yale when a mother returned her child to the medical center insisting that the original diagnosis of juvenile rheumatoid arthritis, they had received on their initial visit might not be correct. After her first visit, she returned home to Old Lyme, Connecticut and by talking to…
Tezepelumab-ekko (Tezspire) is the first and only biologic agent approved by the FDA for severe asthma that is not limited to a specific asthma phenotype. Biologic agents have ben a true god-send in terms of helping patients with severe asthma. The underlying cause for asthma is inflammation. But the cause of the inflammation varies from patient to patient. This variability is where the term phenotype comes into play. Identifying the specific immune mechanism that instigates the inflammation and thus the…
My favorite companion on woodland hikes (other than my wife and dogs) is my Leatherman, the ultimate multitool. It seems that the biologic agent dupilumab (Dupixent) is also becoming a multitool. It was initially approved by the FDA for people with severe eczema (atopic dermatitis). It works by preventing the inflammatory eosinophils from entering the skin. But since eosinophils also cause other types of allergic inflammation dupilumab’s role has expanded to include severe asthma, chronic rhinosinusitis with polyposis, eosinophilic esophagitis,…
Arnold Schwarzenegger once said “don’t be a girly man”. Perhaps this was meant to toughen up timid men with the unfortunate inference that girls are intrinsically timid. New research has found that women have more guts than men. This is a newly found anatomic difference but perhaps the metaphor applies as well. Duke University has done comparative anatomical studies and found that women’s small intestine is 30 centimeters longer than men’s. This newly discovered difference has led to both speculation…
Researcher at the University of Leeds in the UK have completed a four-year study that links gum disease to rheumatoid arthritis. They found a direct correlation between gum disease and both the severity of and exacerbations of rheumatoid arthritis. Various species of the bacteria Streptococcus are the culprits. When a person with gingivitis chews or brushes their teeth the bacteria enter the bloodstream. This activates the immune system to make antibodies. As it turns out the antibodies that attack the…
I recently heard about a mental technique to help me cope with tinnitus. But for the life of me I can’t remember what it was, can you help? I think so. I suspect you heard about a form of cognitive behavioral therapy called somatic tracking exercise. There are good academic studies instantiating its benefit. It has proven effective not only for tinnitus but for other unpleasant or painful sensory inputs. Basically, you pretend you are a non-emotional observer of yourself. …