One Doctor's Opinion
May 20th, 2011

"Hey doc...I'm pretty kid came home today looking like somebody has been slapping his face! They tell me not to worry...but I'm telling them they better confess up! Someone is not telling the truth!" "Ok, ok  Mr. W...just calm down. Just what was the explanation for this whole thing?"

There is a childhood illness called Erythema infectiosum or Fifth Disease. It is also known by the more common slang name of "slapped cheek syndrome". does almost exactly resemble someone who has been slapped across the face. So it is no surprise that Mr. W thought the worst of his child's situation.

Fifth disease is primarily an illness of children aged 5 to 15 years old--although it can affect other age groups but with different manifestations. It is caused by the erythrovirus and is easily spread by secretions from the respiratory tract or contaminated blood.

Usually, the time between actual infection and the first signs of the disease is about anywhere from 4 days to 21 days. The unfortunate part is that children who are infected are most contagious before any signs of the illness show up. This is one of the main reasons why schools can become victims to epidemics if left unchecked. Interestingly, once a person already has the rash, they are much less infectious.

What does it look like? In children, it literally looks like they have been slapped on the cheeks. Their cheeks have a bright red rash that can sometimes also cross the bridge of the nose. As the illness progresses, the rash may spread to the torso, arms, and legs. It may or may not be itchy and can last from a few days to several weeks. If adults or teens are affected, it is more likely to be manifested as a generalized joint arthritis instead of a rash.

The disease is usually self limited and resolves on its own. However, there are some medical conditions that can make certain people more likely to run into problems. Certain blood diseases like sickle-cell disease or some forms of anemia can become a serious medical problem if a person is infected. Women who are in their first trimester of pregnancy are especially at risk if they contract the illness as it can damage the fetus and cause spontaneous abortions.

Slapped cheek syndrome can often resemble other more serious childhood illnesses--so, as always, be sure to seek the advice of your personal physician.

So until next time.....Stay Healthy Hawaii!


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March 11th, 2011

Gotcha! It is not even close to what you were guessing this article was going to be on!

Actually, this article is in response to a patient of mine who asked me about this particular disease and wanted to know more for her own information. So I figured...the information would be great for everyone.

"A puff of smoke"....the meaning of a Japanese word that names a rather rare cerebrovascular condition...Moyamoya Disease. It is caused by the blockage of arteries (from both constriction or clots) at the base of the brain in affected individuals. The descriptive name is from the appearance of the tiny blood vessels that form in the body's attempt to bypass the blockage. The little tangle of new blood vessels resembles a puff of smoke on imaging.

The disease can affect adults (usually in the 30's to 40's), but it is primarily found in children. It often shows itself as unusual strokes or mini-strokes in an age group you would not expect them--children. The stroke symptoms can be accompanied by weakness and sensory loss on the affected side. Sometimes even seizures can result. Other findings that are associated with Moyamoya disease are speech difficulties, a decreased level of consciousness, vision problems, involuntary movements, disturbances in the ability to mentally function, migraine-like headaches, and possibly some other sensory deficits.

Interestingly, the condition often runs in families and is strongly believed to be an inherited disease. Current research has some evidence that the condition is linked to a particular position on a particular chromosome of the human DNA chain. In addition to its inherited potential, the disease can also be acquired. The most common conditions where Moyamoya type of lesions can be found are sickle cell disease, Down syndrome, and neurofibromatosis.

It is found that the vessel constrictions occur as the inner layer of the arteries in cerebrovascular system (arteries that feed the brain structures) begin to "overgrow" inward, slowly narrowing the available area for blood to freely flow. After a while, the vessel becomes so narrow and constricted that it either completely stops the flow of the blood to that area or a clot comes along and forms to finish the job. The result? A fact, often there are other strokes that follow the initial insult. Sometimes the progression of the narrowing seems to be unaffected by the use of medical therapy and other methods need to be used.

How is this diagnosed? Usually by some type of imaging method--CT scan, angiogram, or MRI scan. Its name describes what is seen on these imaging studies near the areas where there are vascular constrictions--a "puff of smoke" seems to appear at these areas.

Moyamoya is usually treated by a few methods. Sometimes medications that prevent platelets (the clot forming cells in our blood) from working properly are used. In general, these classes of medications will make the blood harder to clot in hopes of preventing complete blockages at areas that are already constricted. However, the most effective treatments all involve some form or method of vascular surgery near the areas that are found to be blocked. The strategy is to bring a fresh blood supply to the area from outside of the skull from the vascular rich scalp areas to help form new pathways that will eventually bypass around the blood starved areas. In kind of a similar way as how heart vessel bypasses are used to get around clogged areas to help to feed the areas that were not getting much blood any more.

In general, patients who have this disease who are undiagnosed and remain untreated, usually go on to have recurrent strokes and will continue to suffer the consequence of these strokes. It is for this reason that this condition must be diagnosed and treated as soon as possible.

As always, if you have concerns or suspicions that you or someone you know may have these problems, make sure you discuss them with your personal physician.

So until next time....Stay Healthy Hawaii!

Ooops....almost forgot. One Doctor's Opinion will take a short breather for about two weeks...but don't forget to look for it right after that!


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March 4th, 2011

"Hey doc...I am a little bit worried. Lately I've been feeling something fluttering in my chest. What's up with that?" "Well...Mr. W, let's take a look at you. I think I have an idea what is going on. You may be having palpitations."

Palpitations are noticeable, irregular heartbeats. In general, we all have occasional missed heartbeats or extra beats during the day. However, when we have many of them or prolonged episodes, we begin to become aware of them and feel them as a fluttering feeling in our chest.

What usually causes palpitations? There are many possible causes:

  • Anemia
  • Caffeine
  • Other kinds of stimulants--cocaine, amphetamines
  • "Diet" pills or weight loss medications with certain ingredients
  • Other common substances--alcohol, nicotine
  • Panic attacks or fear
  • Thyroid problems
  • Fever
  • Pregnancy
  • Low blood sugar
  • Heart valve problems--more specifically mitral valve problems
  • Low blood oxygen levels
  • Blood electrolyte imbalance--abnormal blood chemistry studies
  • Overexertion and fatigue
  • Dehydration
  • Lung disease or problems
  • Situations of extreme pain
  • Heart problems--including heart failure and heart attack
  • Various types of heart conduction abnormalities
  • Adrenaline from being physically stressed or overstimulated
  • Asthma medication
  • Hereditary abnormalities

So when do palpitations become worrisome? When palpitations are associated with these symptoms, always seek medical help immediately:

  • Chest pain or chest heaviness
  • Dizziness or feeling faint or light headed
  • Having trouble breathing
  • Having a loss of consciousness
  • Excessive sweating
  • Confusion or neurological problems

How are they diagnosed? Unfortunately, the exact cause of the problem is often not found at the office visit.  Most of the time, the palpitations are intermittent--and of course, they are not going to happen when the doctor is listening. Does a visit to your mechanic for an intermittent, weird car engine noise sound familiar here? The usual course of action is to first take a careful history--i.e. does it occur with drinking coffee or when the person is scared? Whenever they are overly tired?

The next steps usually include a heart tracing (electrocardiogram) and x-rays of the chest to see if anything really obvious is found. Blood tests can help to determine if something metabolic or hormone type of problems are present. Murmurs can be evaluated with a heart ultrasound (echocardiogram) to see if that may be a cause of the palpitations. For very elusive problems, a cardiologist may often use what is called a Holter Monitor (a prolonged heart tracing monitoring). There are several types of studies that vary according to the length of recording of heart activity that is done--for example, one day or one week long etc. These are more likely to capture the arrhythmia if it happens during the testing.

There are other methods of diagnosis that can be used by your personal physician or with the help of a cardiologist. As you can guess, the specific treatment of the disorder is best determined after the cause of the symptom is found.

As always, if you feel you are experiencing heart rhythm problems, make sure you discuss them with your personal physician so that he/she can investigate the cause of your symptoms.

So until next time.....Stay Healthy Hawaii!


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February 25th, 2011

Oops...sorry... What I really meant was welcome to the state of 50...years young that is. Here is a topic I get asked about all the time. So I decided to FINALLY put a quick set of guidelines together guessed it....all the cool things that happen right around the age of 50 and older. The following is a compilation of information found from the Centers For Disease Control and Prevention, The Cleveland Clinic, and Health Maintenance Guidelines from BlueCross BlueShield.

These health maintenance items are meant to be purely a guideline and should not be taken as the absolute law on what should be happening when you reach age 50. Your own physician is your best resource on what kinds of health maintenance you should receive around this age. Your individual situation will be different from anyone else's and your own physician may design a particular schedule of events according to what you need done. Some items may occur later and others may be done much earlier than other people for various reasons. Wow! There was the disclaimer. Got it?

So you find that you have reached the magic number of 50. The following is a general guide as to what you may expect as far as routine health maintenance in your coming years:

  • A comprehensive health maintenance exam (physical exam) about every 1-2 years
  • General health statistics (weight, body mass index, blood pressure) about every 1-2 years
  • General exam for obvious signs of cancer (skin, mouth, lymph nodes, testicles) about every 1-2 years
  • A complete breast exam by a physician yearly starting at about age 50
  • Self testicular and breast exams every month
  • For women, depending on your gynecologist's discretion, you may need a Pap Smear, Human Papilloma Virus, and Chlamydia screening between every 1-3 years according to your particular circumstances. Sometimes these exams can terminate at age 65 to 70--again at the discretion of your doctor
  • For men, yearly Prostate Specific Antigen (PSA) testing and digital prostate exams
  • For women, yearly mammogram
  • For women, Dexa Scan (osteoporosis screening) with a baseline around age 50 or at menopause, then usually every 2 years or earlier at the discretion of the doctor or as circumstances require
  • Screening for alcohol abuse, drug abuse, depression, smoking at every health maintenance exam
  • Lipid panel (cholesterol screening) at least every 5 years unless needed earlier due to cholesterol problems
  • Diabetes screening blood tests every 3 years or more often if there are diabetes or elevated blood sugar issues found
  • Blood pressure screening at least every 1-2 years
  • HIV screening should be done at least once along the way--more often if higher risk activity
  • Annual stool occult blood screening
  • Screening colonoscopy every 10 years or flexible sigmoidoscopy (shorter than a colonoscopy) every 5 years--either one might be done at a more frequent basis depending on findings or at the discretion of the physician
  • Influenza vaccine every year unless contraindicated
  • Pneumococcal vaccine at age 65 unless contraindicated. If high risk adult (cancer, lung disease, diabetes, heart disease, immune system problems) then revaccinate in 5 years. High risk groups may also be able to obtain vaccine at an earlier age
  • Diphtheria/Tetanus/Pertussis vaccine every 10 years up to age 65. Over age 65--one dose...unless contraindicated
  • Varicella-Zoster (Shingles) vaccine at age 60 unless contraindicated

There you have it... as straightforward as I can make a set of complicated recommendations.

As always, if you have questions about your health, seek the advice of your own physician as he/she knows your medical history the best. Your own doctor can help you design a health maintenance program that is just right for your particular situation.

So until next time.....Stay Healthy Hawaii!


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February 18th, 2011

A "burp" is formally called a belch or eructation and medically defined as the expulsion of intestinal gas from the mouth.  Most of us already know that it is usually accompanied by a nasty sound and an even nastier smell. But the real question is whether or not it is purely an etiquette problem or an indicator of other issues. Amazingly, what we have just blindly accepted as a rude burp all this time, may not only be just a burp--sometimes it can  signal other medical problems or conditions.

Most commonly, it is caused by plain old eating or drinking just regular food. Part of the normal mechanism of swallowing our food or liquids will also unavoidably involve the ingestion of air. As we continue to eat, the air pressure builds up in our stomach and out pops the embarrassing sound from our mouth--the other end is another story, but not today.

Here are some possible warning signs that should not be ignored if they happen with the burping (there are more, but these are important) and they should be discussed with your doctor:

  • Any hint of chest pains with burping going on
  • Dyspepsia or indigestion type of feeling
  • Nausea or vomiting
  • Dizziness or lightheadedness
  • Heartburn
  • Excessive sweating
  • Abdominal pain
  • Shortness of breath

Here's a partial list of some causes of belching--some common, others interesting:

  • Being totally normal
  • Chronic air swallowing--especially when eating
  • Chewing gum
  • Being a mouth breather
  • Here is an important one--a certain type of heart attack that affects the underside or lower part of the heart--chest pain with belching
  • Esophageal reflux disease
  • Dentures that do not fit properly
  • Stomach ulcer disease
  • Food intolerances
  • Drinking too many carbonated beverages
  • Intestinal obstruction--may have abdominal pain with belching
  • Tumors in the intestine or stomach
  • Stress
  • Pregnancy
  • Gall bladder or pancreas disorders
  • Obesity
  • Dairy intolerance
  • Hiatal hernia
  • Just simply drinking and/or eating too fast

Wow! Long list....several "go figure" ones huh... Interestingly, the bottom line is that humans are generally a "gassy" species. Burping several times a day is part of a human's normal daily activities...not to mention gases that pass the other way several times a day.

How do we help to reduce our rudeness? First of all.....slow down....take it easy and slow....chew your food and stop gulping it down like you are at a race. The less air you swallow, the less problems you will have. Some problems may be mechanical or even hereditary and you have no control over them. Sometimes changing your dietary habits can help you to avoid foods that you know cause you to be excessively gassy. Other times, the cause of the belching needs to be addressed by a medical professional--ulcers, hernias, heart problems etc.

On a more serious note... In spite of belching being a normal part of all of our every day lives, we need to keep in mind that there are some conditions as listed above that fall outside the normal range when we should become concerned--especially those that are listed in the first list above that are warning signs.

As always, if you feel you are having these problems, make sure and discuss them with your personal doctor as he/she knows you best.

So until next time....slow down and enjoy your meals....and Stay Healthy Hawaii!


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