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Oak Street & Oregon Allergy Blog

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160712Eczema-200Babies and children with eczema, also known as atopic dermatitis, often have a family history of eczema, asthma or allergies. They also have a much higher chance of developing environmental and food allergies, as well as asthma.

In fact, a 2003 study published in the journal Pediatrics showed up to 80 percent of children with eczema go on to develop allergies and/or asthma, while up to 30 percent of patients with eczema may also have a food allergy, compared to 1-3 percent in the general population. This progression of developing eczema in infancy, followed by allergies and asthma as the child gets older, has been dubbed the "atopic march."


GeneticTesting-325When I was diagnosed with breast cancer, one of my first thoughts, after the initial shock, was who else in my family had been stricken with cancer?

Patients who have had family members diagnosed with cancer often worry about their own cancer risk, or the risk of their children. At Oak Street Medical, we have recently started a program to help patients better understand their family risks of developing certain types of cancer, which can be passed down by gene mutations.

The types of cancers we are most often confronted with in a primary care clinic are breast, ovarian, pancreatic, prostate, colon, melanoma and endometrial/uterine. A person's risk level for developing any of these cancers depends on many factors, including the person's lifestyle.

We're helping our patients understand how their level of risk changes in relation to their family history. Risk categories include: general population, familial risk or hereditary risk. A person's risk can vary dramatically, depending on which category you fall into.

Tagged in: Cancer

Many people live with a constellation of symptoms that make up a rare disease that is difficult to diagnose, because it is just that—rare.

160531RareDiseases-325In the United States, the National Institutes of Health (NIH) considers a disease rare if there are fewer than 200,000 individuals affected. For reference, there are nearly 80 million people with high blood pressure in the U.S.

These patients often go from provider to provider seeking an answer to their health problems. In fact, most patients see up to eight different providers before getting a diagnosis, delaying treatment. It can sometimes take seven or more years to get an accurate diagnosis, if ever. Some diseases haven't even been named; they are known as SWAN, or Symptoms Without a Name.


160517MentalHealthMonth-325Most people believe that mental disorders are rare. Each day at Oak Street Medical, we see patients with mental health problems, such as mood disorders, or physical symptoms associated with mental issues—these problems are far from rare.

According to Mental Health America (formerly the National Mental Health Association), an estimated 54 million Americans suffer from mental disorders each year.


160503Hypothyroid-325The goal of treating hypothyroidism is to replace the deficient thyroid hormone. This is done with oral medication, using the synthetic thyroid hormone thyroxine (T4) or levothyroxine. This treatment is proven to be safe and effective with more consistent results.
Most people notice an improvement in their symptoms within two weeks of starting treatment, however, if the problem is severe, it may take longer to take effect. It may also take some time for the doctor to determine the right level of medication to keep the hormone levels in check.
Drawbacks to treatment options
In a previous post, we learned that the thyroid produces two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). In the past, before levothyroxine was synthesized, desiccated animal thyroid (Armour)—now mainly obtained from pigs—was the most common form of thyroid therapy. Since they are not purified, they contain hormones and proteins that never existed in the body outside the thyroid gland. While they also contain T4 and T3, the balance of T4 and T3 in animals is not the same as in humans, so the hormones in desiccated animal thyroid pills are not necessarily “natural” for the human body, nor are the chemicals that are used to hold the pill together.

Furthermore, there can be some variability in the amount of thyroid hormone per pill, which makes monitoring thyroid hormone levels challenging. There is no evidence that desiccated thyroid pill has any advantage over thyroid hormone thyroxine (T4).
Cytomel or T3 was also used before T4 was synthesized. Most of the T3 in the body comes from the conversion of T4 to T3, a process that is normal even in hypothyroid patients. T3 has a very short life span in the body. After taking a tablet of cytomel, there is a very high level of T3 for a short time, and then it falls rapidly. It is impossible not to have too much thyroid hormone in the body soon after taking T3. High T3 levels can lead to unpleasant symptoms, such as palpitations, anxiety and insomnia, and it can also cause harm to the heart and the bones. T3 should not be used alone in the treatment of hypothyroidism.
Some hormone preparations containing T4 and T3 (Thyrolar) are available in the United States. Combination T4/T3 contain much more T3 than what is normally produced by the body, which can produce the same side effects as taking T3 alone. It is a medication that is taken once a day, which ignores the short life span of T3 in the body.
Patient-specific treatment
Certain conditions may require adjustments in thyroid hormone treatment. In patients who are older or who have a weak heart, thyroid hormone may increase stress on the heart, so a lower dose is needed. Pregnant women may need higher doses; after the baby is delivered, the dose may need to be adjusted.
Patients are typically on thyroid hormone replacement medication for life. Regular follow up with an endocrinologist is necessary to ensure proper thyroid hormone levels.