What is your tongue telling you about your health?

It’s important to inspect your tongue, as it can be an indicator of general health.    Here are some changes to watch for:

If you see:

Cottage cheese  white:  This can be a sign of thrush, or an oral yeast infection.  This can happen after a patient is on antibiotics, and can also be caused by a weakened immune system.

Oral thrush:



Brown of black fuzz:  This can be caused by poor oral hygiene.  It is important to brush the tongue or use a tongue scraper.  Cigarette smoking or excessive coffee can also be a cause.

Black fuzzy tongue:



Strawberry red: This can be caused by a vitamin or mineral deficiency, such as lack of vitamin B12 or iron.

Vitamin B 12 deficiency:



Hills and valley:  This can be “geographic tongue”, which is actually harmless, and affects 14 percent of the population.  The cause is not known, but it does not lead to problems.

Geographic tongue:



Any change of the tongue should be evaluated by a doctor or dentist,  especially if it is a a lump or a sore that is not healing.    It is important to inspect the tongue as well as under the tongue for changes, and to seek medical care for anything unusual.

Tongue cancer:

cancer tongue.jpeg


Can you make the diagnosis?

A 32-year-old woman has just arrived home after a family picnic, where she enjoyed friend chicken, potato salad, and corn on the cob.

She has just sat down on the couch to watch her favorite show when she has onset of stomach pain.  Thinking it is heartburn, she goes to the bathroom to take a few antacid tablets.

Soon after however the pain intensifies.  It now seems worse on the right, under her ribs.  The pain is so severe it causes her to vomit.

She decides to go to the Emergency Department.  Once there, the nurse checks her vital signs which are normal.  The patient tells the nurse her pain is better now, and asks if she should just go home.   The nurse talks her into staying.

The doctor then sees her, and orders blood work, which is normal.  An ultrasound is then ordered.   What does it show?



  1.  Nothing, she is just having heartburn.
  2. Appendicitis
  3. An ulcer
  4. Gallstones



If you guessed gallstones, you are right!  Gallstones are stones that form in the gallbladder, which is below our liver on the right side.  They cause severe pain, and can cause vomiting.  Women are at higher risk for gallstones, and women who have had multiple children are at even higher risk.   That is because increased estrogen leads to gallstone production.  Men can also get gallstones however.  Obese individuals are also at higher risk.  Patients with other medical conditions such as diabetes and high triglycerides are also at risk.

Appendicitis causes pain that is usually on the right lower portion of the abdomen.  Ulcer pain usually comes on gradually, is in the upper middle part of the stomach, and is can not usually be seen on an ultrasound.

Gallstone pain often comes on after eating a fatty meal, such as friend chicken.  Gallstones typically need to be treated surgically.

Gallstones in the gallbladder:


Are we suckers for supplements?

Many people buy supplements in an attempt to improve their health.   Every year, American spend billions of dollars a year on these products.  Unlike medication, supplements do not undergo FDA testing for safety or effectiveness of their ingredients.  Here are some popular supplements that have not been proven to be helpful:


Prevagen:  This is a supplement made from jellyfish, and is marketed to improve memory and to prevent dementia.  There are no high quality studies to date that demonstrate benefit from this supplement (the only study on Prevagen was done by an employee of the manufacturer).   Consumers have spent $165 million on this supplement over the last 10 years.


Gingko:  This ingredient comes from the Ginkgo tree.   Studies have not demonstrated any benefit for this supplement, and it can interfere with other prescription medicine. If eaten in large quantities, it can cause toxicity.  Americans have spent $107 million on gingko products since 2007.


St. John’s Wort:  This is a plant found all over the world.  It is used for a number of issues such as for mood and focus.  While there may be some benefit for mood,  medical studies have not demonstrated consistent effectiveness for depression.   Side effects include abdominal pain, diarrhea, and confusion.   Americans have spent $57 million on this supplement.


Glucosamine and Chondroitin:  These supplements are widely marketed for pain relief from osteoarthritis and joint pain.   Medical studies to date have not demonstrated any benefit from these supplements for these conditions.  Americans spend $171 million a year on glucosamine and chondroitin.


Probiotics:  These are microorganisms that are sold as capsules or put into food such as shakes or granola bars.  Studies to date show they may have some benefit for irritable bowel syndrome or antibiotic-related diarrhea, but there is no evidence that they improve overall health.  Americans currently spend $36 billion a year on these products.  Of note, there are foods that contain natural probiotics, such as yogurt, pickles, peas and sourdough bread.



Are you near-sighted or far-sighted?

Are you near-sighted or far-sighted?

Near-sighted means that you can see things that are close or “near” to you, but your distance is blurry for things that are farther away.  The medical word for this is “myopia”.  This can be treated with glasses, contact lenses or surgery. 

There are two types of surgery for near-sightedness.  The most common is LASIK surgery, and there is also PRK (photorefractive keratectomy).  They both treat the condition by removing tissue from the cornea.  This re-shapes the eye to improve vision.

More than 40 million people have had LASIK surgery.   Cost of the procedure ranges from $1000 to $3000 per eye.

While LASIK surgery and PRK are overall safe and effective, complications can include worsening vision and infection.

Far-sighted means that you can see well far away, but if items are close then they are blurred.  LASIK surgery can also be used for far-sightedness.

Presbyopia is a type of far-sightedness that happens as we get older, and usually starts about age 40.  The aging process causes the eye lens to harden.  This is treated with glasses or contact lenses.  Laser surgery for this condition is performed in Canada and Mexico but is still considered investigational in the United states and is not currently FDA approved.


Can you make the diagnosis?

A 45-year-old male patient has had a rough day at the office.  He has very demanding clients, and his secretary has just given her two week notice.

At 4:10 pm, he has the onset of a severe headache, that hits suddenly, like a thunderclap.  He lays his head on his desk, hoping that it will pass. He has never had a headache like this before.

His past medical history is negative for any significant medical problems.  He has never had a problem with headaches.

Should he:

  1. Continue working and wait for it to pass;
  2. Take an Advil and call his doctor for an appointment next week;
  3. Got to an Urgent Care,
  4. Go to the Emergency Department



If you guessed go to the Emergency Department, you are right!


Once at the Emergency Department, the triage nurse checks the patient.  He does not have a fever, but his blood pressure is 150/90 (elevated).  He is alert and is not confused.

The Emergency Physician sees the patient and orders a CT scan, which is negative.

What is the next step?

  1.  The patient should feel good about his negative CT scan, and go home.
  2.   The Emergency Physician should order a blood test.
  3.   The Emergency Physician shoulder perform a lumbar puncture (spinal tap).
  4.   The Emergency Physician should give the patient a prescription for Valium for his stressful job and send him home.



If  you chose 3, perform a lumbar puncture (spinal tap), you are right!  A CT scan will not always show a subarachnoid hemorrhage, which this patient has.

One in every 50 people in the United States has an unruptured cerebral aneurysm.  When these rupture, it can cause a severe headache, “thunderclap headache”.  Forty percent of the time, this is fatal.

But for patients who make it to the Emergency Department, the CT scan will often be normal.  Further testing such as a lumbar puncture or MRI is required.  The aneurysm can then often be treated successfully.



How healthy are Americans who are over 65?


In the United states, 3 out of every 4 Americans  over age 65 have at least one chronic medical condition.  A “chronic medical condition” is defined as a medical problem that will last at least a year, and requires ongoing medical care.

The high rate of chronic medical conditions is partly due to sedentary lifestyle, the obesity epidemic, and tobacco smoking.

Among Medicare patients, 93% of total spending is on chronic health conditions.

More than one third of Americans over 65 are obese, 27% do not engage in any regular exercise, and 8% are smokers.

Chronic medical conditions includes diabetes, which now affects 23% of the older population.  One third of older Americans have high blood pressure, and 5% have congestive heart failure.

Only 1% of our health care dollars is spent on public efforts to improve overall health.




Can you reduce your risk for Alzheimer’s disease?

June is national Alzheimer’s awareness month.

There are 5.5 million patients in the United States who have Alzheimer’s Disease.  The United States spends $259 Billion on health care for those patients currently, and drug companies are spending a fortune trying to find a treatment.

Current treatments have not shown significant response, though some medications offer some help for those afflicted.
Are there ways you can PREVENT Alzheimer’s disease?  There is a genetic component to the disease, but some measures have been shown effective at preventing Alzheimer’s dementia:
1.  Studies have shown that people who pursue intellectual activities such as reading, playing board games, puzzles, learning a second language, or playing musical instruments have reduced risk of Alzheimer’s Disease.
2.  Increased social interaction reduces Alzheimer’s risk.
4.  Moderate red wine use is associated with lower risk of Alzheimer’s.
3.  Increased physical activity has been shown to decrease the rate of Alzheimer’s dementia.
One study in particular is fascinating!  A study by researcher Peter Elwood at the Cochrane Institute of Primary Care studied 2,235 men age 45-59, and followed them for 30 years.
They found that those patients who did a few things reduced their risk of dementia by 60%!  This included eating a diet high in fruits and vegetables, maintaining a body mass index from 18-25, not smoking, and walking 2 miles a day.
If there was a drug on the market that we knew would reduce our risk of Alzheimer’s by 60%, we would all pay a lot of money to take it!