Wellness Posts by Michael Esposito, MD

Do you really need that CT scan?

2007-11-26T23:25:45Z

Wellness.com - Do you really need that CT scan? by Michael Esposito, MD

In the United States it is estimated that seventy-five million CT scans are performed each year. A CT scan is an excellent test to diagnose a multitude of diseases, both acute and chronic. There is no doubt that these scans save peoples lives everyday. For example, CT scan is the best test to diagnose acute cerebral hemorrhage, internal injuries related to trauma or hard to detect fractures. These are just a few examples of many of how CT has revolutionized medicine. The CT scan has save millions of people from morbidity associated with their individual diseases. But their diagnosis was not without a price. CT scan's ionization radiation induces fatal cancers in a certain number of patients everyday.

CT scans utilize ionizing radiation or x-rays to create an image. A CT scan works by exposing the patient to a radiation sources or x-ray source. The patient is moved through the CT gantry as x-rays pass through their body and are captured in detectors. There are many types of CT scanners but all work on this basic principle. Each CT scan gives a patient an average radiation dose of about 10 mSi (mSi or millisivert is a unit used to measure radiation exposure). This dose is equivalent to three times the background dose the average American receives each year. The amount of radiation may not be great but with each exposure your cancer rate increases. It is estimated that one person, over the course of their lifetime, will develop a deadly cancer for every two thousand CT exams performed. Seventy-five million CT scan performed each year will induce thirty-seven thousand fatal cancers. The risk is multiplied for every scan you receive. If you have ten CT scans then your lifetime risk is one in two hundred (1/2000 times 10) to develop a fatal cancer.

The best way to prevent these cancers from occurring is to not perform the CT scans. However, in many cases not having the CT scan would lead to dire consequence or even immediate death. The condition which the CT scan will diagnose is more deadly than the small risk of inducing a cancer. If it is decided by your doctor than a CT scan should be performed, the exam should be tailored to the patient and the body part being examined.

The newest CT scanners deliver greater radiation doses than ever before. However, the CT operator or CT technologist can tailor an exam in many ways to reduce your radiation exposure. The thicker the slices (5 millimeter versus 2.5 millimeter) and the smaller the body part exposed decreases radiation exposure. The technologist also can change the radiation dose or strength of the beam of the radiation delivered. These dose-reduced images might not be as aesthetically pleasing to the reader but are diagnostic in almost every case. In many cases, the dose can be reduced in half without much difficulty. It is even more important in children to limit exposure for they receive greater doses than adult for the same exam partially due to their smaller size.

My purpose here is not to persuade a patient to not receive a necessary medical exam. It is a reminder to patients and doctors alike that there are dangers associated with radiation exposure from CT exams. The test needs to be used appropriately and should not be overused. There is a tendency among doctor and lay people today to 'just get a CT'. Next time you here that phrase you should think, 'Is it worth the risk?" The cancers that are induced today won't manifest themselves until ten or twenty years in the future. Educated consumers can protect themselves now.

By Michael Esposito, MD
Radiologist and Author of "Locked In" - a medical thriller
www.mikeespositomd.com

Flu Pandemic - Do You Deserve A Vaccine?

2007-11-02T07:00:00Z

Wellness.com - Flu Pandemic - Do You Deserve A Vaccine? by Michael Esposito, MD

The United States Department of Health and Human services recently released its plan describing how it will distribute a flu vaccine if, or when, a flu pandemic occurs in this country. The plan divides the population into four tiers based on different factors. The first tier individuals will receive the vaccine before anyone else. They are the health care workers, first responders and people who are vital to keeping society functioning.

The real debate will occur between the people below this first tier level. The ethical debate pits the sick against the healthy, the old against the young, the taxpayer versus the poor and the "more important" versus the "less important" individual. The argument as to why someone should or should not get the vaccine depends on your perspective. Why should someone else get a better chance at survival? Doesn't the United States call for equal protection and equal rights? Does that include survival? Should we take care of the young and strong first, for they are the people who are building and will build our society. Should we use the limited doses we have on the sick and infirm for they are more likely to die from the ravages of the flu? And what happens if the flu is more deadly than initially anticipated? What happens if a pandemic flu such as bird flu occurs which could cause more than half the people infected to perish? Do we scrap the plan and go to the survival or the fittest.

The complete tiered plan can be viewed on the Health and Human services website. The information is being released so that the average American can give the government their opinion on the planned program. We are given until mid-December to email them our thoughts.

The questions seem theoretical now but need to be answered. The time to decide is before there is a crisis. The ethicists, the scientists and politicians have given us the opportunity to be heard. Everyone needs to get involved so when the time comes we are making the decisions which the majority desired. It may be the most important email you ever sent. It may save your life or the life of a loved one. Get involved. Email them at Panfluvaccine@hhs.gov

Posted by Dr. Michael Esposito
Author of "Locked In" a medical thriller
www.michaelespositomd.com

Is Health Care Only for The Rich and The Criminals?

2007-09-17T07:00:00Z

Wellness.com - Is Health Care Only for The Rich and The Criminals? by Michael Esposito, MD

There is equal protection to all citizens under the laws of the United States unless you are sick. Access to medical care in the United States is a privilege of the wealthy, the employed, the elderly, and the incarcerated. God help you get sick if you a low paid worker or a child living with working poor parents. There is no room or money in the health care system for these hard working souls.

These downtrodden are shunned by all who are privileged. Why should they have medicine or access to doctors if they only cut our grass, clean our dishes or mop the floors in our offices? Why should their children have pediatric care? The nerve of them! If they get sick and can't pay, they should pray. Pray to recover before they lose their job and their car. But they could always commit a crime and end up in prison.

Logic dictates the only solution would be to eliminate these people from our society. Make poverty a crime and put them in prison therefore granting them free healthcare. The problem would be solved. No more health care crisis.

Tell that to the people who remained behind in New Orleans. The good life the affluent lived in the Big Easy was assisted by these wonderful hard working people. They did the things that no one else wanted to do. They served at restaurants, the hauled away the trash, and they manicured the lawns in addition to their fingernails. They simply make our lives richer. It is a symbiotic relationship. Take out these people who are the foundation of society and our lives would not be as comfortable. Make health accessible to everyone now.

Posted by Dr. Michael Esposito M.D.
Radiologist and Author of "Locked In," a new medical thriller.
www.mikeespositomd.com

Health Care System Issues - Can Our Government Understand the Problem?

2007-08-28T07:00:00Z

Wellness.com - Health Care System Issues - Can Our Government Understand the Problem? by Michael Esposito, MD

The United States Health care system is broken and there is no easy fix. The health care system, like the military industrial complex of the cold war, is predicated on corporate profits and not the well being of the patient. The CEOs of the large HMOs and pharmaceutical companies have the same agenda as any other corporate leader. Raise their company's stock price or lose their job which pays their obscene salary and bonus. Health care corporation's focus is financial and they are not concerned with access to care or the quality of care their patients receive.

These same companies will push for tort reform because it limits their liability in medical malpractice lawsuits. They want to limit patient access, reduce their costs and not have any responsibility. The trial lawyers will not tolerate these unconstitutional limits and are fed by the victim's misfortune. We have all heard the advertisements asking, "Has anything bad ever happened to you. Someone else should pay. Call us now. Time is running out." How would they survive if they could only make a few hundred dollars an hour? (Assuming, of course, that they are not double billing). However, without these legal wolves patrolling the health care system even doctors would be at risk to corporate domination.

Where does this leave the doctor? Right next to the patient in the over-crowded emergency room wondering how things have gotten so out of control.