1200 Five Springs Rd.
Charlottesville, VA 22902
Phone: 434.977.1933 | Fax: 434.295.3128
Email:  info@DanielSawyerMD.com
    Specializing in Internal Medicine & Infectious Disease    
Immunizations 8/19/2014
August 2014

This is national immunization awareness month. There have been new recommendations for seniors over 65 regarding pnemococcal vaccine. Those patients over age 65 who have not received a dose of pneumococcal vaccine, should be vaccinated with a dose of the conjugate vaccine . This should be followed in 8 weeks by a dose of the polysaccaride pneumococcal vaccine . The two different vaccines protect against different strains of the organism, and work thru a different mechanism. This organism, the pneumococcus organism, can result in life threatening pneumonia and meningitis in the elderly. Any adult with a chronic illness as asthma, diabetes or alcoholism should receive the vaccine. Any patient who has had a splenectomy, anyone with the HIV virus and patients who have had a cochlear transplant. Smokers and adults living in a long term care facility should be vaccinated as well.
Knee arthroscopy ineffective in treating meniscal tears and arthritis of the knee. 5/4/2014
Multiple recent and old studies have demonstrated that knee arthroscopy for osteoarthritis is no better than a placebo operation. Both the 2002 article in the NEJM, as well as a recent study in the NEJM, showed no benefit from arthroscopy over a placebo operation. The 2013 study published in the NEJM showed that arthroscopy for a meniscal tear offered no benefit over a sham operation for a meniscal tear. Physical therapy was as effective as arthroscopy.
Marijuana's Effect on the Brain 4/17/2014
In an article published in the Journal of Neuroscience on April16, 2014 by Dr. Gilman, et al , showed that the routine use of marijuana impairs motivation, attention, learning and memory. These impairments were associated with changes by brain MRI in the nucleus accumbens and amygdala. These are areas which are important for emotion. Marijuana is the most commonly used illicit drug in the United States. With legalization in many states, the use of this drug is likely to increase along with emotional and brain structural changes of our youth.
Swine Flu H1N1 11/4/2009
A publication in the November 4, 2009 issue of JAMA, provides the results of the swine flu pandemic in California. Hospitalized and fatal cases were younger than the seasonal influenza and had a median age of 27. While gastrointestinal symptoms occurred infrequently with the seasonal flu (<5%), these symptoms occurred in one third of the swine flu cases. The risk factors for hospitalization and death were the same as seasonal influenza and included diabetes, cardiovascular disease, chronic lung disease and pregnancy ( third trimester ) . In addition, obesity was a significant risk factor for hospitalization with the swine flu.

The rapid tests for influenza are falsely negative in up to 30-40% of the cases. This is a problem defining the illness for both patients and practitioners. Lastly, there are numerous drugs and drug combinations, which are active against the swine flu if introduced early enough in the illness.
Heart Failure 5/11/2005
A recent article in the American Journal of Medicine demonstrates that exercise training for patients with congestive heart failure is both safe and effective. In this article, aerobic excercise improves peak oxygen consuption and quality of life. Patients with congestive heart failure had significant improvement in exercise tolernace, and the ability to manage routine activities of daily living if they participated in excercise conditioning. Thus if you have the diagnosis of CHF, congestive heart failure and have difficulty performing activities you want, consider a monitored excercise program
Flexible Sigmoidosopy after MI 5/10/2005
Sigmoidoscopy is safer than colonoscopy and may be the preferred test for patients with coronary artery disease. In a recent study, flexible sigmoidoscopy was safe for patients who had a recent heart attack. In this group of patients, this form of screening for colon cancer may be preferable.
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