Mark Glenn Stokes, MD

 They're safe.   They do not cause autism.  They do not alter your DNA.  They don't contain microchips. They've saved untold numbers of lives.  I would caution against believing  information coming from the Federal Government in Washington; under the current administration, vaccine policy is being set by politicians, not scientists, and the veracity is suspect, at best.  I would trust the American College of Physicians and the American Academy of Pediatrics for reliable information.  Here are the vaccines adults should get: COVID-19 every Fall, with a booster in the Spring for those over 65 years of age. Influenza, every Fall. Respiratory Syncytial Virus, once at age 75, or at age 60 should one have: chronic heart or lung disease, end-stage renal disease, diabetes, chronic liver disease, thalassemia, sickle cell anemia, ALS, muscular dystrophy, marked obesity. Tetanus-diphteria-pertussis (Tdap), every 10 years. Measles-mumps-rubella (MMR), if ther...

 We have a lot of data on how and when to screen for certain diseases, particularly cancers, but relatively little on when to stop.  Many guidelines, such as those for mammography and colonoscopies, suggest 70 or 75 years of age, but this is somewhat arbitrary.  A particularly useful thing to think about, in my opinion, is the functional status of an individual in relation to ones perceived life expectancy.  By perceived life expectancy, I mean how long do you expect an individual to remain alive, especially with a reasonable quality of life, not a life expectancy derived from actuarial data.  The data would suggest that an 87 year old man will live for 5 years, but this is based upon a statistical estimate of the population at large.  I've met 87 year old men who I would not expect to live a week, and others that I would not be surprised to live to be a hundred.  I think this is important to consider when offering a screening test.  A woman in ex...

 For many years we had no good screening test for lung cancer.  Traditionally we relied upon chest x-rays (CXR) as the screening modality, but this turned out to be a poor choice.  To qualify as a good screening test, the procedure must meet several criteria. First,  the condition must be prevalent enough in the population to allow  screening to be cost effective.  Lung cancer certainly meets this criteria.  A condition like adrenal cancer wouldn't qualify, as the disease isn't common enough to make a screening test worthwhile.  This of course is from a population point of view; for one afflicted with adrenal cancer, screening might have helped.  But the decisions are based on a value to the population, not an individual. The second criteria is that the test must be easily assessable and acceptable to the patient. A CXR certainly meets this criteria.  A brain biopsy looking for Alzheimers disease would not.  Third, the disease being...

 "I gotta sore throat, doc.  I need an antibiotic." Most instances of sore throat, need, most instances of upper respiratory tract infections, are viral, and self resolve in a short time.  These are are treated with "symptomatic" therapies - throat lozenges, decongestants, etc.  Antibiotics will not help.  The fact that the infection resolves after a few days of an antibiotic is usually coincidence. It would have gotten better regardless.  When assessing the sore throat, we look for four things - tender tonsillar lymph nodes (those that are just under the angle of the jaw); high fever; exudates on the tonsils; absence of a cough. If present, they can be suggestive of a bacterial - streptococcal - infection.  Absent these, the sore throat is likely viral in origin.  Now, sometimes a person will comes in with a cold that has lasted three weeks - runny nose, sore throat, cough.  They give a history that is described as a "double sickening:" ...

Sometimes one needs to reach a physician outside of business hours for medical advice.  I, as a physician, have often been on the receiving ends of such calls. When calling the doctor on call, here are some tips to make the encounter go smoothly.  Reduce the background noise. Turn off the TV.  Put the dog away.  And the kids.  And the six relatives in the background screaming advice or questions.  If I can’t hear you, I can’t help you.    If possible, let me talk to the patient.  Talking to the spouse, or the child or the friend, just confuses things.  I am going to ask you for your temperature, especially if you are calling with symptoms that might be an infection.  No, I can’t hold on while you take it.  Take it before you call. I am going to ask you for your blood sugar if you are a diabetic.  No, I can’t hold while you check it.  Do it before you call. I am going to ask you what mediations you ...

 "Doc, my back hurts.  I need an MRI." The MRI seems to be the Holy Grail of diagnostic tests to many patients, especially for those with back pain. Its utility?  Virtually zero. As with most diagnostic testing, the question to ask is "What am I going to do with the information I get from the test?"  The answer, at least with MRIs order for back pain, is "Nothing." First, a bit about back pain.  In generally, if one does absolutely nothing - no medication, no physical therapy, no MRI, X-ray, CT scan, no massage, no acupuncture - 90% of those presenting with back pain get better in 30 days.  There are exceptions, those that require more aggressive therapy, and more urgent diagnostic testing - the so-called "red flags of back pain" - but those are ascertained by a good history and physical examination.  The majority of cases, though, are not serious, medically speaking.  For sure, back pain can be life interfering, but for the most part acute onset...

 There has always been great interest in the “annual check up” or the “yearly physical.”  But do you know where this came from? In the early 20th Century, as the health insurance industry developed, the insurance companies felt it would be in their best interest if their customers were seen periodically by a physician. Their premise was that problems would be uncovered early, and that would reduce the number and dollar amount of claims they would have to settle, saving them money. (Remember, the mission of insurance companies is not to keep you healthy; it is to increase profit margins).  So they advocated the annual physical and so it has become entrenched in our society.  A myriad of studies, however, have never proven that this activity confers any benefit to the patient. The likelihood of uncovering a serious problem before the onset of symptoms is vanishing small. In nearly 40 years of practice, I’ve diagnosed exactly one problem, before there were symptoms, tha...

 Many patients ask me for an ECG during a visit.  They feel it is part of "the annual check up."  They often say that other doctors use to do it routinely for them. Like many medical tests, ECGs should only be done in response to a symptom or physical finding on an exam.  Chest pain, palpitations, fainting, hypertension - these are all legitimate reasons to obtain an ECG.  In these situations, it can help in diagnosis and management of a number of conditions.  ECGs are terrible, though, used as a screening test.  A normal ECG does not exclude the presence of heart disease.  It may be reassuring to a patient to have a "normal" tracing, but when performed in the absence of a symptom such as chest pain or palpitations, it offers very little useful information. Why do many doctors do ECGs?  It is an easy way to make money.  Medicare reimburses about $20 per ECG.  For something that takes about 2 minutes to perform and interpret, but has...

 I get a lot of requests from patients asking to do a “calcium score”.  A calcium score (CAC - coronary artery calcium) is an assessment of calcium deposition in coronary arteries, as determined through a CT scan of the heart. Since calcium deposits in areas of inflammation, and since plaques, the cholesterol accumulation in arteries often involves inflammation, the degree of calcium can be used as a surrogate marker for the degree of coronary artery disease one may have.  The problem with CAC scores is what do with the information obtained. Many patients ask for them as part of an assessment for chest pain. Indeed, many cardiologists will obtain a CAC score, along with a stress test and an echocardiogram, as part of a “cardiovascular evaluation.”    We can predict fairly well the likelihood of developing clinically significant coronary artery disease (CAD) by calculating something called the ASCVD Risk Score. By clinically significant, I mean CAD that is gong t...