#Middlebury #ToYourGoodHealth
DEAR DR. ROACH: My mother has stage 4 cancer. She just went to a dermatologist, who performed Mohs surgery on her nose. I am BEYOND upset by this unethical behavior. The country is already deeply in debt, and Medicare is paying for this? Unconscionable! Not to mention the pain and suffering of my mother, who is now at risk of a secondary infection. I was sickened by the entire ordeal. – J.B.
ANSWER: I agree with you completely that often patients with terminal diseases receive unnecessary care. There have been studies clearly documenting this. However, the studies don’t answer why, in a particular case, a physician performed these treatments, which add only pain, anxiety and expense.
I suppose it is possible the motivation is simple greed; however, I still have enough faith in my colleagues that I think that is a very unusual reason; I think it’s far more likely that a specialist just doesn’t see the big picture. There’s an old expression that when all you have is a hammer, the whole world looks like a nail, and I think some specialists see a problem and fix it without realizing that the problem they are fixing isn’t likely to ever cause symptoms.
For example, primary-care doctors order unnecessary tests, especially screening tests. I see mammograms ordered for women with advanced colon or ovarian cancer who are in palliative care, and this makes no sense. I have heard some physicians mention that insurance companies monitor the frequency of “quality indicators,” such as mammograms, which affect their ratings and reimbursement. That’s an example of a well-meaning system motivating wrong behavior.
I should emphasize that not all care for terminal patients is useless. If the goal is to improve quality of life or reduce suffering, then I am all for it, after a consideration of the costs (pain and inconvenience as well as dollar costs).
DEAR DR. ROACH: I have heard of yeast infections, but I don’t know what causes them. How do they affect the body, and what can be done to get rid of them? – C.R.
ANSWER: Certain yeasts, but especially the Candida species, are found on our skin, mucus membranes and GI tract. They normally live in balance with the 100 trillion or so bacteria we carry around. However, yeast can cause disease that ranges from fairly mild, like thrush of the mouth or vagina, to life-threatening, like a blood-borne, widely disseminated invasive infection.
Candida infection of mucus membranes is usually caused by changes in our bacteria, especially after the use of antibiotics. The antibiotics kill the bacteria they are supposed to (hopefully), but they also may kill the healthy bacteria that assist us in digestion (leading to diarrhea or worse), and this allows the other bacteria and yeast to grow.
Some people with genetic faults in their immune system are predisposed to chronic candida infections. These are uncommon but can be severe, and may require treatment by specialists, such as infectious disease doctors and immunologists.
The life-threatening yeast infections generally happen in people with severe illness and with poor immune system function.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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