Ward F. Cunningham-Rundles, M.D.
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Ward's Words

An uplifting blog about health, diet, exercise, life, and news from the office of Ward F. Cunningham-Rundles, M.D.

About DR. Ward

Concern about Dense Breasts

10/25/2016

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http://annals.org/aim/article/2534407/variation-mammographic-breast-density-assessments-among-radiologists-clinical-practice-multicenter
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If you have been told of dense breasts on a mammogram, this may or may not be a reproducible finding.  This article demonstrates that the X-ray diagnosis varies considerably from radiologist to radiologist.   
 
Mammography can discover breast malignancies in early phase before anything can be felt clinically.   Sometimes mammography shows dense breast tissue that might hide small lesions. Many state laws require that patients be informed if this is found, because the finding might suggest the value of further testing.  Such laws may have led to excessive reports of such findings. 
 
One’s best bet is see one of the top radiologists who abound in the New York area (and similarly elsewhere) and stay with the same radiologist.  Also bear in mind that the finding may be transient and the underlying cause may well not be serious.  
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Insulin Apps for Insulin-Dependent Diabetics 

10/12/2016

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 http://www.mdedge.com/internalmedicinenews/article/111942/diabetes/experts-insulin-apps-can-pose-major-risks
​Smartphones are potentially the best way for insulin-dependent diabetics to calculate the bolus insulin requirement for a carbohydrate meal.  An FDA official reported at an American Association of Diabetes Educators that the insulin dose calculated by many common apps could be wrong.  This could lead to dangerous or even fatal hypoglycemia.   Currently the only FDA-approved  app is the Accu-Check Connect app.  The app uses data as set up on the patient's
​Accu-Chek by a health care provider.  Undoubtedly other apps are being developed for other glucose meters.   WFCR MD has no connection to the manufacturer of this device or any other such device.    

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Eczema and Atopic Dermatitis

10/7/2016

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http://www.nytimes.com/2016/10/01/health/severe-eczema-atopic-dermatitis-drug.html?_r=0
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​This is an exciting news for severe eczema sufferers.  The product may offer relief for the incessant itching, weeping skin that does not respond to topical or oral agents.  Prior approaches have often been ineffective and with multiple undesirable side effects.
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CT Scanning for Lung Cancer and other conditions

8/20/2015

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http://www.nytimes.com/2015/05/12/health/on-medicare-and-assessing-the-value-of-lung-cancer-screening.html?mabReward=CTM&module=WelcomeBackModal&contentCollection=N.Y.%20%2F%20Region&region=FixedCenter&action=click&src=recg&pgtype=article



This is a useful  discussion of screening for lung cancer in individuals who have been heavy smokers, even if they have long since quit smoking.    It parallels my own experience, where some of my patients have remained disease-free for several years after removal of small lung cancers.  And, aside from coincidence, CT scanning is the only way to find small lung cancers.  

I should mention that several of my patients’ have also had other small cancers found this way, particularly kidney cancers.   But, of course, testing can lead one on wild-goose chases that lead to negative biopsies, some with longer-than-ideal recovery periods.  Scanning also can look for other issues, such as aortic aneurysm and coronary arteriosclerosis. 







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Breast Carcinoma in Situ

8/20/2015

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http://www.nytimes.com/2015/08/21/health/breast-cancer-ductal-carcinoma-in-situ-study.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news

This reinforces the opinion that all of my patients have received from my consulting surgeons for several years.   Most patients can be followed closely for years without further or excisional surgery.   There are exceptions, such as BrCa positive patients, or where there is evidence of extensive disease on mammo or MRI.


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Ward's Words

4/12/2015

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Telemedicine is appropriate in the right circumstances, and, with reservations, I condone it.

http://www.nytimes.com/2015/04/11/us/texas-medical-panel-votes-to-limit-telemedicine-practices-in-state.html

Patients have a crucial need to reach health providers.    A health provider needs to understand a complaint and be familiar with the patient.    Traditionally, this required a face-to-face encounter between a patient and a health provider.    There are circumstances when rendering an opinion face-to-face is not  feasible or may be too time-consuming, or simply involve unnecessary expense.   Face-to-face encounters require discussion, scheduling, traveling and office time that is wasted for a condition that could be solved with remote discussion and possibly a transmitted prescription.  

Phone treatment of  a person whom the health professional knows is  often a good way to give care.   Care rendered to an unknown patient might well  lead to trouble.   This Texas decision is apparently designed to eliminate such evaluations for patients who do not have an ongoing relationship with the health professional.   As described, this decision sounds valid.

I often deal with patients by phone or with other forms of discussion.   The other day, I discussed the physical complaints of a long-term patient using FaceTime.    I prescribed medication based on what he showed me on the phone.    He emailed back a few days later with good results.    I have often used camera-phone JPEG pictures for assisting with rashes or suspected insect bites.   I assessed the swollen legs of a patient who was calling from her Paris hotel room overlooking the Champs-Élysées.   Skype is another reasonable means of communication.   Email communication is appropriate where verbal description is adequate.    At times, appropriate treatment requires lab testing, such as getting a urine culture at a lab just before beginning treatment, in case symptoms don’t improve.    Such lab tests and prescriptions can be arranged remotely.

At times, phone call can discriminate between a cough, mild asthma, and life-threatening asthma.  Recently, a patient in Bayside, Queens called me.   Whereas she was able to speak, but was quite short of breath, I immediately had a private ambulance (Hatzolah) go to her apartment and bring her to her pulmonologist at a Manhattan hospital.   They were at her apartment in five minutes, giving her oxygen and transporting her.  I have known her for a few decades and could discriminate her needs appropriately.   Using a conventional 911 ambulance would have been ok, but she would have to deal with a whole new set of physicians who would not have been familiar with her unique condition.

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Ward's Words

4/9/2015

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I have had a Pebble watch for about 16 months.  It syncs with my iPhone and announces who is calling me, and gives me the source and the first line of all my emails.   As a physician who gets dozens of emails every day, I find this extremely handy, because I can see it when I am doing other tasks without taking out my phone.  It is handy in public, as I can know who is calling even when the phone is on silent, and can be paged in a moment without disturbing anyone.  If I set my phone down and walk away, the wrist still alerts me if I am within about 50 feet of the phone.   And a glance is all I really need to differentiate the trivial from the serious.  In social circumstances, there is the danger that one’s companions may remark “are you bored” or “do you need to be somewhere else”, but generally the topic immediately turns to the Pebble watch.   The Apple Watch should expand this experience to many more people and have many more uses.

http://takingnote.blogs.nytimes.com/2015/04/08/will-the-apple-watch-make-us-happier/?action=click&pg&version=Moth-Visible&module=inside-nyt-region&region=inside-nyt-region&WT.nav=inside-nyt-region
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Ward's Words

4/8/2015

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http://well.blogs.nytimes.com/2015/04/07/can-orange-glasses-help-you-sleep-better/

Having trouble sleeping? Avid electronics user? Wearing special orange glasses before bed may help the mind doze off after hours of staring at computer screens.




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Ward's Words

4/8/2015

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Articles related to the continuing Angelina Jolie story…A must-read for women!

Kelly Osbourne has Cancer Gene, Plans to Take Preventative Measures Like Jolie
http://pagesix.com/2015/03/24/kelly-osbourne-has-cancer-gene-plans-to-take-preventive-measures-like-jolie/?_ga=1.185652064.813490017.1407377915


Angelina Jolie Removes Ovaries in Preventative Surgery
http://pagesix.com/2015/03/24/angelina-jolie-removes-ovaries-in-preventative-surgery/
 


Angelina Jolie Pitt Diary of a Surgery
http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?_r=1   

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Ward's Words

4/8/2015

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Don’t Forget… To read some of these great articles I’ve compiled from the past few days on aging and Alzheimer’s disease.

New ways found to identify signs of Alzheimer’s disease.
http://www.nytimes.com/2015/03/31/health/parsing-ronald-reagans-words-for-early-signs-of-alzheimers.html?ref=science

Alzheimer’s Drug Trial Shows Cognitive Decline Sharply Slowed 
http://www.nytimes.com/2015/03/21/business/alzheimers-drug-trial-shows-cognitive-decline-sharply-slowed.html?gwh=00EB32E2EF10A1F03B63FA04BBAFB00E&gwt=pay&asset 

Older Really Can Mean Wiser
http://www.nytimes.com/2015/03/17/health/older-really-can-mean-wiser.html?gwh=CD305BBBF17CADD5A5A50281084F8D4C&gwt=pay&asset

 
Looking for Parkinson’s Sooner, quite germane to recent patient diagnoses. http://well.blogs.nytimes.com/2015/03/16/looking-for-parkinsons-sooner/   

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    Ward F. Cunningham-Rundles, MD is a doctor of Internal Medicine and Immunology based in New York City.  

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Ward F. Cunningham-Rundles, M.D.
240 East 68th Street
New York, New York 10065
212 REgent 7-8973
212 737-8973
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E-mail: ward@wcrmd.com
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