On May 12, 2016, Dr. Roy Benaroch sat down for a live Q&A session with his fans from across the globe. The chat is over, but the transcript is posted below for you to enjoy.
BENAROCH: Hello everyone!! Thanks a lot for stopping by. I’ll be happy to try to answer any questions about my courses here, or medical issues, or whatever’s on your mind!
[email protected]@: Hi, professor! If you were to meet an aspiring young student, who wishes to become a doctor, what would you say to them? My brother, David, is eighteen years old and wishes to attend Liberty University this August, as he has already been accepted into the medical program. Any tips for him?
BENAROCH: Good for him! The most important thing to think about when considering medical school is whether you really like to study and learn. Medical school is long. If you’re curious, and you like to find answers to questions, you’re going to love medical school (and, I think, love being a doctor).
JONATHAN DOHERTY: What medical mysteries or hurdles do you and other doctors still face today in this era of unprecedented knowledge and technology?
BENAROCH: It can be difficult to keep up with ALL of the evolving knowledge. We have to stay humble, and admit when we don’t know– and then go back and learn more. To me, many of the most difficult issues my patients and families face fall into the arena of mental health. Those are some serious challenges with big consequences, and we’re really at an early stage understanding how to prevent and address mental health problems.
SAM: I have often thought that more patient education would help patients make better decisions and adhere to doctor’s instructions better, yet this does not seem to be a current component of our medical system. What do you think would be the best system for delivering this information?
JIM: …and yet we’re flooded with televised sales pitches from the pharmaceutical industry — hardly the “health” education we need!
BENAROCH: You’re certainly right — patients can be a great ally when they’re “part of the team.” Better medical & science education for all is important, both in traditional schools and via internet talks and sites and (I hope) courses like mine. But when you get down to the patient level, it’s really the doctor’s responsibility to teach, and to make sure that our patients (or, for me, parents) understand. Right. Pharma ads are meant to sell their medications. They’re not a good source for objective health info.
LISA: Do children still get rabies shots when bitten by stray animals? Are they still in the stomach?
BENAROCH: Some stray animals have a relatively high risk ofrabies transmission — bats, skunks, raccoons, foxes, other carnivores. Others very rarely or never transmit rabies (rabbits, rodents). There are specific recommendations for different animals and types of exposures — anyone with any question about an exposure should contact their doctor. Though rabies is very rare overall, it is almost always fatal if post exposure injections aren’t given. And, no, they haven’t been given in the stomach since the 1980’s. They’re given in adults in the upper arm (shoulder area) and right at the site of the bite.
LISA: Thank you!
OUCHIES: Have you heard of “text claw”? I work on my phone and computer all day and my dominant hand hurts at the palm of the hand by the thumb and into my wrist. What should I do to relieve/heal this (besides putting the phone down)?
BENAROCH: I’ve never heard that term– but I like it, it makes sense and is a good description. There are many examples of these kinds of “overuse” injuries — your body is not meant to do the same thing, over and over and over. As you said, one solution is to cut down on whatever you’re doing that hurts! Other solutions would be to take at least a break now and then, and to look into better ergonomic solutions (an alternate keyboard, for instance) that may work better. You can also consider consulting an orthopedic surgeon with expertise in hands.
ENRIQUE: What’s the protocol at the ER for a pregnant woman who is at less than 20 weeks gestation?
BENAROCH: There are some special considerations. X-rays are a no-no (and CT scans, too; ultrasounds and MRIs are OK.) Typically many ordinary problems are handled by the ED doctor, who can consult an obstetrician if needed. Symptoms or issues related to the pregnancy itself will be handled by an OB.
SASSAAFRAS: Is it true that bipolar disorder cannot be diagnosed until early adulthood?
BENAROCH: I wouldn’t say “cannot” — but there has been a shift in the recent psychiatric guidelines & literature to move away from a bipolar diagnosis in children. Many, we now think, were incorrectly diagnosed, and probably have symptoms more consistent with other diagnoses. (Like dysruptive mood dysregulation disorder, a relatively new term)
RICK CARMICKLE: Looking into the future, do you believe using virtual technology such as “telemedicine” can reduce the cost of healthcare or make it more widely available?
BENAROCH: Yes… but. There are some situations where telemedicine, I think, would be very helpful and appropriate. But to diagnose some conditions, a genuine physical exam or testing is needed. A simple ear infection cannot be diagnosed without looking into the ear. A strep throat cannot be diagnosed without a strep test. We shouldn’t sacrifice good care for quick care.
ABC: For someone considering a medical career, what are the main differences between the education and training that a doctor has to acquire compared to a PA? And how are the two viewed differently by medical professional and patients?
BENAROCH: An MD (medical doctor) has a longer educational path, which includes years studying basic science. PAs (“physician assistants”) have a shorter time in school (typically 2 years after college, rather than 4 for med school). I regard PAs as an important part of the team– and I teach PA students at Emory University.
TGC FAN: Please share if you have a favorite medical TV show, movie or book for how accurately it depicts life/work in your field!
BENAROCH: I loved Jerome Groopman’s book “How Doctors Think.” It’s filled not only with captivating, realistic stories, but also with some great insight into medical decisions and how doctors approach medical questions. Highly readable for anyone!
CAROLYN: I have heard that use of a nasal decongestant such as Afrin can be difficult to stop. What about oral decongestants like Sudafed? Is it less likely to give rebound congestion?
BENAROCH: Correct — nasal decongestant sprays (Afrin, Neosynephrine) can cause a big rebound, especially if used for more than a few days, and it may seem like your nose has gotten “addicted” to the spray. Oral decongestants like Sudafed don’t cause much rebound, but they do lose their effectiveness after just a few days. So neither the sprays or pills are really for long term use. BTW that does NOT apply to allergy nose sprays, like Flonase, Nasacort, etc. These can be used continuously or long-term.
VEEK: Do you have any suggestions for summarizing and delivering information to patients in a way that will be most likely to “get them on the team” for health care? I am thinking of difficult problems like using too much sugar — patients are bombarded with incentives for instant gratification from our culture and our media, and it’s especially hard to promote the long term benefits of health versus the short term benefits of “feeling good.”
BENAROCH: What I find helps is to write out tips and instructions as I talk, showing it to families as I write it. Sometimes I’ll add little drawings (though I am NOT a gifted artist.) I’m not a huge fan of handouts or other things that are slick but impersonal.
ZOFIA: Do you know of any new fluid injections for knees other than Cortisone injections to help with pain in older athletes with cartilage damage and arthritis. My husband doesn’t want a new knee yet, but he wants to continue windsurfing, snowboarding, skiing, etc. He was advised to hold out as long as possible, but his knee hurts all the time.
BENAROCH: Honestly, this is out of my expertise. I suggest he work with an orthopedic surgeon and discuss available options.
TGC FAN: Loved your Pediatrics course! My 8-yr-old daughter constantly complains of “cramping” (sounds like a side stitch) whenever she runs for even a minute or two. Water, no water, food/empty stomach. Doesn’t matter. Any ideas how to go about figuring it out? (Her pediatrician says it’s not serious so don’t worry.)
BENAROCH: Agree it’s “not too serious” — but it HURTS! and I would hate this to interfere with her running and playing. The key is to 1) stay hydrated, including before sports; and 2) slowly warm up, stretching the muscles and slowly stepping faster, then, jogging, then running. Kids are much more likely to just TAKEOFFFAST, but they’ll prevent a stitch if they warm up a bit first.
TGC FAN: Great point. She always just sprints ahead to begin. Thanks!
SSASSAFRAS: I’ve never understood why Tylenol is prescribed for arthritis pain when it’s not an anti-inflammatory?
BENAROCH: It’s not an anti-inflammatory, but it is an effective pain medicine, and it’s very safe (especially in people at-risk for problems from NSAIDs, like GI bleeding.) Besides, even NSAIDs are not very strong anti-inflammatory agents. It’s questionable whether taking a few days of ibuprofen or aspirin really has much anti-inflammatory power, anyway. They’re probably working mostly as simple pain relievers.
STOLONATOR: Homeopathy has been disproven repeatedly, but are there “natural” things that can help over all? I’m thinking garlic or cherry juice for their anti-inflammatory properties.
BENAROCH: There are plenty of home remedies and things that help. To me, the difference between “natural” and “not natural” is less important than the distinction between “medicine that works”, “medicine that doesn’t work”, and “medicines that we’re not sure about.”
CAROLYN: What do think of the EarPopper? What if the patient has a healing eardrum perforation from a healed infection, but still has effusion in middle ear? Any other suggestions would be welcome. To drain a middle ear effusion, do you prefer nasal antihistamine or nasal steroid or both?
BENAROCH: The earpopper is a specific medical device that can help clear fluid from the middle ear. It does work, though you have to use it right (the timing is important, and you have to swallow).
JUST WONDERING…: Is a zombie outbreak actually possible?
BENAROCH: I doubt it, but you never know. Good to be prepared.
RGH: If you had to give 3 easy instructions for living a healthy life, what would they be?
BENAROCH: Be good to yourself, your family, and the people you love. Thanks everyone for your great questions (even the Zombie one — ha!) It’s been fun!