Douwe Rienstra, MD

Educational Activities

2006 | 2005 | 2004 | 2003 | 2002 | 2000 - 2001 | 1988 - 1999

December 7th, 2001- Virginia Sybert, MD spoke at Virginia Mason Clinic about pediatric dermatology. Warts in childen usually go away by themselves in two years, which is preferable to any other treatment because there is no risk of a scar. She believes that virus that causes warts is always present on the skin. Occasionally the immune system reacts to the virus and forms a wart.
She also discussed molluscum contagiosum, condyloma acuminatum, fingernail fungus, and tinea (ringworm.)

December 7th, 2001- Roberta Pagon, MD of the University of Washington spoke about genetic testing. An excellent resource of technical information about genetic testing is www.genetests.org. I am not aware of a site geared to patients; genetic testing information changes so rapidly at this point.

December 7th, 2001- Sterling Clarren, MD of the University of Washington gave a talk about children that I consider ground-breaking. What he pointed out is that not all children with learning disorders or behavior problems fit easily into diagnostic pigeonholes. These multifocal, diffuse brain processing difficulties can arise from chromosomal problems (such as Down syndrome), single gene defects (such as William syndrome), multi-gene problems (like autistic spectrum disorders), and brain dysfunction due to fetal alcohol syndrome, lead poisoning, etc. He likes the term "minimal brain dysfunction" to describe this situation.

Dr Clarren points out that even a child who does fit into a diagnostic pigeonhole must be dealt with as an individual, and not just treated according to the doctor's favorite theory. He estimates that 3 to 5% of children suffer minimal brain dysfunction. If their problems are not cared for wisely, these children often grow up into dysfunctional adults. Their own personal tragedy is terrible enough; in addition, though, they cost society a great deal in terms of prison costs, care of the dysfunctional families they may generate, and other welfare costs.

What I liked about his talk was the recognition that the school system's desire to lump children into groups in order to deal with them more easily is not working well with children with minimal brain dysfunction. Our mental and emotional processes are various and complex. When things go wrong they go wrong in individuals who have their own idiosyncrasies to start with (as we all do). This can result in so many patterns of behavior that we would need an infinite number of pigeonholes to categorize them all. Since we don't have an infinite number of pigeonholes, we need to place less emphasis on labelling a child as "learning disabled" or "attention deficit" and more emphasis on finding the strengths of each individual child and promoting those.

November 30th, 2001- Resident physicians at the Virginia Mason Clinic discussed unusual cases. These included people with hepatitis due to herpes simplex, a tumor that secreted adrenal hormones, an unusual skin condition, non-Hodgkins lymphoma, an usual adverse reaction to a topical anesthetic.

November 16th, 2001 - Swedish Medical Center hosted an all-day series of lectures on the basic science of the mind, titled "From Genes to Cognition, from Molecules to Mind." The series is sponsored by an endowment, so the speakers concentrated on the science and not on the pharmaceutical angle.

Lectures covered how the synapses between neurons in the body are formed and evolve, how memory is laid down, how the Zebra Finch learns its song, some of the mechanism of Alzheimer's Disease and how it is caused genetically in a very few people, the basic science of Mad Cow Disease, and about new technologies to allow control of artificial limbs, eyes, and ears.

Andrew Meltzoff, who has written the book "The Scientist in the Crib" reported on his studies of the learning process in infants. He showed a fascinating video of a 2 week old baby sticking her tongue out in response to a similar gesture from an experimenter. I am sure all the mothers in the audience were not surprised to see this, but the experiment disproved the previous best theory about how babies learn. Meltzoff explained how difficult it is for a baby to move its tongue (which it cannot see and has never stuck out purposefully) in response to something it has never seen before. Meltzoff showed that babies have memory, but possibly of a different type than adults, which may be why we cannot remember our early years. He concluded by saying that he never dreamed that as he carried his research into the crib, he'd find another scientist (the baby) looking back and studying him!

The speaker with the most compelling message was Dr William Dement of Stanford. His research on sleep has led to his conclusion that many Americans are dangerously sleep deprived. He described sleep debt, the biological clock, and the many dangers of inadequate sleep (including that the person is too sleepy to fully enjoy life!) His book "The Promise of Sleep" will give you more information. (I read it after hearing this talk. There is a pillow on the cover. Don't let that fool you--the book will keep you awake!)

November 9th, 2001- Virginia Mason Clinic sponsored an all-day conference to update us on treatment of diabetes and other endocrine diseases.

Kenneth Gross, MD, outlined risks associated with elevated cholesterol. For example, people who have had a heart attack do much better when their LDL cholesterol is reduced to less than 100.

Paul Mystkowski, MD discussed diagnosis and treatment of male hormone (testosterone) deficiency. Some men will have no symptom except that they don't feel well or have trouble making decisions. He discussed diagnosis and treatment of adrenal insufficiency. (We test for deficiency of both testosterone and adrenal hormone in our office.)

James Benson, MD outlined diagnosis and treatment of osteoporosis.

Ed Benson, MD discussed diagnosis and treatment of thyroid disease. Some people have just mild degrees of high or low thyroid function. Dr Benson outlined management of these borderline cases.

Paul Mystkowski, MD returned to talk about weight management. He reviewed the various medications used for obesity. Surgery for obesity resulted in a 44 pound weight loss when measured 8 years later. These who underwent surgery developed diabetes just 20% as frequently as the control group. Those people who underwent surgery, who did not have diabetes already, and who maintained a 12% weight loss, did not develop diabetes.

November 2nd, 2001- Barry Siegel, MD, of the Washington University School of Medicine, reviewed advances in the technique of PET scanning. PET stands for Positron Emission Tomography and is performed by injecting radioactive compounds into the body. These compounds can participate in our biochemistry, and the technique gives us a window into those biochemical processes.

The downside is that the technique is very expensive (some of the radioactive compounds need to be produced on the spot and used within minutes). There is a place for it, but as he discussed ongoing efforts to get the government to pay for it, it became clear that politics has as much to do with the use of this test as does patient benefit. Expense/benefit decisions depend upon the nature of the individual patient. Seeing the decision made, and the expense incurred, on the basis of groups will lead to some patients not getting a needed test, and others getting a test they don't really need.

October 18th, 2001- Tom Locke, MD from the Jefferson County Health Department outlined the public health response to anthrax and other biologic threats.  The health departments have been preparing for biologic attacks for four years or so. They have run exercises. A major problem has been lack of funds.

October 17th, 2001- Kevin M Beshlian, MD from Virginia Mason Clinic talked about the treatment of chronic wounds. These include pressure ulcers or "bedsores," and ulcers from venous insufficiency or diabetes. These ulcers can be difficult to treat. The most important thing is to treat the underlying cause, be it diabetes, immobility, venous insufficiency, or nutritional disorder. We learned many tricks and tips to help such wounds heal.

October 5th, 2001- Kathleen Neuzil, MD, from the University of Washington, spoke at the Virginia Mason Clinic about influenza. Influenza is a viral illness leading to occasional epidemics. The 1918 epidemic killed more people in the space of six months than WWI did in four years. Though we've had so such disaster since then, influenza still carries away certain susceptible groups every winter. (Some winters are worse than others.) Influenza can kill these groups of people: those over the age of 70, young children (especially those on chronic aspirin therapy), people of all ages with chronic illness such as asthma, diabetes, kidney disease, and so forth.

The influenza vaccine is about 70 to 80% effective. We have a videotape about nutritional treatment of influenza, and a self-care kit for prevention and early treatment. (Early treatment is most effective.)

September 28th, 2001- Robert H Brown, Jr, MD, from Harvard, spoke at the Virginia Mason Clinic about neurodegenerative diseases. These are diseases such as Lou Gehrig's disease (amotrophic lateral sclerosis), Huntington's chorea, or Alzheimer's, in which the substance of the nervous system degenerates. Dr Brown used the example of amotrophic lateral sclerosis (ALS) to illustrate how basic science research can contribute to treatment. Scientists have discovered the chromosomal aberration that leads to ALS in 10% of victims, and how that aberration leads to the illness. They have been able to produce ALS in mice and fruit flies through the same genetic changes and identify drugs that might ameliorate the illness in these animals. Success with human sufferers awaits further understanding and testing.

September 27th, 2001- Carol Cahill, a librarian at the Port Townsend Public Library, presented a talk at Jefferson General Hospital about internet medical resources. The Internet is now akin to a major reference library in that a person needs a librarian in order to use it most productively. Yes, perhaps you can learn to use a card catalog or Internet Grateful Med, but given any particular question, a librarian will usually be able to help you find more complete information than you can find on your own.

She has posted links to useful online health databases. Some of these require a subscription. Users of the Port Townsend and Jefferson County libraries can enter their library card number to use these resources under the library's subscription.

September 21st, 2001- Christopher Fellows, MD, Virginia Mason Clinic discussed treatment of atrial fibrillation. This was a sequel to his talk given in June. He reviewed surgical treatments and use of pacemakers and catheter treatments. He reports that catheters placed in the heart can destroy the unhealthy tissue that causes atrial flutter, one success in this area of medicine. Unfortunately, this treatment has not been effective for atrial fibrillation. He did not discuss nutritional treatment. Studies have shown success with treatment with magnesium and we have had long-term success with this in our clinic.

September 19th, 2001- Rebecca Corley, MD, Virginia Mason Sequim Clinic discussed diagnosis and treatment of chronic cough. She pointed out that there are cough can occur due to irritation in the esophagus. For that reason, esophageal reflux can cause cough. People might not be aware that they have esophageal reflux, but it still might cause them to cough. Other major causes of chronic cough are asthma and post-nasal drip.

Less common causes of chronic cough are chronic bronchitis from smoking, bronchiectasis, a class of drugs called ACE inhibitors, cough that follows an acute infection, cancer, a type of pneumonia called "chronic interstitial pneumonia,"sarcoidosis, heart failure, and aspiration of food into the bronchial tree due to problems with swallowing.

One thing I learned from her talk is that naproxen sodium (Aleve is one brand) can reduce the symptom of cough.

September 14th, 2001- Benca PJ, MD, Virginia Mason Clinic discussed common problems of the shoulder, including rotator cuff tears, adhesive capsulitis, shoulder impingement syndrome, calcific tendinitis, acromioclavicular joint problems, and others.

June 20, 2001- Christopher Fellows, MD, Virginia Mason Clinic discussed treatment of atrial fibrillation. This form of irregular heartbeat can lead to stroke and reduced function on the heart. Atrial fibrillation can be due to hyperthyroidism, disease of the heart muscle, or over-the-counter decongestants, methamphetamine, or other drugs. There are a number of surgical and pharmaceutical treatments, each appropriate for a different group of people.

June 8, 2001- a physician from the Virginia Mason clinic described his new method of destruction of the clots that cause stroke. Patients must be evaluated within a few hours of the onset of their stroke and must not be on anticoagulants. New imaging techniques determine the cause of the stroke. In some cases, this physician can inject a "clot-busting" drug directly into the clot, which can result in repid restoration of blood flow to the injured brain tissue, restoring normal function.

This is an improvement on the highly-touted but never really practical method of injecting the "clot-busting" drug into a vein in the arm. This does not work well for stroke as it does for heart attack. Even with this new technique, it is practical for only a minority of people who suffer strokes.