CORRESPONDENCE TABLE 1.-Average Charges for Diagnosis of Tonsillitis, Pharyngitis or Upper Respiratory Infection Number of patients
General practitioners ...... ...... $15.03 Family physicians ...... ........ 15.19 Pediatricians .......... ......... 15.48 Internists ...................... 16.06 Ear, nose and throat physicians ... 22.60
211 56 152 23 14
Limited for the pediatricians, internists and ear, nose and throat specialists, and Established Brief for the general or family practitioners. The number of new patients did not explain the differences and was under 20 percent for all specialists. The least expensive visit for handling tonsillitis, pharyngitis or an upper respiratory infection is with private general or family practitioners, and this is a third the cost of a visit to an emergency room in our area. We expect comparable data are available in many locales. A family physician's private office seems the ideal place to care for patients with these illnesses. RICHARD C. BARNETT, MD Director, Family Practice Program Medical Director JONATHAN E. RODNICK, MD Assistant Director, Family Practice Program Communzity Hospital Santa Rosa, California
Rehabilitation Through Marathon Running TO THE EDITOR: Schroeder and Wagner1 have reported in this journal encouraging follow-up statistics on 81 patients with cardiac disease who have completed the 42-km Honolulu Marathon. This event has a medically supervised (noncompetitive) division for rehabilitated cardiac patients and wheelchair athletes at present. They are thinking of adding a "diabetic division" and a "chronic lung disease division" in the future. Interested physicians or their patients can write to J. A. Schroeder and J. 0. Wagner, Cardiac Rehabilitation Program, Central Branch YMCA, 401 Atkinson Drive, Honolulu, Hawaii 96814. In the course of running some 100 marathons myself, I have compiled a list of 131 marathoners with cardiac disease including 48 with previous myocardial infarction and 19 who have had coronary-bypass operations. Follow-up shows that 126 are alive and running after 500 patient-years. Of 466
MAY 1979 * 130 * 5
Figure 1.-Marathon runner's coronary artery showing atherosclerosis and thrombosis. This man, in his mid60's, chewed tobacco and swallowed all the juice. The pronounced inflammation is attributed to the angiotoxic material in tobacco juice. (H & E stain; reduced from X 10)
the five who have died, only one showed progressive atherosclerosis at autopsy (Figure 1). This elderly man continued to chew tobacco and swallowed all the juice from three boxes of chewing tobacco a week. The plaques were very inflamed. This suggests that tobacco juice contains highly angiotoxic material. Rehabilitation programs in Canada and the United States have been using marathon training as a tool for risk-factor modification for almost ten years. Six institutions have cooperated with my forensic surveillance over those athletes with cardiac disease who have reached the 42-km marathon distance. I have been very encouraged by the results. THOMAS J. BASSLER, MD Centinela Hospital
Inglewood, California REFERENCE 1. Schroeder JA, Wagner, JO: Marathon runners with cardiovascular disease (Correspondence). West J Med 129:241, Sep 1978
Theophylline Toxicity TO THE EDITOR: Recent reports on the frequency and severity of the toxic effects of theophylline in obese patients or those with hepatic cirrhosis, chronic lung disease or congestive heart failure, have shown a high morbidity in cases where the serum level exceeds 50 ,ug per ml-roughly twice the therapeutic level.'5 Optimism concerning the prognosis in these cases has been generated by
General practitioners ...... ...... $15.03 Family physicians ...... ........ 15.19 Pediatricians .......... ......... 15.48 Internists ...................... 16.06 Ear, nose and throat physicians ... 22.60
211 56 152 23 14
Limited for the pediatricians, internists and ear, nose and throat specialists, and Established Brief for the general or family practitioners. The number of new patients did not explain the differences and was under 20 percent for all specialists. The least expensive visit for handling tonsillitis, pharyngitis or an upper respiratory infection is with private general or family practitioners, and this is a third the cost of a visit to an emergency room in our area. We expect comparable data are available in many locales. A family physician's private office seems the ideal place to care for patients with these illnesses. RICHARD C. BARNETT, MD Director, Family Practice Program Medical Director JONATHAN E. RODNICK, MD Assistant Director, Family Practice Program Communzity Hospital Santa Rosa, California
Rehabilitation Through Marathon Running TO THE EDITOR: Schroeder and Wagner1 have reported in this journal encouraging follow-up statistics on 81 patients with cardiac disease who have completed the 42-km Honolulu Marathon. This event has a medically supervised (noncompetitive) division for rehabilitated cardiac patients and wheelchair athletes at present. They are thinking of adding a "diabetic division" and a "chronic lung disease division" in the future. Interested physicians or their patients can write to J. A. Schroeder and J. 0. Wagner, Cardiac Rehabilitation Program, Central Branch YMCA, 401 Atkinson Drive, Honolulu, Hawaii 96814. In the course of running some 100 marathons myself, I have compiled a list of 131 marathoners with cardiac disease including 48 with previous myocardial infarction and 19 who have had coronary-bypass operations. Follow-up shows that 126 are alive and running after 500 patient-years. Of 466
MAY 1979 * 130 * 5
Figure 1.-Marathon runner's coronary artery showing atherosclerosis and thrombosis. This man, in his mid60's, chewed tobacco and swallowed all the juice. The pronounced inflammation is attributed to the angiotoxic material in tobacco juice. (H & E stain; reduced from X 10)
the five who have died, only one showed progressive atherosclerosis at autopsy (Figure 1). This elderly man continued to chew tobacco and swallowed all the juice from three boxes of chewing tobacco a week. The plaques were very inflamed. This suggests that tobacco juice contains highly angiotoxic material. Rehabilitation programs in Canada and the United States have been using marathon training as a tool for risk-factor modification for almost ten years. Six institutions have cooperated with my forensic surveillance over those athletes with cardiac disease who have reached the 42-km marathon distance. I have been very encouraged by the results. THOMAS J. BASSLER, MD Centinela Hospital
Inglewood, California REFERENCE 1. Schroeder JA, Wagner, JO: Marathon runners with cardiovascular disease (Correspondence). West J Med 129:241, Sep 1978
Theophylline Toxicity TO THE EDITOR: Recent reports on the frequency and severity of the toxic effects of theophylline in obese patients or those with hepatic cirrhosis, chronic lung disease or congestive heart failure, have shown a high morbidity in cases where the serum level exceeds 50 ,ug per ml-roughly twice the therapeutic level.'5 Optimism concerning the prognosis in these cases has been generated by
