Conditions

Test your medicine knowledge: 55-year-old man with elevated liver enzymes

Conditions
October 10, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.

On physical examination, vital signs are normal; BMI is 24. He …

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Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

Conditions
September 26, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. …

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A patient presents with painless diarrhea. What should you do next?

Conditions
August 29, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena.

On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse …

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How to perform a stool transplant

Conditions
August 25, 2015

Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy.

First, a healthy donor must be identified.  The donor …

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Please, don’t eat your placenta. Here’s why.

Conditions
August 14, 2015

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Every few news cycles placenta-eating seems to make the rounds. I’ve already seen it a couple of times this year, so I figured the Internet is trying to tell me something.

Some women, but mostly those who recommend and/or prepare placenta for them, think that ingesting placenta can cure/help postpartum depression and possibly a host of other postpartum ills and issues. Some …

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10 simple solutions to stop medical student suicide

Conditions
August 8, 2015

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Medical school graduation: Time to celebrate our brand new doctors!

Except for the families who can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday — ever again.

Like Michele and John Dietl.

They lost their son, Kevin (pictured above), just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why?

I’ve become a sideline specialist …

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You might be missing a PCOS diagnosis. Here are 10 reasons why.

Conditions
July 31, 2015

Polycystic ovarian syndrome (PCOS) is becoming a significant problem in women’s health. Between 1 in 10 to 20 women have the condition, although more than 50 percent remain undiagnosed. PCOS is the leading cause of female infertility and women who do become pregnant have higher rates of miscarriage, preterm birth, and gestational diabetes.

Women with PCOS have a greater likelihood of developing diabetes, cardiovascular disease, and endometrial cancer than women without …

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A letter to parents hesitant about vaccines

Conditions
June 28, 2015

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Below is a letter I have written to parents who are hesitant about giving vaccinations to their children.  I don’t know how many it will convince, but I needed a respectful and informative way to follow up with parents who expressed concerns or declined vaccinations, and this is what I now share with them after such visits.  This is written not …

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Which kills more? Guns or cars? The answer will surprise you.

Conditions
June 17, 2015

Here’s a question for you: Which causes more deaths, motor vehicle traffics accidents or firearms?

I asked a bunch of people that question, including a bunch of doctors, and everyone said that motor vehicles did, by a lot.

According to the Centers for Disease Control and Prevention (CDC), in 2013, 33,804 people died from motor vehicle traffic accidents — and 33, 636 died from firearms.

They kill the same number of …

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How heartburn caused a patient to lose her left leg

Conditions
June 10, 2015

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Note: This case is meant to illustrate the potential negative effects of inappropriate imaging.  It is not intended as a diatribe towards any member of the health care team.  Really the only “mistake” made here was the ordering of the CT scan in the first place.

A 37-year-old woman presents to her local emergency department (ED) with a 4-hour history of heartburn …

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The problems with a low salt diet

Conditions
June 3, 2015

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One of my favorite physician sayings is, “Don’t just do something, stand there!” Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for …

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A neurosurgeon teaches us about degenerative disc disease

Conditions
May 31, 2015

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No one wants to hear that they have a disease. And yet everyone will develop some degree of degenerative disc disease (DDD) — or degenerative spine disease — over the course of a lifetime. DDD refers to a combination of age-related and wear-and-tear-related changes that occur within the spine over time. It is very common and a natural part of aging.

Most …

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So your child swallowed a button battery. Here’s what you need to know.

Conditions
May 13, 2015

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Each year children ingest an array of foreign bodies including coins, magnets, and a new subset of batteries known as button batteries. Awareness of this small yet very dangerous foreign body is important for parents to understand so they can act quickly if their child is suspected of ingestion.

What is a button battery?

A button battery is a cylindrically shaped object measuring …

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