A patient walks into the doctor’s office and says:
I hate feeling this way. Yes, I know it’s not cancer and it won’t kill me, but this shaking has made me a different person. I can’t sign my name. I drop and spill things all the time. I’m afraid to pick up my baby grandson. I don’t go out anymore because I’m embarrassed. And I don’t know what can be done. …
Steadying patients’ fears about shaking hands
In a recent People article, Jeopardy! host Alex Trebek shared some good news. Diagnosed with stage 4 pancreatic cancer in March, Trebek said he was told that he has been responding very well to his chemotherapy regimen, and that he’s in “near remission.”
He went on to say, “It’s kind of mind-boggling. … The doctors said they hadn’t seen this kind of positive …
How is Alex Trebek doing with his pancreatic cancer treatment?
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A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication.
All physical examination findings, including vital signs, are …
MKSAP: 63-year-old woman after right hemicolectomy for colon cancer
Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild. The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support. With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …
Bottle-feeding grandmothers vs. breastfeeding daughters: advice from a pediatrician
Two recent patient experiences prompted this post. In the Wall Street Journal, Dana Hawkins-Simons described several years of being seen by specialist after specialist for her complaints of tiredness, dizziness, ringing in the ears, palpitations, shortness of breath and “brain fog.” She finally researched her symptoms and demanded that she be checked for vitamin B12 deficiency, which turned out to be the cause of her symptoms.
Recently, the …
When should you be tested for vitamin B12?
Most Saturdays, I join a therapy session down the hall from where I do my walk-in clinic. A patient of mine has a weekly session just before the Alcoholics Anonymous meeting at noon in our big conference room.
Last weekend he told my behavioral health colleague that the people in the AA group who have the most solid recovery seemed to be the ones who claimed to carry a lot of …
The role of hatred in medicine
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A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her …
MKSAP: 48-year-old woman with elevated liver chemistry tests
Samuel was an English gentleman hailing from London. Close to 10 percent of the U.S. population, over 30 million people, lives with diabetes. Five years ago, Samuel was diagnosed with type 2 diabetes. Taking lisinopril and glipizide, he also goes on hour-long walks every morning at 6:30 a.m. to keep his A1c at his comfort number of 5.5. It has not always been this way for Samuel as he was …
A patient’s tale of type 2 diabetes
There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using …
Don’t forget this common trigger of cyclic vomiting syndrome
It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.
She and her husband were about to try to have their …
The simplest and most important question to ask in the exam room
A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.”
As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves.
Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a …
Many diseases represent an arbitrary number
Busy primary care physicians have a lot on their plates. But when it comes to helping people with diabetes learn how to improve their health, they don’t have to do it all themselves. Diabetes self-management education and support (DSMES) programs, led by a diabetes educator, can provide vital assistance by helping people with diabetes maintain a healthy weight, quit smoking, begin an exercise routine and integrate other self-management behaviors into …
How diabetes education programs can help busy primary care physicians
Here’s what they should have told you: “We found cancer in your lymph nodes, your liver, your lungs, and your brain. It explains your weight loss, your difficulty breathing and your loss of appetite. This wasn’t just your depression like you thought. It started in your lungs, and now it’s everywhere. This cancer has been growing for quite some time. You cannot, even with the strongest medications and the longest …
Why didn’t your doctors tell you the truth?
He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats, to 40 beats, to that which is incompatible with life. The nurse pushed …
A patient that reminded me of the first man I ever witnessed dying
These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.
I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into …
A nurse’s downfall was telling the truth
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A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …
MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.
On physical examination, vital signs are …
MKSAP: 62-year-old woman with a sun allergy
Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate …
Screening elderly men for prostate cancer: More harm than good?
Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …
Important new information in the tragic cases of child abuse
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …
MKSAP: 52-year-old woman with shortness of breath
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