Conditions

MKSAP: 52-year-old man is evaluated for low back pain

Conditions
July 9, 2016

A 52-year-old man is evaluated for low back pain of 3 months’ duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and …

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Obesity changes the way our endocrine system functions

Conditions
July 8, 2016

A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles.

But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction.

The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their …

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A case of abdominal pain in the ER. And a surprising cause.

Conditions
July 6, 2016

(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.)

Dr. Stephen Cluff is like Yoda. Judging by body hair, he’s more like Chewbacca. But he’s short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet’s voice. If I’m stumped on a case, I’ll ask him. If I’m pissed off about department politics, I’ll call him for advice. If I want …

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Don’t remove your own IUD. Please.

Conditions
July 2, 2016

Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube?

All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t.

It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional …

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Open access endoscopy raises potential ethical issues

Conditions
July 2, 2016

Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance.

Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring …

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MKSAP: 32-year-old man with a rash on his face and midchest

Conditions
June 4, 2016

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

A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well.

Medical history is significant for a recent diagnosis …

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How marriage affects men’s colonoscopy rates

Conditions
May 31, 2016

Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.

More recently, a study published in the journal Preventive Medicine found that married men are …

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Don’t be ashamed to receive an epidural during childbirth. Here’s why.

Conditions
May 8, 2016

Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor.

Let me explain.

I get paged for an epidural.  Once I …

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My double life: Mental illness in the health care

Conditions
May 6, 2016

I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have …

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Permission to take my patients’ plasma. It’s a harder decision than you think.

Conditions
April 6, 2016

“I hereby authorize xxx, my patient, to donate plasma up to two times per week.”

I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma.

By the time the fourth form came, I realized …

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Visualize the abnormal prostate with Medcomic

Conditions
April 3, 2016

The Abnormal Prostate

In this Medcomic, we’ll visualize three common abnormalities of the prostate.  Let’s meet our new friends. On the left is Burney and he could certainly benefit from a trial of antibiotics and an analgesic. The large fellow in the middle straining to urinate goes by the name of Turp. On the far right is Grampa Addy, currently dealing with the …

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What surgeons aren’t saying about sex after hip replacement

Conditions
April 2, 2016

As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to …

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Learn multiple sclerosis with the power of comics

Conditions
March 20, 2016

Medcomic-Multiple-Sclerosis

This Medcomic highlights some of the main features of multiple sclerosis (MS).  Although the exact cause of MS is unknown, the disease is thought to occur as an immune-mediated attack on the central nervous system (CNS). As you can see in the illustration, the white blood cells are attacking the neuron and causing inflammation, demyelination, and axonal degeneration that can manifest through …

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What you don’t know about anal sex. A gastroenterologist explains.

Conditions
March 10, 2016

Although it is still early, 2016 is already shaping up to be a year to remember in science: Long-postulated gravitational waves were finally discovered, the CDC scrambles to battle Zika virus on multiple continents, and long-awaited clinical testing begins for a new HIV vaccine.

But these accomplishments all pale in comparison to the monumental study published in the American Journal of Gastroenterology titled “Read more…

A doctor shares the secrets of cancer survivors

Conditions
February 26, 2016

Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you.

Cancer is a …

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Should you have a precolonoscopy visit? The answers may surprise you.

Conditions
February 23, 2016

Your primary care doctor has been nagging you for years. Your wife and brother seem to be in on the scheme too. Every once and a while one of your coworkers even says (with a chuckle) “C’mon Bob, you’re fifty-seven, you really need to get it done!”

“OK, enough,” you finally say, “I’ll go for a colonoscopy!” So at your next visit you ask your primary doctor how to set it …

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We want access to safe and effective Avastin. Here’s a solution.

Conditions
February 15, 2016

Recently, two states in India halted all use of Avastin for the treatment of eye disease following the report of 15 patients who underwent emergency surgery for potentially blinding infections at the C.H. Nagri Municipal Eye Hospital in Ahmedabad.  Though further investigations are ongoing, there is worry that the cluster of infections centered around a tainted lot of compounded Avastin. This most recent event serves as a reminder of …

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A psychiatrist shares her 5 secrets to love

Conditions
February 14, 2016

As a mother of three daughters, I frequently find myself singing along to the catchy tunes of Taylor Swift.  Singer, songwriter, and overall superstar Taylor Swift is famous for penning undeniably captivating love songs. She is popular not only because she has the voice of an angel, a cutting edge look, and a fierce attitude, but also because she is honest and real. Taylor has an uncanny ability to put …

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