Conditions

Want to slow cognitive decline? Here’s how.

Conditions

November 1, 2017

Part of a series.

Cognitive decline is a normal process of aging; Alzheimer’s is a disease.

Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.

Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …

MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

mksap

Conditions

October 21, 2017

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

A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …

The problem with prescribing sleeping pills for older patients

Lea C. Watson, MD, MPH

Conditions

October 11, 2017

It seems that everyone has advice about sleep these days, and we have become immune to it. “Avoid naps, caffeine and alcohol close to bedtime. Get exercise. Get out of bed if you can’t sleep. Turn off the TV and any electronic devices hours before bedtime. Enjoy a relaxing ritual. Keep to a routine.”

Please do all of these, because they actually work! Shifting your bedtime later to achieve sleep consolidation …

A missed diagnosis haunts this physician

Anonymous

Conditions

October 10, 2017

Eighty percent of diagnoses can be made based on the history and physical. Take the subjective and objective; throw in some medical history, family history, social history and you can figure out your assessment and plan. Doctors are the detectives of the body and the more facts, the easier it is to solve the mystery.

This is the fictional note that I wrote in my head concerning a fellow physician friend …

The loss of testosterone and how that affects the partner

Anne Katz, RN, PhD

Conditions

October 9, 2017

I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are …

How anti-vaccine parents are finding doctors willing to exempt their kids

Ana B. Ibarra and Barbara Feder Ostrov

Conditions

September 16, 2017

Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons.

Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She …

Are CTE headlines overblown? A radiologist investigates.

Dr. Saurabh Jha

Conditions

September 6, 2017

A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined.

The mainstream media converged towards numerical consensus.

Fox News reported players in a study had CTE.”
CNN reframed the headline, “CTE found …
Read more…

Are CTE headlines overblown? A radiologist investigates.

The mythical unicorn of vaccine denialists

Christopher Johnson, MD

Conditions

August 28, 2017

I swiped this editorial cartoon by Steve Sack from the redoubtable Dr. David Gorski’s blog, who goes by the nom-de-web of Orac. Recent epidemiology shows reducing the fraction of vaccinated children in the population rather promptly leads to a resurgence of the diseases vaccines protect against. This is the concept of community or herd immunity.

Epidemiologists debate the concept around …

We must make the word “diagnostician” the most prestigious term in medicine

Robert Centor, MD

Conditions

August 16, 2017

The Society to Improve Diagnosis in Medicine has on its website this quote:

1 in 10 diagnoses are incorrect.
Diagnostic error accounts for 40,000-80,000 U.S. deaths annually — somewhere between breast cancer and diabetes.
Chances are, we will all experience diagnostic error in our lifetime.

The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?

In this post, I …

A code in the cath lab that was unlike anything I had ever seen

Daniel Mishkin, MD

Conditions

August 14, 2017

An excerpt from The Other Side of the Bed: What Patients Go Through and What Doctors Can Learn.

As soon as I’d opened my mouth, I regretted it. In the hospital, it’s bad luck to say “It looks quiet,” or anything to that effect. At the sound of those words, …

A nurse was attacked in the emergency department. This is her story.

Debbie Moore-Black, RN

Conditions

August 14, 2017

Victim: Female nurse, age 25

Time: circa 1980

Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.

It was an unusually quiet Friday night in this small emergency department.

We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.

Not only did we cover the entire city, but we also …

Doctors: You’re just as unhealthy as your patients. Here’s why.

Shane C. Quinonez, MD

Conditions

August 8, 2017

Most people reading this would love to lose weight, feel better and live longer. Doctors are a smart and motivated group of people. Unfortunately, that intellect and drive has not prevented us from avoiding an increasing incidence of obesity, diabetes, and hypertension identical to the general population.

While this article may have started out sounding like an infomercial, I promise it will not end like one. …

Let’s talk about the ethics of breastfeeding

Jennifer Lincoln, MD

Conditions

August 2, 2017

In the spirit of World Breastfeeding Week, I want to highlight all we can about breastfeeding; why it’s great for you and your baby, some ways to make it easier, and how to manage common challenges.

But one challenge that often gets ignored in the offices of doctors and lactation consultants is the issue revolving around the ethics of breastfeeding. That is, addressing uncomfortable questions like these:

Are moms who choose …
Read more…

Let’s talk about the ethics of breastfeeding

Deep extubation is a useful technique for any anesthesiologist to master

Karen S. Sibert, MD

Conditions

August 1, 2017

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:

Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes! Take a deep breath!”

Or:

Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence …

When an erythrocyte sedimentation rate leads to a serious diagnosis

Hans Duvefelt, MD

Conditions

August 1, 2017

In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate.

The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one …

Having a baby in a hospital? Here are 10 things you must know.

Valerie A. Jones, MD

Conditions

July 20, 2017

1. You might get sent home. If you show up pregnant with your first baby, and it turns out you aren’t 4 cm dilated yet, you will get sent home because you aren’t in active labor. Please don’t cuss out the charge nurse. Yes, you are in pain — we aren’t denying that. But, there are limited numbers of beds on labor suites, and we need to keep some open for …

MKSAP: 21-year-old woman with mosquito bites

mksap

Conditions

July 1, 2017

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

A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has no significant medical history, and …

Expanding our definition of spiritual competence

Eric Nelson

Conditions

June 30, 2017

The first thing I remember as I regained consciousness, lying in a hospital emergency room, was hearing a nurse ask my mom if I was allergic to any foods. With my eyes still closed, I said, “asparagus,” thinking this might reduce the chances of anyone serving me what was then a dreaded vegetable.

“Asparagus,” repeated the nurse, making a note on my admission form.

And then, with a chuckle and what must …

How do we fix the apathy in nursing home staffs?

Ajay Dave

Conditions

June 22, 2017

My grandmother’s room is silent, save for the plucks of sitar strings and Pixar movie soundtracks I try to stimulate her with. Instead of books, we fill the shelves around her bed with mouth swabs, drab hospital gowns and vials of baby powder. My grandmother — who walked an hour every day, who thrashed me in gin rummy, who rose before sunrise every morning to read — now lies bedridden …

MKSAP: 37-year-old man with low libido and fatigue

mksap

Conditions

June 10, 2017

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

A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.

On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.

Laboratory studies:

Luteinizing hormone

10 …