Conditions and Diseases

Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

MKSAP: 49-year-old-man with right arm weakness

mksap

August 24, 2019

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

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin.

On physical examination, blood pressure is 126/68 mm Hg, pulse rate …

Who should advocate for older patients in the hospital?

Bonnie Friedman and Sara L. Merwin, MPH

Conditions and Diseases

August 22, 2019

It’s often said that pediatricians and veterinarians have the hardest jobs in medicine because their patients can’t tell them where it hurts. But the same is often true for the health care professionals treating older patients who can’t communicate well or don’t fully understand what’s being explained to them.

So, whose job is it to advocate for these patients? The answer is that everyone on the medical team must play a …

10 questions men must ask about their urinary symptoms

Naeem Rahman, MD

Conditions and Diseases

August 22, 2019

Lower urinary tract symptoms in men are amongst the most common reasons for a urological visit. In this post, I explore ten questions that every man must ask when seeking urological help for these symptoms.

1. Are my symptoms related to my prostate?

The natural assumption is that urinary symptoms in men are related to a growing prostate. This may be true, but other variables need evaluation. First, is there excessive fluid …

When patient and surgeon meet in Cancun for surgery

Phil Galewitz

Conditions and Diseases

August 21, 2019

Donna Ferguson awoke in the resort city of Cancun before sunrise on a sweltering Saturday in July.

She wasn’t headed to the beach. Instead, she walked down a short hallway from her Sheraton hotel and into Galenia Hospital.

A little later that morning, a surgeon, Dr. Thomas Parisi, who had flown in from Wisconsin the day before, stood by Ferguson’s hospital bed and used a black marker to note which knee needed …

Can the cardiac risk of red meat be measured? And is it useful?

Steven Reznick, MD

Conditions and Diseases

August 20, 2019

Prevention of heart disease has centered on smoking cessation, controlling blood pressure, achieving an appropriate weight, regular exercise, control of blood sugar, and control of your cholesterol. Despite addressing and controlling these items, individuals still have heart attacks and strokes and vascular events. Researchers are now directing their attention to a dietary metabolite of red meat called trimethylamine N-oxide or TMAO.

Recent peer-reviewed and published studies have shown …

Breastfeeding is best, but why do some countries struggle?

Melvin Sanicas, MD

Conditions and Diseases

August 18, 2019

Breastfeeding provides ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Breastfeeding has numerous health benefits for both the mother and infant. Breast milk contains all the nutrients infants need in the first six months of life. Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also …

MKSAP: 25-year-old woman with chest pain after a motor vehicle accident

mksap

Conditions and Diseases

August 17, 2019

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

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks’ gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin.

On physical examination, the patient is afebrile, blood …

The lingering effects of a mass shooting

Anna Almendrala

Conditions and Diseases

August 15, 2019

Veronica Kelley was working at an office building across the street from the Inland Regional Center in San Bernardino, Calif., in December 2015 when a county employee and his wife entered with semiautomatic rifles and opened fire, killing 14 and wounding 22. Most of the victims were co-workers of the gunman.

The couple went on to wound two police officers later that day before being fatally shot by …

Arm yourself with new dementia information

Marc Rothman, MD

Conditions and Diseases

August 14, 2019

Everyone knows someone today who’s dealing with dementia. And as a geriatrician — that means a lot of questions come my way. Questions about parents who recently had cognitive testing, about the role of assisted living, about prevention — you name it. Dementia is out there in a way it never was before. People have questions, and they need answers.

Dementia is not a normal part of aging

This is where I …

The questions surgeons need to ask their seniors before surgery

Judith Graham

Conditions and Diseases

August 13, 2019

The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die.

The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.”

It’s a scene she’s replayed in her mind hundreds of times since, with regret.

On the operating table, Bob …

Perfect nurse. Perfect manager. Perfect puppet.

Debbie Moore-Black, RN

Conditions and Diseases

August 13, 2019

Perfect nurse.

Perfect manager.

Perfect puppet.

An ICU physician once told me: Nurse managers have a life cycle of a mosquito.

Fast and furious

And then gone.

Deleted until the next one shows up.

It was the perfect ICU.

Twenty-five beds.

Dynamic intensivists. Phenomenal.

And they respected us nurses and collaborated with us. We had perfect cerebral perfusion together.

Experienced ICU nurses who knew what to do like clockwork — teaching the younger new nurses. Teaching them the facts of ICU. …

The last massage of his life

Julie Evans

Conditions and Diseases

August 13, 2019

Clutching my duffel bag under my rain jacket, I dash from my truck toward a house that was built by Frankie, the man I’m here to give the last massage of his life.

I’ve been massaging people since I was five and have been a professional massage therapist for 40 years. I don’t make house calls anymore, but it’s an honor to give a man the last massage of his life, …

Read more…

The last massage of his life

Dear emergency department clinicians: a letter from administration

Edwin Leap, MD

Conditions and Diseases

August 12, 2019

Dear emergency department clinicians:

We at the top of the administrative and regulatory chain understand that you deal with enormously complicated mental health and substance abuse patients all the time. Your resources are limited, and the demands placed upon you are growing.

As such, we (the anointed and well-meaning) wish to offer you some guidelines based on our committee’s extensive lunch-time meetings and brainstorming sessions. All of which, you will certainly understand, …

What are patients’ responsibilities for their health?

Anonymous

Conditions and Diseases

August 11, 2019

I expect my patients to develop or sense responsibility in connection to their health because I believe personal responsibility creates the basis for a constructive, therapeutic relationship and healing process.

My experiences as a patient have made me understand how difficult it can be to maintain a sense of responsibility. I often yearn for clarity and a “gameplan,” but instead find myself confronted with medical guideline gray areas and conflicting treatment …

Toy magnets need to be banned for good

Amy Garcia, MD and Sanjay Krishnaswami, MD

Conditions and Diseases

August 10, 2019

Over the course of little more than a month, we removed 54 tiny toy magnets from the digestive systems of four children. They were lucky: Despite invasive procedures and operations to repair holes in their intestines, their injuries were treated in time, and they will make full recoveries.

In the past, others across the nation have not been …

Read more…

Toy magnets need to be banned for good

The truth about body weight and infertility

Anu Kathiresan, MD

Conditions and Diseases

August 10, 2019

A recent New York Times article entitled, “When You’re Told You’re Too Fat to Get Pregnant” discussed a woman’s journey to having a child, which involved being counseled against undergoing fertility treatment due to her high body weight. She ultimately underwent bariatric surgery, lost weight and was then able to conceive after an IUI (intrauterine insemination) cycle, a fertility treatment that involves placing the sperm at the …

MKSAP: 35-year-old man with persistent heartburn

mksap

Conditions and Diseases

August 10, 2019

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

A 35-year-old man is evaluated during a follow-up appointment for persistent heartburn with chronic cough. He has a 1-year history of gastroesophageal reflux disease and takes pantoprazole twice daily. He reports no nausea, vomiting, or dysphagia. Upper endoscopy performed 1 year earlier showed no abnormal findings.

His vital signs and …

Your anesthesiologist needs to know if you smoke pot

Kate Ruder

Conditions and Diseases

August 9, 2019

When Colorado legalized marijuana, it became a pioneer in creating new policies to deal with the drug.

Now the state’s surgeons, nurses, and anesthesiologists are becoming pioneers of a different sort in understanding what weed may do to patients who go under the knife.

Their observations and initial research show that marijuana use may affect patients’ responses to anesthesia on the operating table — and, depending on the patient’s history of using …

The history of antivaccination sentiment

Caroline Castleman

Conditions and Diseases

August 8, 2019

In 1902, a smallpox outbreak infected thousands of people across the northeastern United States. That year, in Massachusetts alone, 2,314 people were infected, and 284 died. This was not unusual for early-twentieth-century Massachusetts: The smallpox vaccine had been invented more than a century earlier and had markedly reduced the incidence of the disease, but the diminished threat of illness motivated fewer people to opt for vaccination. City officials …

Someone who is both a recalcitrant skeptic and an ardent proponent of childhood vaccines

John M. Glionna

Conditions and Diseases

August 8, 2019

Amid the contentious dispute over immunization requirements for children, Kelley Watson Snyder stands out: She has been both a recalcitrant skeptic and an ardent proponent of childhood vaccines.

Snyder, a Monterey, Calif., mother of two, was a so-called anti-vaxxer for many years, adding her voice to those that rejected mandatory vaccinations for school-age children.

She later realized she was wrong and in 2014 founded a pro-vaccination Facebook group called “Crunchy Front Range …