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.
Coming in to meet the students, house staff, and patients for the first day on service always excites me. This Monday was no exception. What awaited me? How many patients would I need to see? What lessons could I impart?
When I arrived, we had 11 patients, two new, and nine had arrived previously. Going through the list, while routine, always stimulated questions and teaching opportunities. Sometimes the team had questions …
Read more…
When constipation pain was worse than cancer pain
Ten years ago it would not have been worth my time to write about measles nor yours to read about it. In the year 2000, thanks to a very effective 2-shot childhood vaccination program using a combined measles-mumps-rubella (MMR) vaccine, the U.S. was declared free of this potentially lethal disease. However, by the end of April this year, just over 700 cases have been reported by the CDC; the largest …
Read more…
The rise and fall of measles vaccinations
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 …
Read more…
A patient’s tale of type 2 diabetes
A recent New York Times article described a 77-year-old retired gardener in England who had not spoken with another human being in more than six weeks. He told the reporter through tears that he felt “very lonely, and bored.” Recent budget cuts prevented him from taking the bus to the grocery store. Younger people, including his own son, had left town for better jobs in larger cities.
I see this loneliness …
Read more…
Older adults and the epidemic of loneliness
The trend of increasing specialization in medicine may lead to unintended adverse consequences. There is an old saying, “We see what we recognize and we recognize what we know.” My wife’s recent adventures in ophthalmic care is such an example. I offer it as a cautionary tale.
She was born with granular corneal dystrophy (GCD). We would later learn that this autosomal dominant gene was thought to have originated in a …
Read more…
How tunnel vision can lead to bad medicine
The numbers are scary: The average woman has a 12 percent risk of developing breast cancer at some point in her life. For women with certain genetic mutations or risk factors, lifetime risk can climb to 85 percent.
Even more terrifying than the numbers, however, are the rumors; rumors that the contrast dye used in MRIs for breast cancer screenings is harmful; rumors that are driving women away from an adjunctive …
Read more…
MRI safety in breast cancer screening
The boy is three years old and quite curious about the world. He watches his father leave the house and wants to go find him. He looks to his mother but she is napping beside him on the couch, and he would rather not wake her, so he grabs his stuffed dog, Dory, and walks to the door. The door is unlocked, and he heads out of the apartment, wandering …
Read more…
Help stop pediatric drownings
Stress!
It is a fact of life for all human beings. Stress is a normal reaction — psychologic and physiologic — to the everyday demands of life. When your brain perceives a threat, the body reacts with a fight-or-flight response, releasing hormones, increasing heart rate, and blood pressure. When the situation is over, your body returns to a normal, calm state. But sometimes, in our overly-stimulated world, the stress response button …
Read more…
How to help your children manage migraines
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 …
Read more…
Don’t forget this common trigger of cyclic vomiting syndrome
Spot the word “first” in a headline, and you might assume a major milestone has been reached. Think first person on the moon, first woman on the Supreme Court.
But in health care news, things heralded for being first might not amount to a clear advance for patients. Take two recent FDA announcements that made a splash despite weak evidence that they really help people.
In March the FDA announced its approval of a “first treatment …
Read more…
When medical experts say “first,” be careful
I was asked to present information about mental health to a lay audience. This is both an exciting and daunting task. I imagine it’s like asking someone to talk about fish. There are so many kinds of fish! They live in many habitats! Some of them look more like snakes than fish! There are so many directions to go.
I have given a “psychiatry 101” talk to many non-clinical audiences in …
Read more…
3 things about psychiatry that don’t focus on pathology
If you’re sexy, fit and nimble, if you can part your thighs and bend your knees, if you can see your private parts without a mirror, ignore this. Move on. This is not for you.
This is for those with flailing sex-drive and failing abilities whose sex life is a challenge, but they’d like to make their partners happy and have some fun. Maybe your parents or grandparents. This must be an …
Read more…
Sex in the elderly is not a need. It’s a privilege.
As my patients aged along with me, I noticed both the expected increased numbers of people with some form of dementia and even more patients who were worried about this topic. Unless you have been away on a ten-year safari, you are very aware that dementia is a growing problem. Some 5.8 million Americans are living with Alzheimer’s disease, and similar numbers occur in most western countries. The incidence goes …
Read more…
Mild memory loss: Is it Alzheimer’s disease?
As women in medicine, we are always focused on the next goal we need to achieve to advance our career. Though undergraduate education, medical school, residency, and fellowship, we are constantly striving to get the highest score, to maintain a high GPA, to publish papers, to get excellent letters of recommendation. The challenge that women physicians face is balancing these demands in the midst of our passing prime reproductive years. …
Read more…
Woman physicians: Make informed decisions early on planning a future family
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 …
Read more…
The simplest and most important question to ask in the exam room
“I’m sorry, Mr. Smith. Your heart is very sick, and your body has irreversible damage. It’s too dangerous to attempt a transplant or implant a heart pump. There’s nothing more we can do.”
I’ve encountered this scenario more often than I care to admit as a cardiac surgeon that treats advanced heart failure. Tragically, many of these patients present long after being followed closely by their referring providers—“I’ve been seeing Mr. …
Read more…
It’s time we approach heart failure like cancer
When a baby is born, people stop acting like themselves. Gruff grown-ups make goofy faces at infants. Nostalgic moms share their birthing experiences with pregnant strangers. Shy kids clamber onto strollers of babies they don’t know, just to coo at newborns.
In some cases, emotions brought up during this motherhood transition can become intense and get in the way of day-to-day functioning, much more severe than the “baby blues.” There are …
Read more…
Communities can help women cope with maternal depression
