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.
Estrogen is a miracle drug for many women who experience the drenching sweats, sexual dysfunction and frustrating brain betrayals associated with entering menopause. It comes in expensive patches, less expensive pills or injections, as well as vaginal creams or rings. It has gone in and out of favor with the medical community for decades.
Estrogen is the main ingredient in most birth control pills and has been studied extensively in that …
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What’s the latest on estrogen use in post-menopausal women?
Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.
C. difficile colonizes the intestinal tract after the normal …
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Learn about Clostridium difficile infection with a Medcomic
Pulmonary hypertension (PH) refers to increased pressure in the pulmonary circulation. It develops when pulmonary vessels become constricted and/or obstructed, which can occur in a wide variety of conditions. The increase in pressure is measured by right catheterization, and is defined as a mean pulmonary arterial pressure ≥ 25 mm Hg at rest.
PH leads to right ventricular hypertrophy and enlargement as the …
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Learn pulmonary hypertension with a Medcomic
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …
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MKSAP: 64-year-old man with diabetes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.
On physical examination, temperature is 37.3 …
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MKSAP: 63-year-old man with mid-upper back pain
Until very recently, the pantheons of the world’s religions swelled with gods and divine beings to ward off calamities. And none loomed so large as smallpox. From the inky beginnings of civilization, the disfiguring disease slowly spread over the entire Eurasian continent and North Africa. In the last millennium, smallpox alone has caused 10 percent of all human deaths, including half a billion in the 20th century.
In China, the goddess …
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Is smallpox set for a comeback?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or chills. He has no history …
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MKSAP: 48-year-old man with knee pain and swelling
The commentary below is meant to invoke meaningful discourse rather than incite an unpleasant argument.
Less than a year ago, I heard Ben Stiller doling out kudos to his heroic doctor who diagnosed him with early-stage prostate cancer by using a simple, widespread screen.
What was interesting was that Stiller was actually underage. What I mean is that the star was not of age to be screened, according to current prostate cancer …
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Screening: Do you follow guidelines or your gut?
Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die. We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza …
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Medical workers: Vaccinate yourselves first
Physicians’ reactions to ORBITA — a blinded, randomized controlled trial (RCT) from Britain with a sham arm comparing percutaneous coronary intervention (PCI) to placebo in patients with stable angina — are as fascinating as the cardiac cycle. There were murmurs, kicks and pulsating jugulars. Though many claimed to be surprised and many unsurprised by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, …
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A reaction to ORBITA: Keep on stenting, judiciously
A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis.
It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made …
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A first-time case in a 35-year medical career
When a patient is diagnosed with a chronic disease, like diabetes or hypertension, physicians don’t merely suggest medications to lower blood sugar or blood pressure – they insist that patients take medications to protect their health. However, the recommendation to get an annual influenza (flu) shot to prevent flu is often not as emphatic. Research has shown that patients are much more likely to get a flu shot when it …
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Make a difference by being a vaccine insister
In early November, Chuck Norris filed a lawsuit against medical device manufacturers involving gadolinium-based contrast media, a chemical used in MRI imaging scans. The lawsuit stated that the gadolinium that doctors injected into his wife Gena to improve the clarity of her MRIs have left her “weak and tired and with debilitating bouts of pain and a burning sensation.”
As with any adverse effects involving medical procedures in the news, it …
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Is MRI contrast a dangerous threat?
Three to 17 percent of the world’s population suffers from depression, but trying to explain it to the other 83 percent can be difficult. Normal people have bad days and sad moods, but “normal” means they’re actually able to deal with those bad days, whereas depressed people can’t — not in an adequate manner. Explaining why “Cheer up!” doesn’t work is impossible because they just don’t get it.
I can’t speak …
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5 ways to help your friend with depression
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection.
On physical examination, he is a young, healthy-appearing man. Vital signs are normal. No jaundice is …
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MKSAP: 25-year-old man positive for hepatitis B surface antigen
Humans evolved with the constant force of the earth’s gravity. This is relevant to several of our organs, but the brain’s anatomy makes it especially important. The brain floats in spinal fluid encased inside the closed box of the skull. Gravity would be expected to affect the details of that. Indeed, studies of people who spent prolonged periods of time in bed in a head down position indicate this abnormal …
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What happens to our brains in space?
Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even …
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This is the deadly virus you need to look out for
