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.

The opioid epidemic: What we can learn from history

Adam Rodman, MD

October 29, 2017

It’s no secret that the United States is in the midst of an opiate epidemic. Almost 60,000 people died last year from overdoses, and overdose deaths are now the most common killer of Americans under the age of 50. Physicians and our patients have finally started the difficult conversation about what it will take to stop the suffering. But what’s been missing from this conversation is that this is not …

How is mental health care failing American patients?

Linda Girgis, MD

Conditions and Diseases

October 28, 2017

According to the National Institute of Mental Health (NIMH), about 9.8 million adults (or 4 percent of all adults) over the age of 18 years suffered a serious mental illness in 2015. A serious mental illness is one that affects a patient’s daily functioning. Considering all mental illness in adults in the same time period, 43.4 million adults (or 17.9 percent) who met the criteria for a …

MKSAP: 72-year-old man with a holosystolic murmur

mksap

Conditions and Diseases

October 28, 2017

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

A 72-year-old man is evaluated during a routine examination. He has no symptoms or significant medical history. He is active and exercises regularly. He does not take any medications.

On physical examination, blood pressure is 135/70 mm Hg, pulse rate is 82/min, and respiration rate is 17/min. Cardiac examination reveals a grade 3/6 …

C. difficile: We are not winning the war against this cunning adversary

Michael Kirsch, MD

Conditions and Diseases

October 27, 2017

If any reader has heard of C. difficile, affectionately known as C. diff, then I presume you have had closer contact with this germ than you would have liked. It’s an infection of the colon that can be serious, or even fatal. There isn’t a hospital in the country that isn’t battling against the infection.

We are not winning the war against this crafty and cunning adversary.

While the infection is not …

The opioid epidemic in 6 charts

Andrew Kolodny, MD

Conditions and Diseases

October 25, 2017

Drug overdose deaths, once rare, are now the leading cause of accidental death in the U.S., surpassing peak annual deaths caused by motor vehicle accidents, guns and HIV infection.

As a former public health official, clinician, and researcher, I’ve been engaged in efforts to control the opioid addiction epidemic for the past 15 years.

The data show that the situation is dire and getting worse. Until opioids are prescribed …

Read more…

The opioid epidemic in 6 charts

Think of the person behind the cells: the motivations of biomedical research

Samuel Falkson

Conditions and Diseases

October 23, 2017

Born in 1920, Henrietta Lacks lived in Virginia and Maryland, worked as a tobacco farmer, and mothered five children. At age 31, her life was unfortunately cut short by cervical cancer. Since her death, she has helped catalyze numerous biomedical discoveries.

Upon treatment at Johns Hopkins, Henrietta’s physician obtained a tumor sample. To his amazement, her cells survived and divided in a petri dish. Today, her cells are still used in …

Respiratory syncytial virus: Are we making any progress?

Christopher Johnson, MD

Conditions and Diseases

October 23, 2017

It’s fall in the PICU, and we just saw our first severe case of respiratory syncytial virus (RSV) of the season. RSV is by far the most common cause of bronchiolitis in infants. To scientists, RSV is a fascinating virus with several unique properties. One of these is its behavior in the population. When it’s present, RSV is everywhere. Then it suddenly vanishes. There are exceptions to everything in medicine …

The flu vaccine doesn’t cause the flu. Period.

Jennifer Gunter, MD

Conditions and Diseases

October 22, 2017

Flu vaccines are available, and so that means that the anti-vaccine brigade is out in force.

The Daily Mail published an anti-vaccine op-ed by a former reality TV contestant named Katie Hopkins. It was followed by a shorter counter argument by a doctor, but when you are given less than half the word count and are at the bottom of the page it is hard to mount an effective response. …

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

mksap

Conditions and Diseases

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 …

Severe remorse: Does it require a specialist?

Steven Reidbord, MD

Conditions and Diseases

October 20, 2017

In her recent New Yorker article, “The Sorrow and the Shame of the Accidental Killer,” author Alice Gregory claims there are no self-help books for anyone who has accidentally killed another person. Nor published research, therapeutic protocols, publicly listed support groups, nor therapists who specialize in their treatment. She profiles several such tormented souls who bear their burdens largely alone.

Yet dealing with guilt, shame, and regret is a mainstay of …

Your breast cancer screening questions answered

Andrea Eisenberg, MD

Conditions and Diseases

October 19, 2017

Hey ladies! And you gents too! Everyone is affected by breast cancer, either personally or by a family member or friend. Fortunately, we live in a time where breast cancer can be detected earlier and when detected, can be treated and cured. The key is early detection.

There seems to be copious amount of information on the Internet: some good, some not so good. Let’s go through a few of these …

How can we improve mental health screening?

John Corsino, DPT

Conditions and Diseases

October 19, 2017

Medical care and understanding have changed since separation of physical and mental health made much sense. We know now that mental state and internal physiology influence one another and that social factors affect disease risk more powerfully than genetic ones. Still, as a health care system, we perpetuate a culture of division, and limit our capacity to help people because of our inability to categorize them neatly.

There are so many with unmet mental health …

All cancer care needs to consider the whole patient

Stephen Rosenberg, MD

Conditions and Diseases

October 16, 2017

An excerpt from Cancer What You Need to Know.

Treating cancer means taking care of the whole patient — the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond.

Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, …

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus

mksap

Conditions and Diseases

October 14, 2017

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

A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning.

On physical examination, temperature is 37.2 °C (99.0 °F), …

The problem with prescribing sleeping pills for older patients

Lea C. Watson, MD, MPH

Conditions and Diseases

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 and Diseases

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 …

How Alex Wubbels reminded this nurse of her calling

Elizabeth Donahue, RN, NP-C

Conditions and Diseases

October 9, 2017

First I noticed it all over my social media feed — the story of Alex Wubbels, a burn unit nurse at a university hospital in Utah who was arrested and manhandled by police for not allowing them to take a sample of blood from an unconscious patient without a warrant. Then came a slew of texts, emails, and calls from people wanting to discuss the incident, asking me …

The loss of testosterone and how that affects the partner

Anne Katz, RN, PhD

Conditions and Diseases

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 …

Antidepressants and pregnancy: Let’s examine the misconceptions

Adam C. Urato, MD

Conditions and Diseases

October 7, 2017

Recently, another research study (in the prestigious British Medical Journal) linked antidepressant use during pregnancy to an increased risk of psychiatric disorders in the exposed children. Much controversy surrounds this topic — and a great deal of misinformation. Two issues, in particular, seem to be “missed” in the public discourse.

The first misconception is the notion that depression during pregnancy should not be treated because treatment may …

MKSAP: 58-year-old man with hepatitis C-related cirrhosis

mksap

Conditions and Diseases

October 7, 2017

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

A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide.

On physical examination, temperature is 36.8 °C (98.2 …