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.

Does the high-risk psychiatric patient pose a risk for the patient or the doctor?

Steven Reidbord, MD

July 30, 2017

A woman recently requested a medication evaluation at the suggestion of her psychotherapist. The caller told me her diagnosis was borderline personality disorder. She hoped medication might ease her anxiety. She also admitted that two other psychiatrists refused to see her because she was too “high risk.” I asked if she was suicidal. Yes, thoughts crossed her mind. However, she never acted on them, and was not suicidal currently. I …

MKSAP: 34-year-old man with episodic palpitations

mksap

Conditions and Diseases

July 29, 2017

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

A 34-year-old man is evaluated for episodic palpitations of 8 months’ duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father has also undergone thyroidectomy …

Who is alive: man or machine?

Debbie Moore-Black, RN

Conditions and Diseases

July 27, 2017

He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable.

Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to …

Read more…

Who is alive: man or machine?

Should we screen African-American men for prostate cancer?

Kenneth Lin, MD

Conditions and Diseases

July 23, 2017

Regular readers of my blog know that I believe that the harms of prostate-specific antigen (PSA) screening for prostate cancer outweigh the benefits — if benefits exist at all. That isn’t to say that I will not order the test in a man who understands the risks and expresses a clear preference to be screened. In a recent editorial in American Family Physician, I explained my …

MKSAP: 25-year-old woman with type 1 diabetes

mksap

Conditions and Diseases

July 22, 2017

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

A 25-year-old woman with type 1 diabetes presents to clinic requesting more information about use of a closed-loop insulin-delivery system (artificial beta cell).

Although her HbA1c is at goal, she notes frequent hypoglycemia as an issue. In addition, she would like to further improve her glycemic control in anticipation of pregnancy in the next …

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

Valerie A. Jones, MD

Conditions and Diseases

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 …

Senator McCain has brain cancer. Here’s what that means.

Brian C. Joondeph, MD

Conditions and Diseases

July 20, 2017

By now, most readers already know that Senator John McCain has been diagnosed with a brain tumor — specifically, a glioblastoma. I take no pleasure is suspecting such a diagnosis, as I wrote a few days ago, based on a bit of medical logic and observation rather than what the media reported.

This is a devastating diagnosis for the senator and his family, not the blood clot initially …

A physician’s journey about the complexities of gender

Andrea Eisenberg, MD

Conditions and Diseases

July 19, 2017

Entering the dimly light room, I could hear soft music playing in the background. The laboring room was so peaceful, it was hard to believe the patient in the bed was in active labor. But once up close, you could hear her breathing become deeper and louder every three or four minutes as she rode the wave of another contraction. Her husband was by her side, breathing with her, toweling …

What patients can teach doctors about rare diseases

Aamir Hussain, MD

Conditions and Diseases

July 19, 2017

Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis.

Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized …

MKSAP: 20-year-old male college student with a superficial skin infection

mksap

Conditions and Diseases

July 15, 2017

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

A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, clindamycin, and trimethoprim-sulfamethoxazole. He currently …

Children suffer mentally, but no one helps

Jack Turban, MD

Conditions and Diseases

July 12, 2017

Imagine that you come home to find your daughter in tears. She’s been acting strangely for the past year, but she never tells you what’s going on. This time she finally tells you: She can’t stop thinking about killing herself with a knife in the kitchen. After an hour of talking, you realize that she doesn’t want to die, but she has obsessive thoughts about hurting herself. She’s overwhelmed, and …

Impairments vs. diseases in the aging process

Stephen C. Schimpff, MD

Conditions and Diseases

July 11, 2017

Part of a series.

Beginning at about age 40, our bodies begin a process of organ and functional decay of about 1 percent per year. Bone mineral density decline leads eventually to osteoporosis and fracture risk, cognition decline leads to memory and thinking impairments, and muscle decline leads to loss of strength while increasing the fracture risk of a fall.

According to the Centers for Disease Control, almost …

MKSAP: 60-year-old woman with substernal chest pain

mksap

Conditions and Diseases

July 8, 2017

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

A 60-year-old woman is evaluated for a 3-week history of substernal chest pain. The pain is dull, nonradiating, and unrelated to activities. Sometimes the pain is worse after eating spicy foods and can be occasionally triggered by emotional stress. She has not had shortness of breath or weakness. She is moderately active, …

Drowning in a sea of misinformation: Dry drowning and secondary drowning

Seth Collings Hawkins, MD, Justin Sempsrott, MD, and Andrew Schmidt, DO, MPH

Conditions and Diseases

July 6, 2017

Recently, a young child died following days of vomiting. He had been in shallow water in a Texas dike about a week before his death. The story was picked up as an alleged case of a rare condition called dry drowning or secondary drowning. The media accounts went viral, spreading significant fear in parenting communities and among those learning about these alleged conditions from the news …

MKSAP: 21-year-old woman with mosquito bites

mksap

Conditions and Diseases

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 …

We must address young patients’ pain and suffering from the start of their cancer journey

Jennifer Mack, MD, MPH

Conditions and Diseases

June 30, 2017

When a child is diagnosed with cancer, overwhelmed parents and patients are often laser-focused on the path to cure. Even though parents do not welcome pain or discomfort for their child, they may feel that symptoms are a necessary cost of curative care. Likewise, it is easy for us, as pediatric oncologists, to accept symptoms and side effects of treatment as normal. Important new research challenges this assumption and challenges …

Expanding our definition of spiritual competence

Eric Nelson

Conditions and Diseases

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 …

A more careful examination would have saved her expensive procedure

Hans Duvefelt, MD

Conditions and Diseases

June 28, 2017

“Noncardiac chest pain” was Laurie Black’s discharge diagnosis. Her chest CT angiogram didn’t show a pulmonary embolus, her troponins were negative for a heart attack and her nuclear stress test was negative for coronary ischemia.

“So what do you think it was?” she asked while I read through her hospital discharge summary.

“I don’t know. Show me where the pain was,” I answered.

“It started on my back, on the left side, and …

How journalists help doctors fight the opioid epidemic

Sandeep Kapoor, MD

Conditions and Diseases

June 28, 2017

One of the privileges of being a health care provider these days is having access to innovative technologies designed to help save lives. My colleagues and I were recently surprised to discover a powerful tool that could be useful in our line of work: journalists.

I am part of an interdisciplinary team that focuses on finding …