He was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to …
Let older people talk about sex
Heroin abuse in the United States is reaching epidemic proportions. According to SAMHSA, between 2007 and 2012, the number of Heroin users has doubled from an estimated 375,000 to over 665,000. Additionally, in 2010, the number of deaths as a direct result of overdose surpassed auto accident deaths.
It is impossible to avoid the facts about heroin. We are bombarded daily by the national and local media and extensive online resources. …
Does tough love equate to wellness or destruction?
Infants with a first-degree relative (parent or sibling) with celiac disease, and who carry an at-risk (DQ2 or DQ8) gene, have a higher risk of developing the autoimmune disorder triggered by gluten-containing foods. Many parents, especially those with a family history of celiac disease, are understandably nervous about introducing gluten into their child’s diet. They wonder whether there is an ideal time to introduce gluten, if they can prevent celiac …
When should you introduce gluten to your baby?
When people ask me why I, an applied mathematician, study diabetes, I tell them that I am motivated for both scientific and human reasons. 
Type 2 diabetes runs in my family. My grandfather died of complications related to the condition. My mother was diagnosed with the disease when I was 10 years old, and my Aunt Zacharoula suffered from it. I myself am pre-diabetic.
As …
How a mathematician developed an algorithm to help treat diabetes
After writing my 21st post about appendicitis back in November, I swore I would not write about it again for the foreseeable future.
Well, the future is now because investigators from the United Kingdom and Canada just published a meta-analysis including ten papers and 413 children about the efficacy and safety of nonoperative treatment for appendicitis in children.
They concluded that nonoperative management is effective in 96 percent …
Is nonoperative treatment of appendicitis in children safe?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history …
MKSAP: 81-year-old man after a percutaneous coronary intervention
Part of a series.
For most of recorded human history, lifespans did not change.
Life expectancy doubled in the twentieth century. At the time of Lincoln the average life span was 38 years; today it is about 78 to 80 years. But whenever it ends it is like a waterfall. Most people begin to die near to the expected point; the drop off in percentage still living declines precipitously. …
Life expectancy has lengthened, but not equitably
When I was a practicing attorney, my colleagues and I would sit around at lunch, arguing about whose sandwich was better. Alone in our world of books and “right and wrong,” (as in “I’m right, and you’re wrong”), we spent hours creating problems to solve so we could make money. Lawyers — like many professionals — form their own little bubble, but unlike say, IT guys or architects, our bubble …
Lawyers have no business in the field of advance care planning
“Why do you eat so healthy?” or “Where’s your kale today?” I would hear regularly.
For as long as I can remember, my colleagues and friends have often smirked at my lunch choice. To me, I always ate what I enjoyed (even if it was the occasional french fry), and my diet and lifestyle were all about balance. Growing up, I played competitive soccer for 10 years and knew my performance …
The irony of the “sick” caring for the sick
Many patients are referred to me as a psychiatrist to treat their depression. The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right? Not always.
Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms. Well, sometimes …
The answer to depression isn’t always an antidepressant
The publication of Andrew Wakefield’s notorious and now discredited research on autism and vaccines in 1998 triggered a surge of worry about vaccine safety. Since then, questions about a purported connection between autism and vaccines have been asked and definitively answered: There is no link. But there are other factors linked to the development …
What are the real environmental factors linked to autism? Let’s focus on those.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated in follow-up for elevated liver chemistry test results, which were performed to assess a 3-month history of fatigue. He has no history of liver disease and has not had abdominal pain or fever. His medical history is significant for a 3-year history of diarrhea. Following a physical exam, …
MKSAP: 28-year-old man with elevated liver chemistry test result
One night in 1997, as Americans watched Touched by an Angel they were touched by something else unexpected: an ad for a prescription allergy pill called Claritin, sold directly to patients.
Prescription drugs had never been sold directly to the public before — a marketing tactic called direct-to-consumer or DTC advertising. How could average people, who certainly had not been to medical school, know if the medication was appropriate or safe …
The scary evolution of direct-to-consumer advertising
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As a consumer and admirer of movies, I always look forward to the Academy Awards. A celebration of the best movies and performances of the past year. A night filled with spectacular performances, glamor, and amazing speeches. The speeches are truly special for me since we get a glimpse into the true character and soul of the award winners as they thank those who helped them along their journey.
I feel like …
Please include more patients at our medical meetings
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is ramipril.
On physical examination, temperature is 35.8 °C (96.4 °F), blood pressure is 120/68 mm Hg, pulse rate …
MKSAP: 67-year-old man with primary hyperparathyroidism
A report in the Journal of the American Medical Association (JAMA) shows that too few women with recently diagnosed breast cancer and at high risk of a BRCA genetic mutation received appropriate genetic counseling. And that testing for the mutation is a missed opportunity not only to improve treatment for these patients but also to prevent some breast, Read more…
Why aren’t women receiving appropriate genetic counseling?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …
MKSAP: 30-year-old woman with diarrhea
When it comes to the uterus, people tend to have incredibly strong opinions. In fact, many of the people with strong beliefs don’t even have a uterus of their own. I would venture even further to say that if you asked many of these “opinion-havers” where the uterus was in a woman’s body or exactly what its function was, they would have no idea.
Yet, here we find ourselves, 44 years …
Pediatricians face a difficult task determining when to refer a child for a suspected bone marrow failure syndrome. We now realize that only a subset of children with bone marrow failure syndromes present with the findings described in textbooks. These children often appear well and lack classical physical stigmata. By the time they look sick, their marrow’s ability to produce blood cells can be so weakened that it could be …
What pediatricians should know about bone marrow failure syndromes
FODMAP what? Have you heard? It’s the new dietary approach for the bloating and belly cramps seen with irritable bowel syndrome (IBS).
IBS affects one in seven Americans. It’s a gut condition which affects the flora in the bowels and causes abdominal pain, cramping, diarrhea or constipation, bloating, gas and overall discomfort and misery. It can be life changing and debilitating; jeans and Spanx don’t stand a chance!
IBS has …
Help your IBS symptoms with a low FODMAP diet
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