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.

Little is gained by arguing that President Trump has a psychiatric disorder

Steven Reidbord, MD

February 27, 2017

On January 31, 2017, the Psychology Today editorial staff published a well-balanced summary of the debate over whether to declare President Trump mentally ill. While the debate focuses on mental health professionals such as psychiatrists and psychologists who are credentialed to make such diagnoses, the question clearly goes further.

Public commentary following this and other articles expresses outrage — not only at the behaviors and policies of Trump himself, but also at …

MKSAP: 55-year-old man with gout

mksap

Conditions and Diseases

February 25, 2017

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

A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including the ankles …

Read more…

MKSAP: 55-year-old man with gout

Perioperative brain health: The need to better understand this public health problem

Lee A. Fleisher, MD and Roderic G. Eckenhoff, MD

Conditions and Diseases

February 23, 2017

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being …

Overdiagnosis harms kids. Here’s how to avoid it.

Christopher Johnson, MD

Conditions and Diseases

February 21, 2017

A fairly recent article in the Journal of Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students. It is sobering because it describes the potential harm that can come from it — harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.

“Overdiagnosis” is the term the authors …

MKSAP: 74-year-old woman with altered mental status

mksap

Conditions and Diseases

February 18, 2017

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

A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been unable to …

What Tom Price doesn’t know about prostate cancer screening

Kenneth Lin, MD

Conditions and Diseases

February 16, 2017

Dr. Tom Price may become the first medical doctor to lead the U.S. Department of Health and Human Services in 24 years. One might think that having completed medical school and practiced orthopedic surgery before entering politics might give him some extra insight into what works and what doesn’t in medicine. But judging by a letter to then-HHS Secretary Kathleen Sebelius that he signed in 2011 objecting to the …

My child has a concussion. What should I do?

Roy Benaroch, MD

Conditions and Diseases

February 15, 2017

A concussion is a brain injury. A mild one, yes, but one that can lead to longstanding symptoms. What you do after a concussion, immediately and in the weeks that follow, can make a big difference in how your child recovers.

Though it’s a mild injury — there’s nothing to see on a CT, X-ray, or MRI — the effects of a concussion can be significant and uncomfortable for a child …

MKSAP: 67-year-old man with worsening exertional dyspnea

mksap

Conditions and Diseases

February 11, 2017

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 6-month history of worsening exertional dyspnea. He has a history of severe COPD diagnosed 4 years ago and previously had minimal exertional symptoms. However, he now notes shortness of breath when walking short distances that is limiting his activity level. He does not have chest pain, …

When you have a cold, I want you to know why I’m not giving you an antibiotic

Eileen Sprys, MD

Conditions and Diseases

February 9, 2017

I want you to know about colds, and integrity.

Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either.

Truthfully, as odd as this sounds, I wish could find …

Should we stop burping babies?

Chad Hayes, MD

Conditions and Diseases

February 7, 2017

One evening this past week, after my wife finished feeding our 5-week-old daughter, I took over baby duty. I sat her up on my lap and gave her a few thumps on the back. Not hard enough to hurt, obviously, but just to make her burp.

She didn’t burp. So I gave her a couple more gentle-but-firm whacks, still without a result.

And then I remembered the phone call I got a …

Read more…

Should we stop burping babies?

The secret way to eating fewer brownies

Peter Ubel, MD

Conditions and Diseases

February 4, 2017

I know why I sometimes eat too many brownies. They taste great! The same goes, of course, for a whole slew of desserts — I love me my strawberry rhubarb pie, and I never say no to a ginger snap. And while a touch of dessert is often a fine way to top off dinner, many of us get in trouble when we gorge on desserts.

So how can we get …

Read more…

The secret way to eating fewer brownies

MKSAP: 45-year-old man with cough and right-sided chest discomfort

mksap

Conditions and Diseases

February 4, 2017

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

A 45-year-old man is evaluated for right-sided chest discomfort and cough of 2 weeks’ duration. His chest discomfort is described as a vague, painful sensation on the right. The cough occasionally produces a small amount of sputum; he reports no hemoptysis or shortness of breath. He has felt feverish with mild fatigue but …

Let’s talk about sex — with our patients

Dr. Leonard A. Sowah

Conditions and Diseases

February 1, 2017

I recently read a book by Dr. Barbara Natterson-Horowitz a UCLA cardiologist who also happens to be a consultant for the Los Angeles Zoo. In her book Zoobiquity, Dr. Natterson-Horowitz demystified the story of HIV (Human Immunodeficiency Virus) transmission from monkeys in West and Central Africa to humans. Most physicians today, including me, have a limited knowledge of zoonosis (the science surrounding bugs that can be from animals to humans) …

The curious case of a swollen scrotum

Raj Waghmare, MD

Conditions and Diseases

February 1, 2017

It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.

Frank Martin (name changed) has been sent from a walk-in …

Read more…

The curious case of a swollen scrotum

The media made a mistake reporting Carrie Fisher’s death

David Mann, MD

Conditions and Diseases

January 31, 2017

Carrie Fisher’s sad, premature death is an occasion to reflect upon the poor job the news media does in reporting medical news. The initial report from TMZ had the headline “Carrie Fisher Massive Heart Attack on Plane.” If one equates “heart attack” to the more precise medical term “myocardial infarction,” as is usually done, then this is certainly diagnostic overreach on the part of TMZ. From their …

The story of a rare, serious complication of mononucleosis

Niran S. Al-Agba, MD

Conditions and Diseases

January 31, 2017

Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week. She felt something was not quite right and asked me for advice.

“Trust your instinct, go get him, and bring him home.”

She brought him to my clinic the following day. He looked mildly ill. His vitals were stable; he was fatigued, slightly dehydrated, …

Do patients with celiac disease need probiotics?

Maureen Leonard, MD

Conditions and Diseases

January 28, 2017

One of the most common questions that I receive from patients diagnosed with celiac disease is if they should take a probiotic. The only available treatment for celiac disease, an autoimmune disease characterized by destruction of the absorptive surface of the small intestine which develops in genetically compatible individuals, is a gluten free diet. However, patients and providers often question whether supplementation with probiotics may hasten the healing process.

Probiotics are …

MKSAP: 68-year-old man with a right intertrochanteric fracture

mksap

Conditions and Diseases

January 28, 2017

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

A 68-year-old man is evaluated in the hospital for a right intertrochanteric fracture sustained in a mechanical fall. He reports right hip pain but no other symptoms. He has hypertension and type 2 diabetes mellitus and was in his usual state of health prior to the fall. He checks his blood glucose level several times …

Misophonia and suicide: Sound thinking is required

Jennifer Jo Brout, PsyD and Barron H. Lerner, MD, PhD

Conditions and Diseases

January 26, 2017

If you Google “misophonia” you might be shocked to find numerous articles discussing the tragic suicide of 52-year-old Russian-born scholar, Dr. Michelle Lamarche Marrese. Journalist Joyce Cohen was the first to report Marrese’s suicide in the New York Post piece “She could hear everything and it cost her her life.” Cohen explains that she and Marrese had been corresponding about Marrese’s struggles with misophonia for over 14 months, and that …

There’s absolutely no way to stop a cough. Here’s why.

Roy Benaroch, MD

Conditions and Diseases

January 23, 2017

Coughing is one of the most common reasons parents bring their children to see me. And I can understand why. Coughing is noisy and uncomfortable and gets kids dirty looks in schools and subways. Even worse, coughing keeps kids and their parents awake. We’ve all been there, and no one likes to cough.

But coughing is there, usually, for a reason. Almost all coughs are from upper respiratory infections (that’s fancy …