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 perfect birth plan can change. And it often does.

Kim M. Puterbaugh, MD

September 10, 2016

When a patient arrives in labor and delivery clutching her birth plan, I’ll admit, I want to escape immediately to a remote, uninhabited island with no modern form of communication. I’d crate the carrier pigeons, too, just to be safe.

Many of us who deliver babies have an unshakable belief that women with birth plans unlock Pandora’s nether regions, releasing a huge flock of horrifying Kraken. The Kraken takes perverse glee …

MKSAP: 34-year-old woman with very dry, painful hands

mksap

Conditions and Diseases

September 10, 2016

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

A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times daily, often for 2 to 3 minutes at a time. She has been applying lotion multiple times daily with no relief of the pain. She has a history of …

She asked for comfort

Debbie Moore-Black, RN

Conditions and Diseases

September 9, 2016

Mom. She was a feisty 100 percent Italian, straight from New Jersey. Her dad, straight from Italy, was a tailor and made the finest suits for New York and New Jersey businessmen. Mom learned this trade well. She could sew some of the most beautiful tailored suits for herself. She loved to cook and every night was a banquet, a feast which required up to 2 hours of clean-up time …

Read more…

She asked for comfort

The language you speak can affect how your baby cries

Christopher Johnson, MD

Conditions and Diseases

September 8, 2016

I found this study to be absolutely fascinating. The link is to the abstract; the complete article is behind a paywall, but I can get it for anybody who’s interested in reading the whole study in detail. Its title is “Fundamental frequency variation in crying of Mandarin and German neonates.” I have always assumed, like most people I suspect, that babies cry the same the world over. When they’re uncomfortable or …

How nurses and law enforcement can work together

Jason Lee, TCRN, CCRN

Conditions and Diseases

September 7, 2016

The recent horrible events involving racial profiling, excessive force, and gun violence are deeply troubling but not new. Who can forget the Bronx shooting of Amadou Diallo in 1999 when 41 bullets rained down on his unarmed body. I can uniquely identify with the black experience because of my own numerous experiences of being pulled over for no other apparent reason except for being in the wrong neighborhood, wrong state …

Consider screening for BRCA more regularly

Nicholas Fogelson, MD

Conditions and Diseases

September 7, 2016

When I talk to my patients, one of the greatest concerns I hear is regarding the fear that they might get a cancer at some point in their life. It is a very reasonable fear, as cancers of the female reproductive tract and breasts are not as rare as we might like. Perhaps educated by Angelina Jolie’s announcement of her BRCA mutation in 2013, many women now ask me about …

What is the true utility of the DSM?

Steven Reidbord, MD

Conditions and Diseases

September 6, 2016

Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM-IV parked in my office bookcase. The main reason was to enter the right diagnostic codes on insurance forms. I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily mood swings are not characteristic of bipolar disorder, or that six months of sobriety is still “Read more…

What is the true utility of the DSM?

Bedpans to outcomes: Why can’t we quantify nursing care?

Amanda Anderson, RN

Conditions and Diseases

September 5, 2016

“So, will you go get me a bedpan?”

The bar was fancy, so I let it slide. This was not the first time my response to an occupational query was followed with a statement about bedside toileting; people just don’t know what to do when an educated, confident woman says she’s a nurse.

I smiled tersely, as I have trained myself to. In past years, I’d offer varying responses: anger, heated debate. …

MKSAP: 74-year-old woman with peripheral arterial disease

mksap

Conditions and Diseases

September 3, 2016

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

A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. …

Can we break the cycle of chronic pain in patients following orthopedic injury?

Melissa Yu and Maureen McCunn, MD

Conditions and Diseases

August 30, 2016

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

“You are the only one who truly understands your own pain.”

As one trauma survivor from the University of Maryland Shock Trauma Center in Baltimore told us: “The pain is with you 24/7. It is nonstop. And that is the hard part, you cannot escape …

MKSAP: 57-year-old man with substernal chest pain

mksap

Conditions and Diseases

August 27, 2016

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

A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as …

7 pediatrician tips for back-to-school success

Chad Hayes, MD

Conditions and Diseases

August 26, 2016

The new school year is just around the corner (or maybe it’s already started where you live). Either way, here are a few quick tips to make sure you start the year off right:

1. Sleep is key: Poor or insufficient sleep can have significant effects on school performance. Many of us (myself included) let our children stay up later during the summer months. But as school starts back, it’s important …

What PPIs and the Kardashians have in common

Dr. Paul Moayyedi

Conditions and Diseases

August 24, 2016

The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll and Austin Hill, the architects of modern epidemiology, realized that it was hard for epidemiology …

MKSAP: 61-year-old man with generalized weakness

mksap

Conditions and Diseases

August 20, 2016

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

A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years.

On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and respiration rate …

Please don’t take gynecological advice from Khloe Kardashian

Jennifer Gunter, MD

Conditions and Diseases

August 18, 2016

The latest celebrity to use the internet like a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down.

But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office …

How the book “When Breath Becomes Air” changed my practice

Kim A. Reiss, MD

Conditions and Diseases

August 13, 2016

Behind every door in my clinic, is human suffering. It hangs like a mist; I can see the living ghosts of my patients through it.

As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting. I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics: a …

Exciting implications of the neuro-immune link no one is talking about

Keith Pochick, MD

Conditions and Diseases

August 13, 2016

A recent research paper from the University of Virginia may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as “organic” or “psychiatric.” UVA researchers have discovered a complex network of lymphatic vessels which service the brain, prompting a serious update of the concept of a highly selective “blood-brain barrier.”

When asked about methods to study the immune response of the brain and …

MKSAP: 62-year-old man is evaluated for declining exercise capacity

mksap

Conditions and Diseases

August 13, 2016

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

A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. …

A miracle in the intensive care unit

Debbie Moore-Black, RN

Conditions and Diseases

August 12, 2016

She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have.

Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days. And finally said their …

Read more…

A miracle in the intensive care unit

Health care has far too many medical panels

Rocky Bilhartz, MD

Conditions and Diseases

August 10, 2016

We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because …