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.

Vaccinations are more about trust than science

Niran S. Al-Agba, MD

April 26, 2016

I am going to confess that I am my children’s pediatrician. I have given them every vaccination they have ever had and probably would not trust another provider to do it. I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease. I completed medical school and three years of pediatric training that helped shape this belief. I have seen death …

Why the cancer moonshot is already off course

Matthew Katz, MD

Conditions and Diseases

April 25, 2016

The cancer moonshot initiative raised skepticism because of the limited funding to end cancer. Unfortunately the recently announced panel membership confirms that while the project may launch, skewed representation may tilt the mission off course.

It is no surprise that the panel heavily tilts toward immunology, medical oncology, surgery and big science. But three core specialties you would find at any tumor board are missing: pathology, radiology, and radiation …

MKSAP: 55-year-old man is evaluated following a screening for type 2 diabetes mellitus

mksap

Conditions and Diseases

April 23, 2016

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

A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin.

On physical examination, blood pressure is 123/76 mm Hg and pulse rate is 72/min. …

Drug addiction is a learning disorder

Randi Hutter Epstein, MD, MPH

Conditions and Diseases

April 22, 2016

When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much.

Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was …

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Drug addiction is a learning disorder

Should cardiologists evaluate their obsession with LDLs and HDLs?

Robert Centor, MD

Conditions and Diseases

April 21, 2016

This post is purposely controversial. I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue. This post is hypothesis challenging. I may be right, or I may be wrong. I hope we get some debate on my speculations.

The latest blow to the cholesterol hypothesis: “Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart …

Is the government’s National Pain Strategy doomed to fail?

Kenneth Lin, MD

Conditions and Diseases

April 21, 2016

Over the past few months, the federal government has mobilized against what is being called “the opioid crisis“: a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations …

What does a perfect world for postpartum moms look like?

Jennifer Lincoln, MD

Conditions and Diseases

April 19, 2016

“One can dream.”

That’s often a quote we hear when we talk about winning the lottery or landing a job that lets us do something great like being a taster of new ice cream flavors for a living (I wish).

However, what’s sad is that many American moms utter those same words when they think about life after baby. A year of paid maternity leave. Access to a good lactation consultant. Family members who …

Identifying a rare disease: Why proper communication is key

Richard Robinson, MD

Conditions and Diseases

April 18, 2016

Today’s restless society has taken its toll on modern medicine. Among all the strategies for protocol optimization and health insurance improvements, doctors get to spend less and less time actually talking to their patients. Each check-up needs to be performed in a certain amount of time, and every procedure needs to be completed as quickly as possible so that hospitals are efficient and profitable.

While this makes perfect financial sense, it …

MKSAP: 77-year-old woman with a left middle cerebral artery ischemic stroke

mksap

Conditions and Diseases

April 16, 2016

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

A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is otherwise significant for …

We are born with our arms wide open. We die in much the same way.

Jordan Grumet, MD

Conditions and Diseases

April 11, 2016

We are born with arms wide open, and we die in much the same way. It is that which we carry, in the time between, that defines us.

The newborn, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other. She grasps and roots at inanimate objects with the same voracity she reaches for her mother. It is a time of differentiation, a time …

MKSAP: 30-year-old woman with right antecubital fossa and biceps pain

mksap

Conditions and Diseases

April 9, 2016

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-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.

On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and …

A refreshing day of real doctoring

Hans Duvefelt, MD

Conditions and Diseases

April 7, 2016

Back in my first year of blogging, I wrote a post, titled “A Day Without a Diagnosis,” about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school.

That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring.

My first patient of the day was …

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A refreshing day of real doctoring

Permission to take my patients’ plasma. It’s a harder decision than you think.

David Margolius, MD

Conditions and Diseases

April 6, 2016

“I hereby authorize xxx, my patient, to donate plasma up to two times per week.”

I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma.

By the time the fourth form came, I realized …

How everyday people catch sexually transmitted infections

Jill Grimes, MD

Conditions and Diseases

April 4, 2016

An excerpt from Seductive Delusions: How Everyday People Catch STIs.

Dear Ashley,

Your blood count and mono test did not show any signs of mononucleosis infection. Unfortunately, however, your throat swab was positive for gonorrhea. Please schedule an appointment today in urgent care so you can be treated with the appropriate shot …

Visualize the abnormal prostate with Medcomic

Jorge Muniz, PA-C

Conditions and Diseases

April 3, 2016

In this Medcomic, we’ll visualize three common abnormalities of the prostate. Let’s meet our new friends. On the left is Burney and he could certainly benefit from a trial of antibiotics and an analgesic. The large fellow in the middle straining to urinate goes by the name of Turp. On the far right is Grampa Addy, currently dealing with the …

We must do a better job of contraceptive counseling

Poppy Daniels, MD

Conditions and Diseases

April 2, 2016

Decisions about how many children to have (if any) or what type of contraception to use are complex. For patients who are not health care providers, the doctor-patient relationship remains a critical relationship by which these sometimes difficult decisions are navigated. As a practicing gynecologist for 13 years, I continue to be mystified at how many women report to me a nearly complete lack of counseling prior to being prescribed …

What surgeons aren’t saying about sex after hip replacement

Troy A. Miles, MD

Conditions and Diseases

April 2, 2016

As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to …

MKSAP: 32-year-old woman is evaluated for anticoagulation management

mksap

Conditions and Diseases

April 2, 2016

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

A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks’ gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Medical history …

How safe are home births? A pediatrician explains.

Christopher Johnson, MD

Conditions and Diseases

March 30, 2016

The debate over the safety of giving birth at home, both for the mother and for the infant, has been debated for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1 percent in the U.S., although it’s much higher than that in many Western European countries.

The shift to hospital births …

MKSAP: 48-year-old woman with type 1 diabetes mellitus

mksap

Conditions and Diseases

March 26, 2016

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

A 48-year-old woman returns for a follow-up visit for management of type 1 diabetes mellitus. She reports doing well since the last visit. Overall, she believes that most of her blood glucose levels are at goal, but is concerned about occasional episodes of hyperglycemia occurring in the morning before breakfast. She eats a bedtime snack …

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