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.
We, as a society, can’t ignore these numbers: over 47,000 human lives lost prematurely in one year from drug overdoses, a 7 percent spike over the previous year, with opioid painkillers and heroin driving much of this tragic surge. If this trend isn’t disturbing enough, four out of five new heroin abusers began their habit by abusing painkillers.
These numbers have faces. Caring for patients who abuse and …
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The critical medical and moral stakes for all patients in pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle …
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MKSAP: 59-year-old woman with continued substernal chest pain
On any given night in the United States, according to the Department of Housing and Urban Development, over half a million people are without a home. That number may have decreased nationwide in the past few years, but California remains on the forefront of the problem, accounting for 20 percent of the country’s homeless in 2014.
With the winter’s freezing temperatures and El Niño’s massive rainstorms, what to do about the …
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Solving homelessness requires finding answers to these 2 questions
It’s January 2016. News stories have inspired significant anxiety about Zika virus. It’s a scary topic because news about the outbreaks are just unfolding, and this affects an already anxious group: pregnant mamas and expecting families. I want to share with you real-time information and data to try to alleviate anxiety and educate the best I can.
I suspect with time some of this will change. I’ve curated the most common questions and answers …
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Scared about Zika virus? Here are some answers that you need to know.
There is no doubt that Zika is causing worldwide hysteria as a rapidly spreading virus with potential of pandemic proportions. The virus is transmitted by the Aedes aegypti mosquito, which also carries both dengue fever and yellow fever.
While a relatively innocuous virus with 80 percent of those affected being asymptomatic, mild symptoms of illness such as fever, rash, joint pain, and conjunctivitis are associated. The most worrisome outcome of this …
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The potential solution to Zika is hidden in its name
When my twin sons were born prematurely at 26 weeks’ gestation, my family’s lives were thrust into the whirlwind of the NICU and living daily with the reality of the babies (William and Elliott) being on life support. Having had no prior intense and prolonged experiences with the hospital, and watching helplessly and fretfully as my tiny two-pounders fought for their lives, it’s almost impossible to put into language what …
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The benefits of trauma-informed care in the NICU
A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment.
I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part …
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Is it the doctor’s fault if a patient doesn’t want to come in?
Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes.
It is common practice to leave a permanent tattoo at …
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Gastroenterologists are the tattoo artists of medicine
I woke up to someone forwarding this tweet.
Yes, some company is selling tiny bags of herbs (they call them pearls) to stuff in the vagina for three days to cleanse your uterus or shrink your fibroids or treat bacterial vaginosis or tighten your vagina.
This is not only pointless it could be very dangerous. Here’s why.
Your uterus and vagina want you to leave them alone.
Your uterus isn’t tired …
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Your vagina doesn’t need a herbal cleanse. Here’s why.
I run a dilator program for women with rectal or anal cancer where I educate patients about the need for and correct use of vaginal dilators to mitigate the effects of radiation on the vaginal wall. Many women don’t understand the need for dilators after radiation for this cancer, so I always start with a description of the anatomy and …
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A story of how small things really can make a big difference
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin.
On physical examination temperature is 36.7 °C (98.0 °F), blood …
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MKSAP: 68-year-old man with dyspnea on exertion
Recently, new dietary guidelines were released, recommending reducing sugar intake overall, and reducing meat intake in growing boys. Last year, as we remain in the throes of a nationwide obesity epidemic, the FDA changed the nutritional labels we’ve become all-too-familiar with. The emphasis is now on calorie count of an “appropriate” serving size. So much for my pretending that the “appropriately served” pint of ice cream I just downed had 350 …
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Childhood aspiration on food is a public health issue
Sometimes as a travel medicine doctor you feel like Red Riding Hood’s mother.
Your patients come in asking for advice about upcoming travels. Much like Red’s mother you want to wrap your patients up in a protective cape and guide them on safe travels.
You want to teach them to avoid any wolves that may be lurking out there. Like impetuous teenagers, your patients don’t always listen.
And Zika virus just made it worse …
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This is what you should know about Zika virus
My son Acton is truly a miracle baby because he was not even supposed to be here. I had gone through four years of infertility with three miscarriages and an ectopic pregnancy (pregnancy in my fallopian tube), causing my left tube to be removed. After my last miscarriage, I was told I was in perimenopause and had less than 1 percent chance of ever getting pregnant again, let alone carrying …
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The story of how a NICU nurse became a NICU mom
“Hey mon, you alright?”
“You have a blessed day.”
“How is your morning walk pretty ladies?”
“Yeah mon, no worries. Everything alright.”
These “stock phrases” are just a few of the things I heard each and every day while staying in Negril, Jamaica. I travelled to the island to take a short vacation and also attend a destination wedding this past month. While on the island, I was pleasantly greeted by the local Jamaicans …
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Dare to make yourself more human
It was that time of the year at the cancer center — with treats all around, chocolates, cookies and gingerbread houses, gifted from the patients to their doctors. Yes, it was the excess sugar holiday season. Most of these patients were follow-ups — the already established patients of the cancer center, expressing their gratitude in taking care of them in the tough times earlier in the year. Among all the …
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Stop comparing cancer with diabetes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen …
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MKSAP: 50-year-old man with a large bleeding gastric ulcer
At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that, “The meaningful use program as it has existed will now effectively be over, and replaced with something better,” and later clarified on Twitter that, “In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something …
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Meaningful use is dead. Is it time to celebrate?
Computed tomography (CT) is a powerful diagnostic tool that allows rapid diagnosis of disease. CT is widely available in the U.S. and is a mainstay of medical diagnosis. Estimates state that 85 million CT scans were performed in the U.S. in 2012. To create images, CT scanners pass ionizing radiation (x-rays) through the body thereby exposing patients to radiation. Patients who are imaged with CT have …
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The financial costs of treating CT-induced cancer
I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer.
Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened.
A study found a higher incidence of breast cancer with …
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The mystery of false positive mammograms and cancer risk
