On May 2, 2015, at approximately 6 a.m. local time, the Duchess of Cambridge was admitted to the Lindo Wing of Saint Mary’s Hospital after going into labor. At 8:34 a.m., the Duke and Duchess welcomed a baby girl, Charlotte Elizabeth Diana, into the world weighing 8 lbs. 3 oz. Kensington Palace announced the arrival of the fourth royal in line to the British throne at 11 a.m. At around …
Deliver a princess. And then be home for dinner.
It’s a headline that I suspect many thought would never be written, but it was — in the New Orleans Advocate: “Harrah’s Casino in New Orleans gives patrons lollipops as it introduces smoking ban.”
Six months ago, there weren’t many who thought this could happen, that the city council of New Orleans would pass, and the mayor would sign …
What we can learn from a smoking ban in New Orleans
It was a Wednesday in late spring, 1972. I was a nursing student in my final months of training, eagerly awaiting graduation.
When I arrived on the maternity ward that morning, my nursing instructor told me that I’d be caring for a baby, only hours old, with special needs.
I thought she’d send me to the neonatal ICU. Instead, to my surprise, she motioned toward the linen closet, its doors closed tight.
“The …
Honoring the impact of even the smallest, briefest lives
One of the words we don’t use anymore is cretin; it’s long been a derogatory slur rather than a precise description of something. But a century ago cretinism actually meant a specific thing: a person, generally a child, who was severely damaged by a lack of thyroid hormone during early development, particularly fetal development. Now we call the condition congenital hypothyroidism. A few cases still exist, which is why we …
Eliminating hypothyroidism from iodine deficiency
I suffered from extreme nausea during my pregnancy; I had triplets, and I’m pretty sure I had a triple dose. I never threw up, but you know how your mouth salivates the moment right before you vomit, that sensation that sends you running to the bathroom? I had that. All. Day. Long. For four weeks.
By day four or five I was …
She took Zofran and her son had a heart defect. Here’s why she’s not suing.
The patient was a young looking 74-year-old woman, accompanied by her husband. She was not exactly sure why she was seeing me and nodded as I explained that I see all women with anal or rectal cancer who are being treated with radiation therapy. I explained that we recommend that these patients use vaginal dilators to improve elasticity after …
How do you know if cancer treatment worked?
In my work as a bioethicist, I have very rarely taken an “absolutist” position regarding the use of a biomedical technology. But when I read an article titled “Chinese Scientists Edit Genes of Human Embryos, Raising Concerns,” my reaction was that this should not be done. I am not alone.
The technique mentioned enables genes to be altered in every cell …
Editing the genes of human embryos: A line that should not be crossed
Each year children ingest an array of foreign bodies including coins, magnets, and a new subset of batteries known as button batteries. Awareness of this small yet very dangerous foreign body is important for parents to understand so they can act quickly if their child is suspected of ingestion.
What is a button battery?
A button battery is a cylindrically shaped object measuring …
So your child swallowed a button battery. Here’s what you need to know.
For many women, pregnancy is a wonderful experience. There are, however, many changes and challenges the mom-to-be can expect, and back pain is one of them. The good news for pregnant women is that the development of severe or debilitating low back pain is very rare.
The incidence of symptomatic low back pain that is severe is about 1 to 2 percent. …
Back pain during pregnancy: Advice from a neurosurgeon
With the flurry of Twitter posts about Maureen Dowd’s article “Stroke of Fate” in the New York Times, it almost seems as if the subject is already stale.
Maureen Dowd is the Pulitzer Prize-winning op-ed columnist for the New York Times who tells a compelling story about a young patient who suffered from a stroke. The patient was …
An emergency physician defends the profession from the New York Times
Can beliefs make you fat?
The answer to this question might seem pretty obvious. If I believe that the best way to lose weight is to super-size five meals a day at McDonald’s, while consuming bags of Doritos to tide me over between meals, that belief is probably going to make me fat. If I believe that the best way to get in shape is to watch other people exercise, I’m …
A belief in exercise can become dangerous
About 17 years ago, Jeff Taylor, an AIDS advocate, became worried he might have anal cancer. Through his work, Taylor knew that anal cancer rates had risen steeply among people with HIV. He was having discomfort, and he knew that there was a simple screening test: a swab that is processed just like a routine Pap smear.
His doctor knew about the …
Anal health should become a routine conversation topic between doctors and patients
Patients are gradually becoming more aware of the value of second opinions on their pathology slides. When there is a significant change in the diagnosis, the decision to get a second opinion can be life altering and even life-saving. A recent example is the case of Rita Wilson, where the self-initiated second opinion of her breast biopsy resulted in a change in diagnosis from a non-invasive lesion to invasive …
Pathology second opinions can be valuable even with no change in diagnosis
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I walk into the neonatal intensive care unit (NICU) each morning and see as many as 15 tiny patients. Some born just a few weeks premature, but others born so early they could fit into the palm of my hand, weighing as little as a pound. And I can’t help but think that there should be better communication about how to reduce the risk of preterm labor. Even if we …
There’s hope for preterm births: Why aren’t more patients getting the message?
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 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?
On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …
MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue
The medical field, more so than many other professional arenas, is continuously struggling to balance the concepts of increasing quality metrics, decreasing overall expenditure, and riding the crest of the current technological and scientific expansion wave. Within the past half century, our profession has borne witness to an explosion of advancement, and with this has come a contemporaneous increase in both the need for sub-specialization and, bluntly, the associated cost of …
Dense breast tissue: What is the role for additional screening?
I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.
He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he …
A rare case in a rural doctor’s office
A variety of factors contributes to the challenge. First, even in this era, in which autism is a household word, it is not unusual for me to give the diagnosis to parents who have not considered the possibility that their child has autism. Statistically speaking, the children we see at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center for these initial evaluations are very young — on average, 24 months …
After an autism diagnosis: A new parental role
I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have …
Resistant hypertension? Or failure to take blood pressure correctly?
“Good morning baby,” she said to me each morning I when I came into her room.
Ms. K was an educated woman in her early 50s with three children. She loved drinking tea in the morning. She also had a very advanced case of lobular carcinoma of the breast that had extended into her abdomen. A cluster of cancer cells was obstructing her small intestine, causing her to have nausea, vomiting, …
Why code status should be modified
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