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.

Don’t give life to the killers of yesteryear

Emily Gibson, MD

February 11, 2015

Disneyland is in the news, and not because it is the most magical place on earth. It also is the origin of the most recent rubeola measles outbreak, now spread to seven states and Mexico with over eighty cases diagnosed so far. Unvaccinated children are being kept home from school in some California districts and vaccination requirements once again have become a battleground between public health agencies and the “right …

Measles in Disneyland: How is the media reacting?

Roy Benaroch, MD

Conditions and Diseases

February 11, 2015

This past Christmas holiday, an as-yet-unidentified “index case” — the first person to start an epidemic — visited Disneyland in California. Five employees became infected, along with dozens of visitors to the park. Since then, the outbreak has spread to about 80 people, including people who’ve caught it not directly from visiting Disney, but by coming in contact with Disney cases. These “secondary” cases will soon lead to “tertiary” cases …

What does a pain physician think about the movie, Cake?

James Patrick Murphy, MD

Conditions and Diseases

February 10, 2015

I saw the movie Cake tonight. I felt it was my duty. I am, after all, a pain specialist.

I’d read that it was gritty, honest, and accurate, and that Jennifer Aniston was very convincing. I found all that to be true.

It’s the show’s first weekend in Louisville theatres, and the crowd at this 5:30 p.m. showing was decidedly mature, reverently attentive, and noticeably equipped with more walkers and canes than …

Sitting is a major health risk. But don’t panic.

David L. Katz, MD

Conditions and Diseases

February 8, 2015

The big medical news recently was that sitting hours a day is taking years from our lives, whether we exercise or not. We have heard similar things before, so the now reiterated message is: Yes, we are sitting on a major health risk. Sitting is the major health risk! The new study, a meta-analysis in the Annals of Internal Medicine, purportedly adds precision to the estimate of risk.

There …

The bacteria that almost killed my grandmother

Natalia Birgisson

Conditions and Diseases

February 8, 2015

“Hefur þú lært um Staphylococcus aureus?” I almost don’t recognize the bacteria name because my grandmother pronounces it differently in Icelandic.

“Já–” I’m about to translate my microbiology flashcard for her when she interrupts, her hands busy kneading the cookie dough and her eyes on my little sister near the oven.

That’s the bacteria that almost killed her eleven years ago, she tells me. I can hear her words building up. This …

MKSAP: 72-year-old man with dyspnea at rest

mksap

Conditions and Diseases

February 7, 2015

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

A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased …

Advances in hepatitis C treatment. Why aren’t they being used?

Nezam H. Afdhal, MD

Conditions and Diseases

February 7, 2015

The really incredible advances in the treatment of hepatitis C bring to life several relevant questions as we move forward into 2015. First, who should be treating hepatitis C patients (primary care providers, gastroenterologists, infectious disease specialists)? Second, can we really afford to use these new treatments? I recently discussed this topic with my GI and hepatology colleagues in AGA Perspectives, the bi-monthly opinion magazine of the American …

A doctor’s first-hand account of the flu

Mike Sevilla, MD

Conditions and Diseases

February 3, 2015

Even I am not immune to influenza. In Northeastern Ohio, there have been more hospitalizations and school closings this year from influenza. And, let me tell you, as a family physician who also sees patients in the hospital and the office, we have seen a lot more respiratory illnesses versus last year.

No, I’m not one of those Dr. Oz hypocrites who skip the influenza vaccine. …

Psychiatry is devalued: And patients suffer because of it

Natalie Wilcox

Conditions and Diseases

February 1, 2015

This past week I spoke with a patient who noted that since his wife’s death six months ago, he had lost 40 pounds, slept a maximum of four hours nightly, and stopped enjoying activities he used to take pleasure in. He found it difficult to concentrate at work, and getting out of bed each morning was described as his greatest struggle. While relaying this story, the man was on the …

Pathology plays a central role in the era of personalized medicine

Michael Misialek, MD

Conditions and Diseases

January 31, 2015

As a pathologist, I recognize the importance of every diagnosis. Behind each slide is a patient, a family, a network of family and friends. A string of dominoes that is set into motion with my diagnosis. All treatment begins with a diagnosis. Each day I make these diagnoses, but on holidays, it takes on even more meaning. As the rest of the world is celebrating the season, coming together, medicine …

Children with developmental disabilities and the guilt parents feel

Lisa Shulman, MD

Conditions and Diseases

January 30, 2015

Recently, at a holiday meal with my extended family, it came to light that neither of my typically developing teenage children really knows how to tie his or her shoes. It seems that for the past decade or so, both have been using the “bunny ears” technique introduced to preschoolers for tying their shoes. My children appear never to have moved on from there to the mature “around the tree” …

Kids need more sleep and later school start times

Marvin Wang, MD

Conditions and Diseases

January 30, 2015

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Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m.

The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep.

The timing of the AAP’s …

Inactivity kills more than obesity: Let’s go beyond the headline

David L. Katz, MD

Conditions and Diseases

January 29, 2015

A new study about physical activity, obesity, and mortality has been propagating so many headlines and so much commentary, it’s pretty much a given that if you are seeing this, you have seen something like: “Inactivity kills more than obesity.”

As is generally true in such cases, few of the people opining about the study seem to have actually read it. I suppose that’s understandable — once you get to particulars …

Stop with the curbside consultations. They don’t help anyone.

Miranda Fielding, MD

Conditions and Diseases

January 29, 2015

Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast. She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer. This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast …

Let’s be judicious in our use of surfactant

Danielle Moriates, RN

Conditions and Diseases

January 29, 2015

When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive …

How much testing should you do in chronic abdominal pain?

Michael Kirsch, MD

Conditions and Diseases

January 26, 2015

I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal …

Stop yelling at your kids. Here’s how to do it.

Claire McCarthy, MD

Conditions and Diseases

January 24, 2015

Everyone yells at their kids. Oh, I’m sure there are some truly perfect parents out there who don’t (and some who don’t because they are physically unable to yell), but the rest of us do. Parents are human; we all get frustrated, angry, exhausted and scared and, well, yell.

But yelling rarely helps. It usually makes things worse. And it makes us …

What do you value most at the end of life?

Anne Katz, RN, PhD

Conditions and Diseases

January 24, 2015

A friend of mine died after outliving her prognosis for more than a year. I was with her at almost all her appointments with various oncologists. She had asked me to be the note taker for these appointments so that she could focus on the discussion as it happened and then have the notes to review afterwards.

Her treatment course was …

MKSAP: 25-year-old woman comes for a preconception evaluation

mksap

Conditions and Diseases

January 24, 2015

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

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …

3 amazing medical advances that haven’t caught on

Ilana Yurkiewicz

Conditions and Diseases

January 23, 2015

The life cycle of a medical advance usually goes something like this: from discovery at the research bench and replication of findings to translational research and clinical trials, to implementation. The bottleneck can be at any one of these stages, and often it is in the discovery one; we just haven’t yet found the thing that works.

But other times, we have — the intervention works, we have shown and confirmed …