Before the Internet age, people with excessive and irrational worries about their health (we called them “hypochondriacs”) went to their doctors for reassurance. Today these patients still schedule appointment — often with exasperating frequency — with their primary care physicians when they’re concerned about an unusual lump or vague symptom. But most likely they’ll have first consulted WebMD or the Mayo Clinic website and come up with a differential diagnosis of their …
Although I never disclosed this in my medical school interviews for fear of being just another cliche (“Hollywood sparks interest in medicine story”), I decided to become a doctor in 1997 at the age of 11 when I first saw the movie, Outbreak. For years and years, this was my favorite movie. The scene where they showed the electron micrograph image of the Ebola virus had me captivated. I was staring at …
Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition.
Pardee UNC Health Care is implementing a new nursing protocol that puts nutrition at the center of the care team and the locus for reducing readmissions, pressure ulcers and lengths of stay.
Pardee’s efforts come as more and more studies document the seriousness …
A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The …
If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place.
What might be their unique insights? What will be their prescriptions?
One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil …
Did you know that your digestive tract contains over 400 different types of bacteria? This complex ecosystem is called intestinal microflora. The concentration of bacteria in the gastrointestinal tract increases dramatically moving from the stomach towards the colon. In humans, the intestinal microflora is vital in many important functions including digestion of nutrients and prevention of infection. Disruption of the “normal flora” can lead to many problems including diarrhea, bloating, …
Turn on the television, and you will see the headlines. “Ebola in America.” Or, “Hospital worker who handled Ebola is on cruise.” And then there is the “Ebola fears prompt parents to keep children home from school.” The headlines go on.
Go onto Facebook or Twitter, and you will see Ebola as the most viewed article, or the most tweeted topic. Ebola is everywhere.
A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed …
Being a nurse is a risky job. Needle-stick injuries, violence, back injuries, and infectious disease are all potential threats. But until recently, nursing was not usually viewed, like police work, or commercial fishing, as a life-endangering career choice. Those who risk their lives for their work go into it knowing the risks, and receive intensive training and protective gear.
I wish Dr. Nancy Snyderman the best of health. I’m happy that she remains free from the deadly Ebola virus, and hopefully it will stay that way.
It must have been extremely difficult for her to be under quarantine, especially since she was feeling healthy. It’s simple: When you feel good, you want to be active. In Dr. Snyderman’s case, she …
With all the news about enterovirus 68 sending hundreds of children to hospitals, it’s easy to panic when you hear about a case in your neighborhood — or, even worse, if your child starts coughing.
But please, don’t panic.
This virus has certainly caused trouble and tragedy. But enteroviruses are incredibly common, causing 10-15 million illnesses a year — and usually, those illnesses are minor. This one, for reasons we don’t fully understand, is …
Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.
When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …
Josh Green’s novel — and recent film — The Fault In Our Stars (TFIOS) is a new classic of young adult fiction, deservedly famous, and it’s easy to see why. The story is simultaneously deeply sad and really funny, mostly due to the narrator, Hazel. She is an intensely likable 16-year-old, who charms you even while she explains, stoically, that she is dying of thyroid cancer that has spread to …
A 30-year-old woman is evaluated for episodic migraine without aura that first presented in high school and has persisted into the third trimester of her current pregnancy. The headache attacks occur two to four times monthly and last 12 to 24 hours. She experiences moderately severe pain, significant nausea, no vomiting, and …
The evolution of our species has been powered and guided by a survival advantage. Our unique adaptation for survival lies in the development of a brain that can plan, worry, and abstract. Perhaps the most …
I did not think I would ever quote Donald Rumsfeld in one of my blog posts, but some of the missed opportunities as well as the media and public panic surrounding the Ebola epidemic in West Africa have brought this quote to the forefront of my mind this past week.
First, let me share my personal view of the Ebola crisis in …
The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived …
This weekend the kids and I had our influenza immunizations.
There is always a difficult lead up as Oliver has severe anxiety around every medical procedure. An EKG (painless heart rhythm test) and a throat swab cause extreme fear and often tears and anything with a needle, well, let’s just say that’s on a whole different level of terror and emotional pain.
I remind myself that his anxiety is a normal response …
Last week, after dinner, as I was rinsing the dishes, I casually mentioned to my wife, “I spoke with the volunteers at Doctors Without Borders today, and they need help.”
This was before the first case of Ebola was diagnosed on U.S. soil. A pregnant silence fell in the kitchen except for the clattering of dishes and the boiling of water as …
Happy BRA Day! October 15 is officially Breast Cancer Reconstruction Awareness Day. It’s a natural time to discuss commonly-asked questions about breast reconstructive surgery.
Breast cancer is a devastating diagnosis and the treatment tends to have a direct impact on a woman’s self-esteem, especially if there has been a mastectomy or partial mastectomy. Just knowing breast reconstruction is an option is consoling; it offers hope for many patients. Yet physicians and …
