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.

5 things internists should know about treating survivors of childhood cancer

Lisa Diller, MD

August 4, 2014

Recent research finds that many internists do not feel comfortable or prepared to care for survivors of childhood cancer. Although the rarity of childhood cancer may explain this, the fact remains that as more and more pediatric cancer patients survive into adulthood busy internists often have some survivors in their practices. These patients would have been treated during the last decades of the 20th century or the beginning of …

What if jet lag was infectious?

Alberto Hazan, MD

Conditions and Diseases

August 2, 2014

Jet lag, also known as desynchronosis or flight fatigue, is defined as “extreme tiredness and other physical effects felt by a person after a long flight across several time zones.” Besides insomnia, symptoms of jet lag include weakness, fatigue, dehydration, body aches, diarrhea, dizziness, headache, irritability, and memory loss. Jet lag is one of the circadian rhythm disorders; others include shift work disorder, sleep phase disorder, and irregular sleep-wake rhythm.

Symptoms …

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What if jet lag was infectious?

Are vasectomies a risk factor for prostate cancer?

Rajiv Singal, MD

Conditions and Diseases

August 2, 2014

Recently, I realized that patients coming to my office seeking vasectomies required an additional piece in their counseling. What led to this change? Earlier this month a study out of Harvard University suggested an association between vasectomy and lethal prostate cancer. Published in the Journal of Clinical Oncology, the researchers found that “men with a history of vasectomy had a 10% increased risk of prostate cancer, …

It’s time we stood up for the orphan of organs: the brain

Marilyn B. Benoit, MD

Conditions and Diseases

July 31, 2014

It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of …

Why we don’t usually give emergent radiation therapy

Miriam A. Knoll, MD

Conditions and Diseases

July 29, 2014

The first lecture in a radiation oncology residency program is “Radiation Oncology Emergencies,” to educate the new residents how to manage inpatient consultations and emergencies. While preparing my lecture this year, it occurred to me how useful this basic information would be to the physicians calling for the consultation. Sharing our thought process in triaging patient explains why we don’t rush to utilize radiation, even in cases of a cord …

MKSAP: 68-year-old woman with exertional leg discomfort

mksap

Conditions and Diseases

July 26, 2014

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

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

Here’s why you can’t resist eating that dessert

Peter Ubel, MD

Conditions and Diseases

July 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our …

A case that illustrates the way medicine is meant to be

Ira M. Pinnelas, MD

Conditions and Diseases

July 22, 2014

As most everyone knows, medicine is not an exact science. Every patient and every family must be treated individually. We all recognize that many things have the possibility of not going perfectly, especially when an ill child presents to the hospital. I am lucky enough to be a part of many families’ experiences at the hospital that go so well that you want to tell people about them.

Goodness knows, there …

We need to make eating real food a whole lot easier

Brad Stulberg

Conditions and Diseases

July 20, 2014

I want to commend Mark Bittman on the underlying message in his recent editorial in the New York Times, “What Causes Weight Gain.” Bittman suggests that as much as we need research to “determine precisely what causes diet related chronic illnesses,” we also need a program that will get this “single, simple message across: eat real food.” While we have yet to isolate what in our diet is …

MKSAP: 65-year-old woman with prodrome of pain on the tip of the nose

mksap

Conditions and Diseases

July 19, 2014

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

A 65-year-old woman is evaluated for a prodrome of pain on tip of the nose followed by a painful eruption involving the right periorbital tissue.

On physical examination, all vital signs are normal. There are grouped vesicles on an erythematous base on the tip of the nose and about the right eye.

Which of …

Water births aren’t safe. Here’s why.

Roy Benaroch, MD

Conditions and Diseases

July 18, 2014

You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air. You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their …

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Water births aren’t safe. Here’s why.

Stupidity is worse for us than either sugar or saturated fat

David L. Katz, MD

Conditions and Diseases

July 18, 2014

A recent meta-analysis by an accomplished international team of researchers, published in a prestigious medical journal, shows that high intake of saturated fat is exactly as bad for health as a high intake of sugar and refined starch. The study also suggests there is something far worse.

The study, which pooled data from prior research and in the process aggregated findings for over 500,000 people, compared the rates …

Vaccine denial: A case of toddler logic syndrome

Justin Morgan, MD

Conditions and Diseases

July 13, 2014

A couple of weeks ago, my family was traveling out of town. I was driving and my wife and almost 2-year-old daughter were buckled up in the back seat playing with some toys. My wife pulled out a brand new container of Play-Doh. As my daughter was preparing to pull the lid off to see what was inside, I drove through a section on the interstate where there was a …

Recognizing and treating self-injurious behaviors in teens

Susie Raskin, LMHC

Conditions and Diseases

July 11, 2014

“Is it weird that I cut myself on purpose?”

A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times.

They ask:

“What is it about?”

“Isn’t it just a way to get attention?”

“Why would someone do that?”

“Are they trying to kill themselves?”

It’s not only teens that ask about self-injury. I’ve …

Dense breasts on mammogram? Don’t be afraid.

Margaret Polaneczky, MD

Conditions and Diseases

July 10, 2014

Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: “A sentence in the fourth paragraph grabbed me by the throat. ‘Your breast tissue is dense.'”

I can’t really blame Rabin for being afraid. The information about breast density in …

Learning about human nature after a cancer diagnosis

Elana Miller, MD

Conditions and Diseases

July 10, 2014

Recently, in front of my family, friends, colleagues, and teachers, I accepted my diploma during the graduation ceremony for the UCLA psychiatry residency program.

While it wasn’t my real diploma — it’s been months since I’ve been able to work, so when I’m better I need to go back and finish some requirements — my residency program coordinator put together an awesome fake diploma so I would have something to pick …

With advanced cancer, there are no guarantees

Merry Jennifer Markham, MD

Conditions and Diseases

July 9, 2014

“I just want to know that she’ll be able to travel,” my patient’s husband said.

Stan and Jane Jackson (names changed) sat side-by-side on the mauve loveseat in the exam room. A binder filled with sheaths of paper — copies of Jane’s lab reports, CT scan reports, discharge papers, and chemotherapy information handouts — sat open on his lap. On top …

How to test for ADHD

Roy Benaroch, MD

Conditions and Diseases

July 9, 2014

I wrote recently about getting started with an evaluation for a child who’s not doing well in school. Don’t rush to just do ADHD testing: There are many reasons for attention problems, and it’s best to not just zero in on ADHD at the start.

Still, there’s a time when confirmation and testing for an ADHD diagnosis is appropriate. What kinds of tests are available?

A clinical history is, well, talking …

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How to test for ADHD

Radiation risk or timely diagnosis: What would parents choose?

Skeptical Scalpel, MD

Conditions and Diseases

July 8, 2014

It is so nice to be right.

To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they’ll get an accurate diagnosis.

A recent study validates that opinion.

MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries …

A rational approach to CT lung cancer screening

Kenneth Lin, MD

Conditions and Diseases

July 7, 2014

Recently, a family physician colleague asked me to explain why the Affordable Care Act requires private health insurers to provide first-dollar coverage for preventive services that the U.S. Preventive Services Task Force assigns an “A” or “B” (recommended) rating, but allows public insurers (Medicare and Medicaid) to determine if and how they will cover these services.

Until recently, the question hadn’t come up, since Medicare has agreed to cover pretty much every …