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.

Address the racial disparity of colorectal cancer

J. Leonard Lichtenfeld, MD

June 5, 2014

An article published recently in the American Cancer Society journal CA: A Journal for Clinicians received a lot of media attention. The report showed dramatic declines in the rate of people being diagnosed with colorectal cancer, as well as decreases in the rates of colorectal cancer deaths over the past number of years.

But the press didn’t say much about the fact that not everyone has benefited …

The military is off-track when dealing with mental health problems

Allen Frances, MD

Conditions and Diseases

June 4, 2014

The headline reads, “Study: Mental illness rate higher in soldiers.”

The article goes on to offer alarming statistics:

The rate of major depression is five times as high among soldiers as civilians; intermittent explosive disorder, which results in episodes of extreme anger, is six times as high; and post-traumatic stress disorder was nearly 15 times higher than among civilians, the study found.

This would be pretty scary if true — but …

A physician’s guide to interpreting cancer statistics

Kenneth Lin, MD

Conditions and Diseases

June 2, 2014

I’ve had many Twitter conversations with cancer screening advocates who fear that the U.S. Preventive Services Task Force’s “D” (don’t do it) recommendation against PSA-based screening for prostate cancer will lead to a dramatic spike in prostate cancer deaths as primary care physicians screen more selectively, or perhaps stop screening at all.

I seriously doubt these apocalyptic forecasts (for one thing, prostate cancer causes only 3% of deaths in men, and the decline …

Esophageal cancer: How far should we screen?

Julian A. Abrams, MD

Conditions and Diseases

June 1, 2014

The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally …

MKSAP: 51-year-old woman with diarrhea and bloating

mksap

Conditions and Diseases

May 31, 2014

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

A 51-year-old woman is evaluated for a 6-month history of diarrhea and bloating. She reports four to six loose stools per day, with occasional nocturnal stools. She has had a few episodes of incontinence secondary to urgency. She has not had melena or hematochezia but notes an occasional oily appearance to the …

Pediatric screening tests: You can’t have it both ways

Roy Benaroch, MD

Conditions and Diseases

May 28, 2014

In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health.

Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A …

How do we fix the high blood pressure problem?

Robert Pearl, MD

Conditions and Diseases

May 28, 2014

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are …

Power morcellation: Answers to your safety questions

Jennifer Gunter, MD

Conditions and Diseases

May 28, 2014

The Food and Drug Administration (FDA) recently released a statement about power morcellation during hysterectomy and myomectomy (surgery to remove uterine fibroids), raising concerns about these devices spreading unanticipated cancers. There have been several reports in the literature and the press alike of this happening and when it does it significantly worsens the prognosis. The American Congress of Obstetrician and Gynecologists (ACOG) is now re-exploring this issue. Pending a full review the FDA …

Curing hepatitis C, but at what cost?

Albert Fuchs, MD

Conditions and Diseases

May 27, 2014

In the contest to get a creative name, few pathogens have done worse than hepatitis C. In the 1970s there were two known viruses that caused hepatitis: liver inflammation. You might have already guessed that these two viruses were called hepatitis A and hepatitis B. It was known at that time that people sometimes developed hepatitis after blood transfusions and that the majority of those patients tested negative for hepatitis …

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Curing hepatitis C, but at what cost?

When should we test for celiac disease?

Sophie M. Balzora, MD

Conditions and Diseases

May 26, 2014

May marks Celiac Disease Awareness Month, with the goals of raising awareness of the disease and its potential health complications, and also to help elucidate which patients warrant diagnostic testing for the disease.

A few days ago on Twitter, I noticed that #glutenfree was trending (again). It is fascinating to observe how gluten-free businesses are beyond booming as diseases and conditions such as celiac disease, wheat allergy, and non-celiac gluten intolerance …

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When should we test for celiac disease?

The depressed may appear like you and me

Afshine Ash Emrani, MD

Conditions and Diseases

May 25, 2014

I received a panic call from Jim, who had been a patient for over ten years. His 5-year-old daughter had passed out. Amanda was rushed to the ICU for new onset diabetes. After stabilization, she was transferred by helicopter to a university hospital for an insulin pump insertion. He knew that her life, his life, would never be the same.

Two weeks later, I received another call from Jim. This time, …

MKSAP: 32-year-old woman is evaluated for increased hair growth

mksap

Conditions and Diseases

May 24, 2014

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

A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a 5-year history of hypothyroidism. Her only medication is levothyroxine.

On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/72 mm Hg, and pulse rate is 80/min; …

Integrating genomics in your office

Katherine Sutherland, MD

Conditions and Diseases

May 22, 2014

DNA Day came and went this past April. On this date in 1953, the work of James Watson and Francis Crick (and, though she doesn’t appear as an author, Rosalind Franklin) describing the structure of DNA was published. The paper, published in Nature, connected a string of dots that stretched back a century, to Gregor Mendel’s work describing the heredity of peas.

That string of dots (or peas, as the case may …

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Integrating genomics in your office

Is this the end of rheumatology as we know it?

Jonathan S. Hausmann, MD

Conditions and Diseases

May 21, 2014

Recently, an international research team led by Xavier Rodó published a fascinating study in PNAS suggesting that Kawasaki disease is caused by an agent transported by wind from farms in Northeast China. This agent, possibly a fungal toxin, is responsible for triggering an exuberant immune response in children, causing the typical manifestation of the disease: fevers, rash, conjunctivitis, “strawberry tongue,” enlarged lymph nodes, and swelling of the extremities. Untreated, Kawasaki disease can cause aneurysms of the …

Can appendicitis be managed without surgery?

Skeptical Scalpel, MD

Conditions and Diseases

May 20, 2014

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery.

The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients.

Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis …

Having an epidural doesn’t mean you’re any less of a mom

Jennifer Gunter, MD

Conditions and Diseases

May 19, 2014

Reports that Mila Kunis, the actress, plans on a “natural” delivery is all over the Internet. As a celebrity she is clearly a medical expert and somehow it is relevant to hear how an actress with no financial concerns, doesn’t need to work on her feet until she goes into labor, has a BMI of 19 (OK, that’s a guess) who has never delivered before is planning to have her …

You can never be prepared for a diagnosis of breast cancer

Madhulika Sikka

Conditions and Diseases

May 18, 2014

An excerpt from A Breast Cancer Alphabet.

There is a hushed reverence in the waiting area outside the Oval Office. After all those years of The West Wing, one might think there would be a bustle of activity — a swirl of smart, earnest people walking and talking at the same time. Perhaps I would …

Before treating physical pain, address the emotional one

David Hanscom, MD

Conditions and Diseases

May 17, 2014

The patient was a 78-year-old businessman who acted and looked about half his age. He was very pleasant and talked freely about his lower back pain and the pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe when he stood or walked on it, and it immediately disappeared when he sat down. His MRI scan revealed that …

MKSAP: 64-year-old man with a rapidly spreading rash

mksap

Conditions and Diseases

May 17, 2014

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

A 64-year-old man is evaluated in the emergency department for a rash that first developed 3 days ago and has rapidly spread to cover most of his body. His skin is painful. He has a history of mild psoriasis and asthma. His psoriasis has been well controlled with topical corticosteroids as needed. …

How do psychiatrists manage clinical uncertainty?

Steven Reidbord, MD

Conditions and Diseases

May 16, 2014

Lucia Sommers of the department of family and community medicine at the University of California, San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best. She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry. Sommers and her co-author John Launer recently published a book that argues for managing clinical uncertainty in primary care using …

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