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.

MKSAP: 63-year-old man with pleuritic left-sided anterior chest pain

mksap

May 10, 2014

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

A 63-year-old man is evaluated for pleuritic left-sided anterior chest pain, which has persisted intermittently for 1 week. The pain lasts for hours at a time and is not provoked by exertion or relieved by rest but is worse when supine. He reports transient relief with acetaminophen and codeine and occasionally when …

Vaccines and public health: Can we have our cake and eat it too?

Jennifer Adaeze Anyaegbunam

Conditions and Diseases

May 8, 2014

Physicians today are challenged with the unique task of navigating the fundamental incompatibility between patient autonomy and the goals of public health. A few months ago, I faced that challenge when my elderly patient declined to receive the recommended influenza vaccine.

“I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact,” I reflected in a recent post. “It’s been quite a challenge …

Recognize and minimize the concussion damage from youth sports

Robert Pearl, MD

Conditions and Diseases

May 7, 2014

Concussion expert Dr. A. Chainey Umphrey has assessed the damage youth sports can inflict. He has seen it ruin lives.

It happens in one form or another every day: A high school senior leaps to head a soccer ball. She takes an elbow from an opposing player going for the same ball. Woozy, she shakes it off and stays in the game.

Six months later, her blistering headaches have subsided but she still experiences …

Salt in our diet: The impact of recent studies

David L. Katz, MD

Conditions and Diseases

May 6, 2014

We have long had abundant reason to believe that most of us living in the modern world consume too much sodium and would benefit from consuming less. But whether the topic is salt, or saturated fat, or calories, or even the health effects of consuming vegetables and fruits — saltation (the jumping from one position to another) seems to be the prevailing inclination in modern nutrition. Certainly it …

The uncertainty of monitoring prostate cancer post-prostatectomy

Miranda Fielding, MD

Conditions and Diseases

May 6, 2014

Heisenberg uncertainty principle: A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known.

Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not Breaking …

Despite positive trends, diabetes care has a long way to go

Albert Fuchs, MD

Conditions and Diseases

May 6, 2014

The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leading cause of kidney failure and of blindness in adults.

A study performed by researchers at the …

Responding to cancer as the surgeon or the survivor

Carol Scott-Conner, MD, PhD

Conditions and Diseases

May 6, 2014

“The plastic surgeons tell me that women who like to swim do much better with reconstruction than with prostheses,” says a young breast surgeon at our weekly breast cancer tumor board, the working conference where we discuss every new breast cancer patient before starting treatment.

There’s a slight note of surprise in her voice; to her, it’s simply another consideration when advising women before mastectomy.

For decades, the only option after a …

A dose of reality on the dietary fat issue

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

May 2, 2014

With the Mediterranean diet all the rage, not only because consumers like its tasty composition but because of research touting its health benefits, experts have had to become more specific about recommendations for fats.

There’s a steady drumbeat these days — from everyone from chefs to food writers to health gurus — criticizing nutritionists and the “diet police,” who, they claim, …

Dealing with all the behavioral conditions of unknown etiology

Steven Reidbord, MD

Conditions and Diseases

May 1, 2014

A few years ago I wrote that uncertainty is inevitable in psychiatry. We literally don’t know the pathogenesis of any psychiatric disorder. Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric. Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric conditions went to neurology; brain tumors and hemorrhages went to neurosurgery; and so forth.

This leaves psychiatry …

A patient’s role in ensuring high quality colonoscopy

Douglas K. Rex, MD

Conditions and Diseases

April 29, 2014

The American Cancer Society recently released important new data showing that the rate at which people are diagnosed with colon cancer in the U.S. has dropped 30% in the last ten years for those aged 50 and older. Much of this decline was attributed to the widespread uptake of colonoscopy screening. Colonoscopy is the only screening test that examines the entire colon and allows removal of precancerous polyps in the …

No, bras do not cause breast cancer

Jennifer Gunter, MD

Conditions and Diseases

April 29, 2014

The myth that bras cause breast cancer is apparently coming ‘round the barn again. The latest scare-you-out-of-your-brassiere “article” claims there are “five research studies” that show a strong correlation between bra wearing and breast cancer. Well, that certainly sounds all scientific.

Why the bra hullabaloo? A couple of anthropologists wrote a whole book about their incorrect theory back in 1995, Dressed to kill: The link between breast cancer and bras. …

Read more…

No, bras do not cause breast cancer

Kids in foster care end up on antipsychotic medication for ADHD

Claudia M. Gold, MD

Conditions and Diseases

April 25, 2014

A recent study, one that received relatively scant media attention (compared with a concurrent New York Times piece about a new psychiatric diagnosis termed “sluggish cognitive tempo” that may be the “new ADHD”) showed that antipsychotics are being prescribed to nearly one third of kids (age 2-17) in foster care who are diagnosed with attention deficit hyperactivity disorder (ADHD).

This disturbing statistic brought to mind a common complaint I hear from parents …

Should BMI be used to measure obesity in children?

Roy Benaroch, MD

Conditions and Diseases

April 25, 2014

Stephanie wrote in about a very common problem:

My daughter is 4 years old. She isn’t the tallest cat in town (she is about the 15th-25th percentile for height), and her BMI always ends up being in the high range (like over 85%). I worry about it. I am very health conscious for myself and my family. We live by all of the “rules.” And yet.

The family doctor doesn’t worry — …

Read more…

Should BMI be used to measure obesity in children?

Why is hepatitis C underreported?

Kristina R. Chacko, MD

Conditions and Diseases

April 25, 2014

Hepatitis C virus (HCV) continues to be the number one cause of cirrhosis and liver cancer and the primary indicator for liver transplantation in the United States, yet it remains vastly underdiagnosed.

More than three million people in the U.S. are infected. Guidelines support widespread screening for HCV, and excellent treatments are now available.

So the question remains: Why is HCV underreported?

When “good” news disguises bad

A recently published Read more…

Why is hepatitis C underreported?

Sluggish cognitive tempo is a dangerous diagnostic idea

Allen Frances, MD

Conditions and Diseases

April 23, 2014

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced by extensive drug company affiliations — and always ungoverned by simple common sense, a respect for …

7 steps to eliminating the war analogy in cancer care

Matthew Katz, MD

Conditions and Diseases

April 22, 2014

From a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. Why …

Measles and the media: Are parents are being duped?

Wendy Sue Swanson, MD

Conditions and Diseases

April 21, 2014

Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell.

My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, …

It’s about mental health, not mental illness

Jeff Rubin, EdD

Conditions and Diseases

April 20, 2014

In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve. Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but — in general — we still have a long way to go in our attitudes toward mental illness.

I think it’s …

Can one have a voice without vocal cords?

James P. Thomas, MD

Conditions and Diseases

April 20, 2014

I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her …

MKSAP: 76-year-old woman with left knee pain

mksap

Conditions and Diseases

April 19, 2014

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

A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …

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