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.

Watchful waiting for prostate cancer: Implications of a new study

J. Leonard Lichtenfeld, MD

March 13, 2014

News reports covering a prostate cancer study recently in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to “watchful waiting” after they were diagnosed.

But guess what? There’s a critical fact that seemed to be missing in much of the coverage I saw. And that fact …

One physician’s story of weight loss

Robert Centor, MD

Conditions and Diseases

March 10, 2014

Having now lost more than 30 pounds, I am very close to declaring victory (maybe a few more pounds over the next few months). A colleague has asked me to write my tips as a handout for patients. This is a daunting task, but that has never stopped me!

The weight loss formula is simple and well known. Achieving lasting weight loss remains challenging. The mathematical formula is simple. Weight loss …

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One physician’s story of weight loss

Let’s do something about teen stress

Claire McCarthy, MD

Conditions and Diseases

March 10, 2014

Adults are the ones who are supposed to be stressed, not kids. Childhood is supposed to be the stress-free part of life, right?

Well, maybe not. At least not for teens.

According to a recently released survey from the American Psychological Association, teens are actually more stressed than their parents.

Researchers surveyed 1950 adults and 1,018 teens last summer and asked them a whole bunch of questions about the stress in their lives, and how …

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Let’s do something about teen stress

Daylight saving time means different things to different folks

Donald Bucklin, MD

Conditions and Diseases

March 8, 2014

Daylight saving time is approaching again. At first glance, it might seem enough to just remember to spring forward. But do you realize daylight saving time is one of the grandest social engineering experiments in America?

Almost the entire country moves their schedule up one hour. Every meeting, romantic dinner, and heart transplant occurs one hour later. Every business, court appointment and movie showing is one hour later. In virtual lockstep, …

Well-being of a population is both measurable and consequential

Brita Roy, MD, MPH, Carley Riley, MD, MPP, and Cary Gross, MD

Conditions and Diseases

March 8, 2014

As a nation, we are constantly monitoring and appraising the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each …

MKSAP: 43-year-old man with severe abdominal pain

mksap

Conditions and Diseases

March 8, 2014

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

A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days’ duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish …

Has the tide really turned against childhood obesity?

David L. Katz, MD

Conditions and Diseases

March 7, 2014

The media headlines attached to the major medical news story of the past week might have been: “Shocking but true: Nearly 1 in 10 US children under the age of 5 is obese!” Had that been the headline, it would indeed have been every bit as true as it is shocking. And the really shocking part is: that’s the good news! Hold that thought, please.

Some years ago, at the prompting …

The failure of vaccine messages

Roy Benaroch, MD

Conditions and Diseases

March 7, 2014

Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease.

Yet: there are still pockets of intense resistance …

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The failure of vaccine messages

The risks of treating high blood pressure in the elderly

Leslie Kernisan, MD, MPH

Conditions and Diseases

March 6, 2014

When it comes to high blood pressure treatment in the elderly, the plot continues to thicken.

Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+.

And now this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication …

Treating a symptom is not the same as treating a disease

Michael Kirsch, MD

Conditions and Diseases

March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

The sixth sense of an experienced clinician

Lucy Hornstein, MD

Conditions and Diseases

March 5, 2014

I just didn’t like the looks of him.

It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in …

The costs of care was far beyond her means

Monica Williams-Murphy, MD

Conditions and Diseases

March 5, 2014

Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer …

ADHD and the value of uncertainty

Claudia M. Gold, MD

Conditions and Diseases

March 4, 2014

A recent article in the New Republic, provocatively titled “ADHD Does Not Exist,” starts out well enough. The author, a psychiatrist with “over 50 years experience” points to the fact that ADHD describes a collection of symptoms, rather than their underlying cause. Using stimulants to control these symptoms, he argues, is analogous to prescribing pain medication for cardiac chest pain rather than addressing the underlying circulatory problem.

But my …

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ADHD and the value of uncertainty

The benefits of screening mammography have been greatly exaggerated

Charles Wright, MD

Conditions and Diseases

March 4, 2014

When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease. It seemed obvious that the earlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body. A huge amount of research evidence since then has slowly and painfully led to a …

Get rid of the cancer first before considering breast reconstruction

Miranda Fielding, MD

Conditions and Diseases

March 2, 2014

When it comes to surgery for cancer, having a “positive margin” is a bad thing. It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t. For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy. For a woman who has just had a …

Why we need to break the silence on eating disorders

Andrew Boozary, MD, MPP

Conditions and Diseases

March 2, 2014

Over the course of medical school, you are expected to get comfortable with a whole host of expensive-sounding equipment (see: popsicle stick becomes tongue depressor).

You sling a stethoscope around your neck, maybe tuck a reflex hammer in your white coat pocket, and begin that privileged journey of looking for things that don’t sound or sit quite right.

You learn rather quickly that it won’t be you on stage, and somehow, you landed …

8 myths about painful breastfeeding

Bobby Ghaheri, MD

Conditions and Diseases

March 2, 2014

In this post, I will do my best to try and address what is commonly said by doctors, dentists and lactation consultants who don’t understand the correlation between tongue-tie and lip-tie and poor breastfeeding. I think that we must first disprove what they think they know. I think these myths are born out of a complete lack of education, and with time, hopefully we won’t hear them as frequently.

I’ve compiled a list …

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8 myths about painful breastfeeding

The conspiracy of cancer prognosis

Rick Boulay, MD

Conditions and Diseases

March 1, 2014

It should be easy, right? I mean, I am a professional with what feels like eons of training. So how can an oncologist with years of experience fail at perhaps the most important question a patient can ask, ”How long do I have, Doc?”

It’s not that I want to avoid the question. Well, okay, sometimes I do. It’s not the most pleasant of conversations to have. But really, I don’t …

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The conspiracy of cancer prognosis

How we doubled colorectal cancer screening rates

Theodore R. Levin, MD

Conditions and Diseases

March 1, 2014

March is colorectal cancer (CRC) awareness month, so it’s an appropriate time to reflect on how to increase the number of people who get screened for this cancer that’s largely preventable through screening. Between 2005 and 2012, Kaiser Permanente, Northern California, doubled the percentage of our eligible patients who were screened for CRC.

So how did we do it?

We employ a combined screening model with fecal immunochemical test (FIT) outreach and …

Tips on getting your picky eater to eat

Natasha Burgert, MD

Conditions and Diseases

February 28, 2014

CNN recently released a report on picky eaters. This short piece featured the family of a picky pre-schooler, Harper O’Bamsawin. The brave O’Bamsawin family opened their house to the world, seeking solutions to improve their dinner table experience. The result, however, was an expose of common problems left unsolved.

As the camera revealed a typical meal in Harper’s home, it quickly became clear that Harper’s parents have fallen into …

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Tips on getting your picky eater to eat