From the beginning, there were so many signs that my cancer didn’t have a chance.
First, there was the rock-hard lymph node above my collarbone that disappeared with one night of steroids, even before I started chemotherapy.
Then, there was the chest x-ray done only a few days after starting my first round of chemo. It’s not pretty, and you can see that the …
My cancer has been knocked into oblivion
The recent tragedy of Jahi McMath, the 13-year-old girl who died following complications of tonsillectomy and adenoidectomy, has focused many people on the question of brain death. Although I have no more details about this case than anyone else reading the news, I am quite familiar with the sort of things that happened to this unfortunate child. As many of you know, her family does not believe she …
Analyzing the Jahi McMath case
The day after the temperature dipped from 60 degrees to 25 degrees, I mistakenly left for work without a winter jacket. Rushing 50 yards to the hospital doors with my arms clung to my chest in the blistering cold, my tie flew over my shoulders, my teeth chattered, and my fingers went numb.
That evening I began to sniffle. The next morning I had a sore throat, and the following day …
Do cold temperatures cause colds?
The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.
Fever is clearly not a parent’s …
5 truths about fevers in children
Imagine a teenager with a chronic disease causing frequent diarrhea, upset stomach, and hospitalizations. Her doctor explained that she had a chronic condition called inflammatory bowel disease (IBD) that she would have for the rest of her life. The fact that she has a chronic disease means that she will need to navigate a complex health care system that is expensive, has a lot of variation in the quality of …
Can texting help children with inflammatory bowel disease?
In 2002, two seminal papers were published simultaneously in the New England Journal of Medicine, demonstrating that therapeutic hypothermia for comatose patients could result in improved survival and improved neurological outcome after out-of-hospital cardiac arrest, which altered the course of ICU history.
One after another, ICUs across the United States and around the world adopted protocols for rapidly achieving and …
Therapeutic temperature management takes a step up
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 33-year-old woman is evaluated for a 5-month history of amenorrhea and a 3-month history of galactorrhea. The patient says her menstrual cycles were normal before onset of amenorrhea. She takes no medication.
On physical examination, vital signs are normal. Visual field findings are normal. Bilateral galactorrhea is noted.
Results of laboratory studies show …
MKSAP: 33-year-old woman with amenorrhea and galactorrhea
A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn’t think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission.
And there she sits …
Options for the injured older adult in the emergency room
When it comes to the parts of parenthood that people dread, well, there’s so much to choose from. There are poopy diapers. Vomit. Tantrums. Nasty teenagers. But all of that pales in comparison with … The Talk.
The talk about sex, that is.
Nobody wants to talk to their kids about sex. Nobody wants to think about their kids having sex — the same way nobody likes to think about their parents …
6 tips for talking to your kids about sex
Cardiovascular disease — including coronary atherosclerosis and cerebrovascular disease — remains the number one cause of mortality in the United States. One out of three people in this country will die of cardiovascular causes. Although I can’t say that the other top causes of mortality are particularly attractive — cancer, chronic lung disease, accidents and dementia — premature cardiovascular death can certainly be very devastating and it makes sense to do …
Applying the new cholesterol guidelines to real life patients
A middle-aged obese female with a past medical history of diabetes and congestive heart failure is in cardiac arrest after several hours of immobility on an airplane. What is the cause of her condition?
If this were a USMLE exam, my thoughts would race to Virchow’s triad: stasis, endothelial injury, hypercoagulability. But this wasn’t an exam. This was a few rows behind me on an airplane.
I sat only …
An embolus in one but trauma in many at 30,000 feet
Would you tell me, please, which way I ought to go from here?
That depends a good deal on where you want to get to.
I don’t much care where –
Then it doesn’t matter which way you go.
– Lewis Carroll
In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials.
An instructive case is in the …
Why imaging industry should pay attention to clinical trials
‘Tis the season to be coughing …
It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.
Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …
Treating post-viral coughs: This too shall pass
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The four pedestrians never saw it coming.
Around 11:45 p.m on June 15, 2013 on a road in Burleson, Texas (a suburb of Fort Worth), the driver of a stranded SUV and three people who had stopped to help her change a flat tire were killed when 16-year-old Ethan Couch smashed into them with his red pickup truck. Seven other teens were in the truck with him. Drunk, and driving 70 …
Affluenza: How to be sick without being sick
Justin Bieber was arrested recently in Florida for a DUI. The smirk on his face is a bit misplaced. While it’s no longer a surprise when we hear about a celebrity’s challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean this kid (he’s 19-years-old) really could have killed himself last night. Thank goodness he’s …
Use Justin Bieber as a teaching moment for kids
It’s time again for bronchiolitis, which usually comes in winter through spring. In some ways this problem is similar to asthma, but in other important ways it is very different. With winter upon us it’s time to reacquaint ourselves with this common entity. There is a reliable seasonal arrival of the virus we call RSV, the chief cause of bronchiolitis. The letters stand for respiratory syncytial virus, a description of what …
Bronchiolitis and RSV: What you need to know
The doctor at the summer camp I attended as a kid believed that calamine lotion and time cured just about anything that ailed campers — and he was right. Time still heals most wounds, but patience is a tough sell to people whose visits to my office often involve taking off work or getting a babysitter, fighting traffic, and shelling out for parking and insurance co-pays.
After all that, time doesn’t …
When it comes to back pain, time is an underused treatment
Since prior to my entrance to medical school, common wisdom for treating sore throats involved the prevention of rheumatic fever. Since group A strep pharyngitis is the cause of most acute rheumatic fever, all efforts have focused on treating group A strep. Studies in the 1950s showed that penicillin treatment decreased the probability of patients developing rheumatic fever.
The prevailing theory in the 50s and 60s, that we should diagnose group …
A cognitive error when treating adolescent pharyngitis
I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.
According to the Centers for Disease Control and …
Refusing the flu shot: Respecting the patient’s right to choose
An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.
The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …
Mohs surgery is vilified, physicians again fail to respond effectively
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