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.
When the American Academy of Pediatrics came out with new guidelines a couple of years ago extending the age of diagnosis of ADHD (attention deficit hyperactivity disorder) down to age 4, it seemed as if Pfizer might have been waiting in the wings. Soon after, a new preparation of ADHD medication in an oral suspension, for kids too young to swallow pills, became available.
I was a lone voice expressing opposition …
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Rising ADHD rates is a symptom of our broken health system
Lebron James makes over $19 million per year playing basketball for the Miami Heat. Not surprisingly, this salary is peanuts compared his endorsement earnings, which in 2012 topped $42 million. Although perhaps peanuts is the wrong word to use when discussing James outside earnings, which to my knowledge have not involved foods anywhere near as healthy as peanuts. Instead, according to …
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Lebron James: The king of junk food
Each time I reach the point of recommending radiation treatment for someone with a brain tumor or head and neck cancer, I ask for a higher level of trust from each patient than usual: let us make a mask to keep you safe.
Radiation therapy is already a leap of faith — who wants invisible rays shooting through them? Fear of unknown …
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Radiation therapy is a leap of faith
Henry Markram is one of the world’s leading neuroscientists. After a brilliant career of influential research, he has been charged with leading Europe’s Human Brain Project, a $1.3 billion project that aims to build a supercomputer model of the brain. But Markram is also the father of a boy with autism. And that has changed everything.
Maia Szalavitz’s poignant article The Boy Whose Brain Could Unlock Autism chronicles Markram’s personal and scientific …
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The intense world paradigm for understanding autism
I don’t have much in the way of eyebrows. They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back. There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often.
I was in there about a year ago when she told me, “I …
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The cost of peace of mind: A case of unneeded bilateral mastectomy
I have two patients with phenylketonuria (PKU). Both are about my age. Laura, a non-verbal, slender woman with weathered features but the mind of a very young child, lives in the community. Her sister, Regina, has lived all her life in a nursing home. She doesn’t have a wrinkle in her face, and seems mostly unaware of her surroundings.
The two girls were born several years before Dr. Robert Guthrie developed …
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2 patients who are part of the history of medicine
JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC-8) guidelines December 18, 2013. They recommended blood pressure lowering drug treatment for patients 60 years old and over with systolic blood pressure (SBP) 150 or higher or diastolic blood pressure (DBP) 90 mm Hg or higher. For patients under 60 years old, they recommended medications for DBP 90 mm Hg or …
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A call to retract the JNC-8 hypertension guidelines
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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MKSAP: 76-year-old woman with left knee pain
I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage …
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Holding children back a grade and ADHD: A problem or solution?
I’m not going to discuss the entire subject of cholesterol in this post, but one part of it: specifically, how to discuss with your doctor how much cholesterol should matter to you.
If you have read any health news recently, you know that the American College of Cardiology and the American Health Association issued new guidelines to help doctors advise patients about cholesterol medications. The new recommendations are accompanied by a …
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How to talk to your doctor about cholesterol
Ex-marines are some of the toughest patients I ever see, when it comes to dealing with pain from cancer. And career ex-Marines have the market cornered on toughness.
Take for example, an elderly friend in Kansas who woke up one morning with severe upper back pain, feeling faint, and decided as was his Marine Corps habit that a cold shower would be “just the thing.” The cold shower likely saved his …
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The best gift of all: When the sickest patients feel better
A colleague of mine recently pointed out a study by the Center for Health Care Strategies (CHCS) about mental health care for children. Among their findings was this: Almost 50 percent of children enrolled in Medicaid who are prescribed psychotropic medications receive no identifiable behavioral health treatment.
This is a disturbing, though not surprising, statistic given that these medications are commonly prescribed by primary care clinicians. Children living in poverty often experience greater environmental stress and may …
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Mental, not behavioral, health care: Why it matters
I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice. This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most …
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An important lesson in personalized patient care
On December 9, 2013, 13-year-old Jahi McMath underwent a tonsillectomy at a children’s hospital in Oakland, California. She suffered postoperative hemorrhage and became comatose. She was declared brain dead by doctors at that hospital on December 12th. This was later confirmed by a court-appointed outside consultant.
There are many issues surrounding this case. Was the tonsillectomy indicated? Some stories reported that it was done to improve her obstructive sleep apnea. Why …
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Brain death is still misunderstood by the public
A standard part of any psychiatric evaluation involves inquiring about a patient’s sleep. Hidden in the answers that follow the basic question of, “How are you sleeping?” are the clues that are needed to diagnose what is ailing the patient seeking help from me.
For those with depression, they typically report early morning awakening (i.e. they wake 3-4 hours earlier than needed) and are not able to return to sleep. Those …
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Treating the nightmares associated with PTSD
Many people have heard of the company 23andMe; hundreds of thousands throughout the world have used the company’s Personal Genome Service (PGS), which provides a report that offers detailed information about an individual’s DNA. For $99, a consumer receives a test-tube kit from the company, fills the tube with saliva and sends it back. The company then performs a DNA analysis and provides information about the person’s health risks, ancestry …
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How should personal genetic tests be regulated?
