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.

The conundrum of forcing treatment on psychiatric patients

Allen Frances, MD

October 9, 2013

When is it justified to force treatment on someone?

Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances.

I once put the question to its supreme test — 35 years ago while having dinner with Tom Szasz. Tom was the probably the greatest defender of patient rights since Pinel (the father of modern psychiatry who, two centuries ago, started …

Radiation from x-rays and living in Denver: They’re not the same

Jennifer Gunter, MD

Conditions and Diseases

October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

Obesity in children: What is the responsibility of doctors?

Manoj Jain, MD, MPH

Conditions and Diseases

October 8, 2013

Lying in a hospital bed, my seriously obese patient could barely see her swollen and odorous right foot over her abdominal fat. The foot was soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity. Her two children, ages 6 and 12, hovered from the hospital bed to the couch. In between, the bedside table was strewn …

How postpartum depression affects children

Nicole Letourneau, PhD and Justin Joschko

Conditions and Diseases

October 5, 2013

At long last, people are talking about postpartum depression. Dismissed for years as no more than a touch of the baby blues or else unheard of entirely, postpartum depression — or PPD, as it is often known — has become an open subject. Healthcare providers are aware of it, many nurses and physicians routinely screen mothers for it, and articles in parenting magazines and major newspapers have been written about …

MKSAP: 56-year-old woman with Sjögren syndrome

mksap

Conditions and Diseases

October 5, 2013

A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids.

On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid …

Examining the link between bacteria and obesity

David L. Katz, MD

Conditions and Diseases

October 4, 2013

We have, it seems, moved on from acknowledging it takes a village to raise a human being. We are well into the realm of realization that it takes a village just to be one. More and more studies are demonstrating the importance of the germs that outnumber our cells by an order of magnitude at least, to virtually every aspect of physiology. But while epiphanies of this …

Fear of disease needs to overcome the fear of vaccines

Mike Sevilla, MD

Conditions and Diseases

October 4, 2013

One of the reasons I love social media is that it keeps me up to date on breaking news stories. Here are two stories that came through my social media channels recently. Both of these have to do with immunizations, which, of course, is a healthcare and social media hot topic, especially among pediatricians.

“U.S. Measles Cases in 2013 May Be The Most In 17 …

Social support matters in cancer survival

Suzanne Koven, MD

Conditions and Diseases

October 2, 2013

A study by researchers at Brigham and Women’s Hospital and Dana Farber Cancer Institute published in the Journal of Clinical Oncology confirms what primary care doctors already know: marriage is often, but not always, good for your health. The study found that among more than a million people with common cancers such as colon, lung, breast and prostate, those who were married were more likely to be diagnosed early and stick …

4 myths and truths about milk

Naline Lai, MD and Julie Kardos, MD

Conditions and Diseases

October 2, 2013

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We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

Read more…

4 myths and truths about milk

Think about alcohol as a prescription drug

Alex Lickerman, MD

Conditions and Diseases

September 29, 2013

Imagine there was a practice that I could teach you that would reduce your relative risk of having a heart attack by nearly 40%. Imagine also that if you carried out this practice just once a week you’d find yourself feeling less anxious, more confident, better able to enjoy yourself socially, and in general significantly less stressed (at least while actively engaged …

MKSAP: 45-year-old man with a daily cough

mksap

Conditions and Diseases

September 28, 2013

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

A 45-year-old man is evaluated for a 6-month history of increasing daily cough, sputum production, and dyspnea on exertion. He has been employed as a coal miner for 10 years. He has never smoked and does not have a history of diabetes mellitus, hypertension, or hyperlipidemia. His family history is negative for cardiopulmonary disease.

On …

Concern about autism on the part of a parent is an emergency

Lisa Shulman, MD

Conditions and Diseases

September 26, 2013

I recently returned from a 10-day vacation from my position as a developmental pediatrician. I specialize in the early identification and management of autism at Einstein’s Children’s Evaluation and Rehabilitation Center. The night before returning to work, I decided to check my voicemail.

Since my last vacation, a new office voicemail system had been installed. It seems that I now have an unlimited amount of …

The time to get flu shots is now

Wendy Sue Swanson, MD

Conditions and Diseases

September 25, 2013

Please don’t tune me out on this one. Don’t let this post resemble Gary Larson’s The Far Side cartoon where you only hear, “Blah, blah, blah, Flu shot, blah, blah, blah, Flu shot, blah, blah, blah”

I write about flu every year because it’s one infectious disease that is not only more aggressive and dangerous for babies and young children, it’s vaccine preventable. The flu causes high fever, terrible cough, body aches, and significant discomfort. …

Read more…

The time to get flu shots is now

Childhood obesity: A problem of will and money

David L. Katz, MD

Conditions and Diseases

September 25, 2013

The American Heart Association recently published a sobering “scientific statement” on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria, between 4 percent and 6 percent of our kids between the ages of 2 and 19 have severe obesity.

Those percentages probably don’t fully convey how common that makes …

A symptom that will hasten Medicare’s eventual insolvency

Henry Kimmel, PsyD

Conditions and Diseases

September 25, 2013

Days from her 80th birthday, “Nancy” (not her real name) is doing well. She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator. Her busy schedule of weekly activities includes several appointments with physicians. Nancy’s medical needs are covered by Medicare.

Nancy’s been in psychotherapy for a half-century. She’s seen me, her psychotherapist, for the past three years. Nancy reports difficulty developing meaningful …

The catch behind free prostate cancer screening

Janice Boughton, MD

Conditions and Diseases

September 25, 2013

I just got an email from a hospital where I sometimes practice with a picture of two aging but clearly active and vital men standing on a beach with the words “free prostate cancer screening” printed below in an attractive font. The hospital is sponsoring the screening, along with the urology clinic affiliated with the hospital. The advertisement gives guidelines for who should avail themselves of this service, including men …

Can sexualized images from pop music be a teachable moment?

Heidi Roman, MD

Conditions and Diseases

September 24, 2013

I have a confession. I like pop music. During my commute each day I admit I often make the mind-bending switch between NPR and the top 40 station. Even if you trend toward a more high-brow music collection, perhaps you’ll allow me that these tunes are catchy and they’ve got a beat. But lately I’m feeling fairly conflicted about it.

I didn’t watch the VMAs. …

After a Creutzfeldt-Jakob exposure, should patients be told?

Timothy Lahey, MD

Conditions and Diseases

September 21, 2013

Recently we have learned that 15 patients in New England were exposed to a rare infection called Creutzfeldt-Jakob disease (CJD) when neurosurgical instruments contaminated with the infection were used in their care. Each had undergone a brain or spinal surgery in early 2013, and now their future was uncertain.

Creutzfeldt-Jakob disease is caused by an infectious agent called a prion — as is “mad cow disease.” Originally discovered in the brain-eating Fore cannibals of Papua New …

Necrotizing fasciitis: A case study and discussion

Adam Bitterman, DO

Conditions and Diseases

September 21, 2013

Necrotizing fasciitis is a rare but life-threatening soft tissue infection. Its presentation is characterized by rapidly spreading inflammation and resultant death both of the surrounding soft tissue and fascial planes. Prompt recognition and aggressive treatment is paramount in order to avoid fatality. Often times, symptoms may overlap in their presentations so one must maintain a high index of suspicion and a multidisciplinary approach facilitated appropriate imaging studies and resulted in a …

MKSAP: 47-year-old woman with severe fatigue

mksap

Conditions and Diseases

September 21, 2013

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

A 47-year-old woman is evaluated for a 6-month history of severe fatigue in the afternoon that is often disabling. The patient has a 15-year history of multiple sclerosis. She states that her mood is good and that she is not feeling depressed or sad. She describes no problems with her sleep, and her partner …

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