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.

Fish oil and prostate cancer: Go beyond the headlines

David L. Katz, MD

August 12, 2013

I suppose it may help diffuse any relevant tensions to get the punch line out of the way: I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement (krill oil in my case). We will, as well, continue using various omega-3 supplements in varying doses for specific therapeutic purposes in my clinic.

And now, let’s turn to the …

We face an epidemic of excessive busyness

Suzanne Koven, MD

Conditions and Diseases

August 11, 2013

In the past few years, I’ve observed an epidemic of sorts: patient after patient suffering from the same condition. The symptoms of this condition include fatigue, irritability, insomnia, anxiety, headaches, heartburn, bowel disturbances, back pain, and weight gain. There are no blood tests or x-rays diagnostic of this condition, and yet it’s easy to recognize. The condition is excessive busyness. It’s one with which, as a fellow sufferer, I empathize …

MKSAP: 19-year-old woman with progressively worsening diarrhea

mksap

Conditions and Diseases

August 11, 2013

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

A 19-year-old woman is evaluated for a 3-month history of progressively worsening diarrhea, abdominal pain, and weight loss. Her brother was diagnosed with Crohn disease at age 16 years.

On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/65 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. Abdominal examination …

MKSAP: 58-year old woman with fatigue and weight loss

mksap

Conditions and Diseases

August 10, 2013

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

A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history.

Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 …

Do you worry about the diseases you learn in medical school?

Hans Duvefelt, MD

Conditions and Diseases

August 7, 2013

It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was Morbus Crohn, chart notes …

Melanoma refuses to abide the laws of general civilization

Samyukta Mullangi

Conditions and Diseases

August 6, 2013

Melanoma

The man who had been seated in room 2 by the medical assistant had been seen 6 months previously for a small, pigmented lesion behind his left ear, which a punch biopsy subsequently proved to be malignant melanoma in situ. He was sent to the Mohs surgeon in the interim who carefully excised just as much skin as was absolutely necessary and …

Drug addiction: 5 things we can learn from Cory Monteith

Jan Gurley, MD

Conditions and Diseases

August 6, 2013

503591-cory-monteith-glee-golden-globes-617-409

Hollywood stars, like Glee’s Cory Monteith, aren’t the only Americans struggling with addiction that kills. Monteith, who died of a heroin and alcohol overdose, exemplifies the public health tragedy that is opioid overdose deaths in America. The fact is, there is no greater public health issue.

From as far back as 2008, we have been dying more from poisoning – almost all poisonings …

MKSAP: 27-year-old woman is evaluated for a 4-week history of wheals

mksap

Conditions and Diseases

August 4, 2013

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

A 27-year-old woman is evaluated for a 4-week history of wheals, characterized by a burning sensation without pruritus. Each individual lesion persists for 48 hours and slowly resolves, leaving a bruise. Current medications are diphenhydramine, hydroxyzine, cetirizine and oral contraceptives. The patient’s mother has systemic lupus erythematosus.

On physical examination, vital signs are normal. She …

Skip breakfast at your own risk

David L. Katz, MD

Conditions and Diseases

August 3, 2013

That breakfast is important is denoted by the name itself. At some point, we either break our fast, or just keep fasting — and eventually, starve. So for those of us disinclined to starve, fast breaking has to happen at some point. By convention, that’s breakfast.

Much else about breakfast, what we eat and when for instance, also tends to be a matter …

Read more…

Skip breakfast at your own risk

MKSAP: 76-year-old woman with dizziness and palpitations

mksap

Conditions and Diseases

August 3, 2013

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

A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has a history of hypertension and heart failure with preserved ejection fraction. Medications are hydrochlorothiazide, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 80/60 mm Hg, pulse rate …

It’s time primary care doctors diagnose autism

Denise A. Somsak, MD

Conditions and Diseases

August 1, 2013

I remember how my son’s autism diagnosis was delivered. He was three years old. It wasn’t a surprise really, merely a confirmation of something that I expected and feared. He was already enrolled in speech and occupational therapy making very little progress. He saw a developmental specialist at age two and two and half who initially believed that he was not autistic but merely delayed with sensory issues. After we …

Anesthesiology and obstructive sleep apnea: A patient safety challenge

Jeffrey S. Jacobs, MD

Conditions and Diseases

August 1, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Obstructive sleep apnea (OSA) has been diagnosed in more than 18 million American adults, but there are likely millions of others who suffer with OSA, but are undiagnosed. While OSA is frustrating to the patient and the patient’s family, it is crucial to remember OSA is a significant …

Losing my temporarily able-bodied status

Sandra L. Shea, PhD

Conditions and Diseases

August 1, 2013

I thought of Peter when I lost my TAB status.

I lost it on vacation. These things happen. Suddenly, one Friday night in Florida, I was no longer a TAB. Shouldn’t have been too surprised, I guess.

But I didn’t expect it would involve a chicken.

I should explain.

I’m a medical educator: I have a PhD in experimental psychology/neuroscience, and I teach first-year medical students. In our curriculum, the students work through patient …

Exercise is a powerful tool in the fight against cancer

James C. Salwitz, MD

Conditions and Diseases

August 1, 2013

If you had cancer, how good would a treatment have to be, how much would it have to help, for you to use it? How about if it gave you a 5% better chance of cure? A 10% chance? How about a 20% chance to be beat the disease using a treatment without side effects that is free? “Sign me up,” you say? Nonetheless, only 8% of breast cancer patients …

Is obesity a symptom or a disease?

Shirie Leng, MD

Conditions and Diseases

July 31, 2013

There’s a great scene in the classic West Side Story in which members of the Jets gang go through all the different things people say is wrong with them.

“The problem is he’s crazy, the problem is he drinks, the problem is his mother, the problem is he stinks.”

“I’m depraved on account ‘a I’m deprived!”

It’s satire, and it’s funny, and it’s a catchy song, but it illustrates the complexity of social and …

Read more…

Is obesity a symptom or a disease?

Hospital care practically guarantees that we won’t get good sleep

Peter Ubel, MD

Conditions and Diseases

July 31, 2013

The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won’t get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.

Recently I was all-too-miserably reminded of …

Let’s stop worrying about what we call obesity

Claire McCarthy, MD

Conditions and Diseases

July 30, 2013

Should we call obesity a disease—or a condition?

This is a question that has become really controversial. This week, the Council on Science and Public Health of the American Medical Association (AMA) put out a report saying that obesity shouldn’t be classified as a disease. The next day, the AMA’s House of Delegates disagreed, saying it should be.

You know what I think? I don’t care.

It’s not that I don’t care about obesity. I passionately …

The bar for becoming a stool donor just got higher

Michael Edmond, MD, MPH

Conditions and Diseases

July 29, 2013

Recently, I have spent a lot of time talking to patients, trying to explain why I’ve had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge bureaucratic hurdle to getting a much needed therapy for patients with recurrent or intractable C. difficile infection.

Even before the FDA did this, there were already hurdles for patients who are really suffering …

Haunted by an autism diagnosis: A sense of closure after 20 years

Lisa Shulman, MD

Conditions and Diseases

July 27, 2013

I believe most physicians have cases that haunt them, often patients whose treatment courses do not go ideally and who leave a mark on the physician, altering the way he or she practices ever after. When the physician is a surgeon, it might be a patient who died on the table. For a hematologist, it might be a patient with cancer who could not be cured. For a developmental pediatrician, …

Why you should never order a herpes IgM blood test

Jennifer Gunter, MD

Conditions and Diseases

July 27, 2013

Routine screening blood tests for herpes are not recommended by the Centers for Disease Control. When I say routine screening I mean a scenario such as, “I want to get checked for everything, ok?”

Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) …