Following the lead of the World Health Organization and the National Institutes of Health, the American Medical Association declared obesity a “disease.” The AMA cited the plethora of evidence linking obesity to chronic disease including the number one cause of mortality in the US, cardiovascular disease. They describe the move as an effort to urge physicians and third party payers to recognize the need for obesity treatment ranging from behavioral …
Angelina Jolie shared publicly her decision to have a preventive double mastectomy after genetic testing revealed that, due to a mutation in the BRCA1 gene, she carried an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer. Jolie identifies her mother’s decade-long struggle with ovarian cancer and death from that disease six years ago as one of the primary influences behind her decision.
Let’s make it easy on ourselves. I haven’t yet established why — other than liking the particular operation — we’re removing this nice person’s colon. So since our patient has agreed to remain exposed and to do so for all to see, I declare s/he has diverticulitis. (Were it cancer, the operation would be largely the same, taking a bit more out.) Most likely …
A 78-year-old man was admitted to the hospital 5 days ago for worsening heart failure.
On physical examination at admission, temperature was normal, blood pressure was 150/88 mm Hg, pulse rate was 108/min, and respiration rate was 22/min. There were bibasilar crackles and dullness to percussion at both posterior lung bases. Jugular venous distention, an …
A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days’ duration. He is a health care worker and has a bicuspid aortic valve. He takes no medications.
Blood cultures are obtained at the time of admission, and he is started on empiric vancomycin for possible endocarditis.
Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …
Our bodies are mostly water — about 60% water, in fact. This varies a little with age and sex, but it is a good rough estimate. Of that 60% water, about a third of it is outside the body’s cells, so-called extracellular fluid, and two thirds of it is inside the body’s cells, so-called intracellular fluid. The easiest way to remember this is the “60/40/20″ rule: total body water is …
Sue wondered if all doctors subscribe to the same magazines, buy the same cheap furniture, post the same worthless insurance information. She wanted to throw it all through the receptionist window. The second opinion was a waste of time and she had little of that. She was there to make her family happy, but was upset they could not cope, that they were not ready to face the truth, and …
Here is an edited email I received from an athletic colleague:
John,
A 50 year-old male healthy athlete has the new problem of occasional periods of premature beats. She (or he, doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. Otherwise the history, exam, ECG, ECHO and electrolytes are normal.
What’s up with PVCs? Why? Could they be 1) consequence of (chronic) exercise or 2) related in …
The American Medical Association (AMA) has voted to formally recognize obesity as a disease. In the shadow of this recognition is the untimely and tragic passing of a great actor, James Gandolfini, who, known for throwing his weight and clout around onscreen as Tony Soprano, is suspected to have died from a heart attack at the early age of 51.
A 56-year-old woman is evaluated in the emergency department for sudden onset of a severe generalized headache that began 36 hours ago and has not responded to over-the-counter medications. The patient has a history of hypertension treated with lifestyle modifications. She has a 30-pack-year smoking history.
On physical examination, blood pressure is 148/68 mm Hg, …
There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …
Many years ago, I worked as a counselor at the city camp in North Miami Beach, Florida. Camp “No Mi Be” was attended by what seemed to be a countless number of very active, very inquisitive, and pretty-much-unstoppable 10-year-old boys.
We learned quickly that the best way to start the day was with running. Run, run, run. We’d make the kids run back and forth to the fence, or run around …
Last week I served lunch at my son’s school. It was a hoot, really, serving an entire K-8 school lunch. Dishing out lasagna, broccoli, pizza, and grilled cheese provided all sorts of insight into what lunch is like in 2013. My son didn’t choose exactly as I’d predict (see below). When a 33-year prospective study published recently which connects childhood ADHD with adult obesity, …
Like many other Millenials who grew up in the age of Lara Croft and Brangelina, I greeted Angelina Jolie’s announcement that she had undergone a preventative mastectomy and reconstruction last month with sadness for her loss and admiration for her heroic decision and very public disclosure. I hope her story will lead other women to undergo screening and potentially save lives, but real improvement in women’s health outcomes requires …
Before critiquing the American College of Physicians’ recent guidance statement on screening for prostate cancer, I will begin by saying that I generally hold the ACP’s clinical guideline development process in high regard. They often base their guidelines on comprehensive and methodologically sound reviews of the evidence produced by Evidence-Based Practice Centers.
In some cases, when several good-quality guidelines are already available, the ACP chooses not to reinvent the wheel …
Kangaroo care (KC) is the practice of skin-to-skin contact with a premature baby and parent. In low and middle-income countries, where there are fewer medical resources, Kangaroo care has been shown to reduce mortality among premature babies and shorten the length of hospital stay.
Kangaroo care is also very beneficial in high-income countries even in the midst of extremely high-tech care.
Holding a premature baby skin-to-skin:
Improves breast milk production and breastfeeding (when mothers …
As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …
When we think of strokes, we imagine older adults. Yet, one out of every 2,800 newborns (under 1-month) suffers a stroke. In children up to 18, it occurs in 11 out of 100,000. I know how serious this can be – my daughter experienced a stroke before birth. The day before she was born, we discovered she had hydrocephalus (water on the brain). When she was a day old, an …
