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.

MKSAP: 19-year-old woman with bilateral leg weakness

mksap

April 13, 2013

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

A 19-year-old woman is admitted to the hospital because of a 2-week history of bilateral leg weakness and numbness accompanied by urinary incontinence that began after a viral gastrointestinal illness of 3 days’ duration. She has no personal or family medical history of note and takes no medication.

On physical examination, temperature is 36.7 °C …

Roger Ebert did not lose his battle with cancer

Michael A. Wosnick, PhD

Conditions and Diseases

April 11, 2013

Roger-Ebert_612x451

I was very saddened to learn of the death of Roger Ebert. I, like so many around the world, was impressed and inspired at how he handled himself in the aftermath of his cancer surgery years ago that left him disabled and disfigured and unable to eat, drink or speak. And yet, despite his struggles he remained a dominant force in film …

The elective induction of labor is no longer sustainable

Vivian E. von Gruenigen, MD

Conditions and Diseases

April 10, 2013

Why do some obstetricians, midwives and family physicians electively induce labor? The answer is long and politically infused. Nevertheless, it includes patient desires, physician convenience and the acceptance of induction as a form of labor.

The induction of labor is the use of medicine or other methods to initiate uterine contractions. If performed for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix ought …

Awareness about intraoperative awareness

Nina Singh-Radcliff, MD

Conditions and Diseases

April 8, 2013

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

During the Civil War, anesthesia was provided by dipping cloth in chloroform or ether and holding it over a patient’s nose and mouth. Today, anesthetic medications are delivered in a controlled (and more civil) manner through specialized devices to provide unconsciousness for surgery.

Over the last several …

Robotic prostatectomy: A debate with a urologist

Skeptical Scalpel, MD

Conditions and Diseases

April 8, 2013

I’m involved in a protracted and good-natured (I hope) debate about the merits of robotic surgery with a University of Pittsburgh urologist named Ben Davies. Today he tweeted the following (with translation for the Twitter averse):

“I would love for a $ISRG [stock symbol for Intuitive, makers of the robot] MD hater (like @Skepticscalpel) to actually watch 10 open RRPs [radical retropubic prostatectomies] …

Explaining the rise in the autism rate

Sanjay Gupta, MD

Conditions and Diseases

April 6, 2013

A recent report stating that one in 50 school children carries an autism diagnosis appears to confirm anecdotal evidence that we are experiencing an increase in the autism rate.

But there are a number of things that should be considered in a discussion of these findings — and leading that discussion should be methodology.

These new data from the CDC’s National Center for Health Statistics (NCHS) are culled from a …

Read more…

Explaining the rise in the autism rate

Sexual health in women treated for cancer

Don S. Dizon, MD

Conditions and Diseases

April 4, 2013

As an oncologist who also runs a sexual health clinic for women treated (or under treatment), I am discovering that my perspective on both issues of cancer treatment (and survival) and life after cancer (and quality of life) is somewhat unique. I am conscious of how difficult it is to bring up cancer therapy and survivorship (let alone sexual health) within …

I let my hope and optimism interfere with accurate communication

Peter Ubel, MD

Conditions and Diseases

April 4, 2013

Andrews was easily the most anxious patient I took care of that month, a gray Michigan February (is there any other kind?) which I spent in the hospital caring for patients admitted to the general medical ward at the Ann Arbor Veterans Affairs Medical Center. (Andrews is a pseudonym, as are all the patients I blog about, unless otherwise indicated.) He had plenty to be anxious about, too. His leukemia …

The quality and quantity of calories both count

David L. Katz, MD

Conditions and Diseases

April 4, 2013

Among others, Gary Taubes has famously argued that calories don’t count. Perhaps the more nuanced version is that the quality of calories, not the quantity, is what counts. Mr. Taubes and I have discussed this, and agreed to disagree. Leaving aside Newton and laws of thermodynamics, there is the Twinkie Diet on my side: evidence that weight can be lost when calories are restricted, no matter how truly dreadful the …

5 essential concepts to know about code status

Brian J. Secemsky, MD

Conditions and Diseases

April 3, 2013

Full Code. Do not resuscitate. Do not intubate.

Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response.

Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves.

Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with …

Consider new treatment options for aortic stenosis

Steven R. Gambert, MD

Conditions and Diseases

March 31, 2013

I recently encountered a previously functional and independent 80-year-old woman who slipped and broke her hip. Surgery was required to repair the injury and was her only hope of returning to her premorbid state. She lived alone and was still able to shop, clean, and cook for herself, despite being on several medications for congestive heart failure. She had a long-standing history …

CRE bacteria: The next superbug threat in your hospital

Daniel J. Morgan, MD

Conditions and Diseases

March 31, 2013

A new CDC report is bringing a lot of attention to the emergence of drug-resistant bacteria in hospitals and long-term care centers across the country. Carbapenem-resistant Enterobacteriaceae, or CRE, strike critically-ill patients in nursing homes and intensive care units where infections can be fatal in up to 50 percent of cases, according to the report.

Without being able to count on …

MKSAP: 51-year-old man with acute myeloid leukemia

mksap

Conditions and Diseases

March 31, 2013

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

A 51-year-old man is being followed in the hospital after receiving chemotherapy for acute myeloid leukemia 1 day ago. Kidney function was normal at the start of his treatment, which consisted of normal saline at a rate of 200 mL/h and rasburicase on the day of chemotherapy. He reports no symptoms except for some …

Be careful when ordering your own genetic tests

Benjamin T. Galen, MD

Conditions and Diseases

March 30, 2013

Direct-to-consumer genetic testing is increasingly available to the general public. Reduced cost and ease of testing make this service easy and seemingly harmless. For less than $100 and without even having your blood drawn (a saliva sample is sufficient), a private company promises to provide you with information about your ancestry and your health.

However, undergoing genetic testing of any kind is not a trivial decision. It is not like having …

3 scientific breakthroughs plagued by uncoolness

Janice Boughton, MD

Conditions and Diseases

March 28, 2013

During the last year I have been paying particular attention to lesser known and under appreciated miracles in medicine. It is a mystery why miracles of any sort would be under appreciated, but it is so very human to ignore things in plain sight which disrupt our deeply held belief systems or even are simply not what we are looking for.

For those readers who don’t believe that they could actually ignore something …

Should Medicare cover PET scans for the diagnosis of dementia?

Leslie Kernisan, MD, MPH

Conditions and Diseases

March 27, 2013

Do they need a PET scan to confirm the presence or absence of amyloid plaque?

More importantly, would doing such PET scans make meaningful impacts on patients’ health?

Those are the questions that a Medicare expert panel recently considered, and their impression, after carefully reviewing lots of high-quality research, is that we don’t yet have evidence supporting the benefit of using the PET scans. Unsurprisingly, some experts disagree, including a working group …

Baby cured of HIV: What’s the real story?

Paul Sax, MD

Conditions and Diseases

March 25, 2013

As undoubtedly you’ve heard by now, there’s another person cured of HIV out there — this time, it’s a baby born to an HIV-infected mother.

Here’s the story: The mother didn’t know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as the results …

How can you tell if adjuvant chemotherapy works?

James C. Salwitz, MD

Conditions and Diseases

March 25, 2013

Think you know something about oncology? Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works? Ridiculous question? Not at all. The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.

In the 1960s, breast cancer surgeons had a serious problem. They were doing large complex …

MKSAP: 64-year-old woman with fever and chills

mksap

Conditions and Diseases

March 24, 2013

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

A 64-year-old woman is hospitalized for a 2-day history of fever and chills and a 1-day history of hypotension and dyspnea. Medical history is significant for adenocarcinoma of the colon diagnosed 3 weeks ago for which she had a partial colectomy. Her course was complicated by the development of a polymicrobial intra-abdominal abscess. After …

We need greater access to home hemodialysis

Peter Laird, MD

Conditions and Diseases

March 23, 2013

As a doctor who also happens to be an end stage renal disease (ESRD) patient, I appreciate this opportunity to reflect on the great strides that have been made to improve the lives of ESRD patients and the steps that still need to be taken to make sure kidney patients have access to the best dialysis treatment possible and the best chance …

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