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.

What doctors are supposed to do when your child has an earache

Claire McCarthy, MD

March 19, 2013

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Your child has an earache. You are worried it is an ear infection. You call the doctor and make an appointment. After all, he needs antibiotics, right?

Maybe not.

We have a real problem of antibiotic overuse in our country–and because we are overusing our antibiotics, many bacteria are getting smarter and stronger. Because ear infections is the diagnosis that kids in the United …

When you’re feeling sad or depressed, try to find anticipatory joy

Alex Lickerman, MD

Conditions and Diseases

March 19, 2013

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Having to confront an indeterminate outcome that might be bad seems to cause more anxiety than having to confront an outcome known to be bad.

In one study, patients requiring colostomies (a rerouting of the passage of stool from the rectum to an opening in the abdomen) that were potentially reversible were actually found to be less happy six months after their operation …

An OB/GYN perspective on Choosing Wisely

Margaret Polaneczky, MD

Conditions and Diseases

March 18, 2013

From ACOG comes five new cautions, part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, to eliminate wasteful and unnecessary medical interventions that can actually cause harm. All the recommendations are evidence-based and have broad consensus.

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age. Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk …

MKSAP: 65-year-old man with daytime somnolence

mksap

Conditions and Diseases

March 16, 2013

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

A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife. He does not have blurred vision, tinnitus, or headache. He has no cardiopulmonary symptoms and does not smoke cigarettes. The patient has hypertension for which he takes lisinopril and atenolol.

On …

Caring for the emotional needs of a cancer patient

Miranda Fielding, MD

Conditions and Diseases

March 10, 2013

Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …

MKSAP: 54-year-old woman is evaluated during a routine examination

mksap

Conditions and Diseases

March 9, 2013

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

A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels like she “just doesn’t want to be touched.” She used to enjoy intercourse and does not know why she feels this way now, but she acknowledges that it is causing …

Why physicians should look beyond smoking cessation

Tamir Katz, MD

Conditions and Diseases

March 5, 2013

It’s not only about smoking cessation.

As I entered the examination room, J.L., a new patient here for a well visit, was sitting comfortably on the examination table. In his mid thirties, tall, slim and with an athletic build, he had a relaxed, easygoing air about him.

Before entering the room, I had quickly scanned his chart, and noted that in the pre-examination questionnaire, …

Incidentalomas: The real cost of ordering tests

Edward Pullen, MD

Conditions and Diseases

March 2, 2013

I recently read a very good article in the New York Times about a patient found to have the classic incidentaloma, a small mass in the adrenal gland. This is estimated to be seen in 4% of abdominal CT scans, and is rarely serious but typically leads to recommendations for additional testing and follow up CT scans to assure that it is not either a metastatic cancer …

MKSAP: 67-year-old woman with severe muscle weakness

mksap

Conditions and Diseases

February 24, 2013

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

A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …

MKSAP: 28-year-old man with left calf deep venous thrombosis

mksap

Conditions and Diseases

February 23, 2013

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

A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d.

On physical examination, temperature …

The myth about screening for heart disease

Davis Liu, MD

Conditions and Diseases

February 20, 2013

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

In the spring of 2008, NBC’s Meet the Press moderator and Washington bureau chief, Tim Russert, died suddenly of a heart attack at the age of fifty-eight. Time magazine identified him as one of the one hundred most influential people in world in 2008. His …

The young and healthy can die from influenza complications

Emily Gibson, MD

Conditions and Diseases

February 20, 2013

Nothing was helping. Everything had been tried for a week of the most intensive critical care possible. A twenty year old man, completely healthy only two weeks previously, was holding on to life by a mere thread and nothing and no one could stop his dying.

His battle had been lost against MRSA pneumonia precipitated by a brief influenza-like illness. Despite aggressive hemodynamic, …

Anesthesiology and the heart: Working together for the best outcomes

John R. Rotruck, MD

Conditions and Diseases

February 19, 2013

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

February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to best care for one of the most important organs.

Each medical specialist takes great care to focus on …

MKSAP: 76-year-old woman with dizziness, shortness of breath, and palpitations

mksap

Conditions and Diseases

February 17, 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 …

MKSAP: 20-year-old man with a 6-month history of low back pain

mksap

Conditions and Diseases

February 16, 2013

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

A 20-year-old man is evaluated for a 6-month history of low back pain accompanied by prolonged morning stiffness. His symptoms improve over the course of the day, but he is now unable to play recreational soccer. Rest, physical therapy, and acupuncture have not improved his symptoms. Use of ibuprofen or diclofenac provides only partial …

2 missed opportunities to teach fall prevention

Louise Aronson, MD

Conditions and Diseases

February 14, 2013

Two famous American women. Two missed opportunities for improved quality of care and patient safety in America.

In December, it was Hillary Clinton and in January, Barbara Walters. Both women fell, hit their heads, and ended up in the hospital. In each case, the focus of the media coverage reflected one of the biggest flaws in our American approach to medicine: readers and viewers learned about the costly and relatively high-tech …

10 reasons why your kids are picky eaters

Lilli B. Link, MD

Conditions and Diseases

February 10, 2013

If only it was as simple as looking into our old Magic 8 Balls® to find out if it is “very doubtful” or “decidedly so” that refusing to stop at the Good Humor® truck on the way home from school will be the right thing to do for our children. It is worries like this, along with the challenge of raising children …

Evidence based medicine: Go beyond the headlines and dig into the data

Marc Cohen, MD

Conditions and Diseases

February 10, 2013

Labor Day weekend, a young man in his early 50s came into our hospital.

He had multi-vessel coronary artery disease. I sent him in for surgery. Every one of his vessels was blocked. The surgeon came to me and said he couldn’t find enough veins to bypass all the occlusions.

There was an artery in the back of the heart, and he didn’t have any veins left to work with. Let’s sit …

Idiopathic neuropathy: 2 steps providers can take

Shanna K. Patterson, MD

Conditions and Diseases

February 10, 2013

It is estimated that over 20 million Americans have neuropathy. Many people don’t know that prior to the advent of the obesity pandemic and the associated rising rates of diabetes, leprosy was the most common cause of neuropathy worldwide. Although it is now widely recognized that diabetes is the most common cause of neuropathy, for up to 30% of patients the cause of their neuropathy remains unknown. These cases are …

How to know whether your cough is serious

Suzanne Koven, MD

Conditions and Diseases

February 7, 2013

I saw 17 patients in my primary care practice yesterday. Six of them were coughing.

One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …

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