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.
In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected …
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Avoid malpractice while treating minor head trauma in children
There is a healthy debate over whether a lab that created an extremely infectious version of influenza ought to publish the genetic sequence. The debate speaks to a larger problem: sometimes, medical advances do the world a disservice. The medical field could use some soul-searching, just as physicists did in the wake of the Manhattan Project.
A few years ago, I read a neat research finding. In a pregnant woman, …
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When medical advances do the world a disservice
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.
If …
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Why we should eliminate the diagnosis of ADHD
As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.
One of …
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Treating heart failure on a budget
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history …
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MKSAP: 60-year-old woman with pruritic hives
What could be so simple as a blood test?
A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.
That was the thinking of my wife’s physician when she ordered a test called the “CA-125.” …
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How the CA-125 became a $50,000 blood test
Many healthcare professionals find fibromyalgia difficult to believe as “a real disease” and most of all difficult to handle, and to be honest it is not so difficult to see why. Doctors and other healthcare professionals have learned how to search for diseases based on the specific symptoms the patients present, but fibromyalgia – and several other chronic pain syndromes – do not fit into that model.
The patients are presenting …
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Understanding the pain of fibromyalgia
As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.
With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based …
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3 best practices for both physicians and patients to treat diabetes
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.
The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …
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How Patrick Swayze died: Why we should care
“I laughed so hard, tears ran down my leg.”
That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a common question that I ask patients in the office. The responses I get include, “fine, except when I ____”, or, I’m fine as long as I know where the bathrooms are. …
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Reclaim your life from urinary incontinence
Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families. Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease.
1. …
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Myths and misses about Alzheimer’s Disease
The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases. Most cancer survivors, however, are not unscathed by the experience. As I tell my patients, they won’t be entirely as they were before treatment. How these issues are dealt with varies from person to person. But, awareness that chronic problems may persist long after treatments end …
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Incorporating 12-step program concepts into cancer survivorship
I’ve written many times that losing weight is the second hardest thing I ask my patients to do. (Breaking an addiction like smoking or alcoholism is the hardest.) The frustrating thing is how little we know about how to lose weight successfully. But we are learning more all the time about why losing weight is so difficult.
Much about dieting and weight loss is poorly understood, but let’s first lay out …
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Overweight people have a weight thermostat that is turned up too high
The chart below shows the unheralded rise in pediatric obesity (not overweight, just obesity) over the last 40 years. Outrageous, and downright scary. Kids today are flocking to multi-billion dollar pediatric centers for adult-onset diabetes, heart disease, joint replacement and bariatric surgery. This too little (but definitely not too cheap), too late approach is literally killing us. The generations behind us are not only impacting the expense of healthcare, but …
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Keep your kids off the obesity chart
On the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity – its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.
Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.
One family physician noted in his presentation the case of …
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Obesity is a sign of good health in some cultures
Dear Doctors:
I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother’s team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blindsided by this.
While no one likes to talk about the topic of death, it is important to remember that …
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Why palliative care and hospice is the ultimate gift
Doctors, nurses, ministers, first-responders and many individuals have interrupted their daily lives for weeks and months at time to lend a helping hand. To show solidarity communities have thrown parties, organized fundraisers and joined with relief organizations. “Text for Haiti” became a popular way to make individual contributions through mobile phone text messages as many leaders urged financial contributions over direct donations of foodstuffs, clothes and other supplies. Early indications …
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Early lessons from Haiti in global health
I saw a patient in my office this week who had received a stent from one of my partners last month. The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a …
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Meaningful treatments in the battle against coronary disease
