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.

Genetically informed therapy and technical innovations in cardiology

Stephen C. Schimpff, MD

October 3, 2011

I want to give an overview of cardiac care advances – the first two themes are discussed here. I want to thank Dr. Mandeep Mehra, chief of cardiology at the University of Maryland for conceptualizing these themes for me.

First is genetically informed therapy. Pharmacogenomics is having an impact in the use of warfarin (Coumadin) and clopidogrel (Plavix). Warfarin dosage can now be titrated in part based on a person’s genomic makeup. In …

The decision to pursue a rare illness

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

October 1, 2011

Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.

He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …

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The decision to pursue a rare illness

MKSAP: 75-year-old woman with a sudden loss of vision

mksap

Conditions and Diseases

October 1, 2011

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

A 75-year-old woman is evaluated for a sudden loss of vision in the left eye that began 30 minutes ago. She has a 2-week history of fatigue; malaise; and pain in the shoulders, neck, hips, and lower back. She also has a 5-day history of mild …

An MRI for back pain may only confuse the diagnosis

Kerrie M. Reed, MD

Conditions and Diseases

September 29, 2011

“Doc, my back is killing me! I think I need an MRI.”

I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …

Divorce after the diagnosis of Alzheimer’s disease

Dominic A. Carone, PhD

Conditions and Diseases

September 25, 2011

I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected …

Health effects of the BP Gulf Coast oil spill

Erin Marcus, MD

Conditions and Diseases

September 24, 2011

People living along the Gulf of Mexico are still feeling the effect of the BP oil spill disaster, the largest oil catastrophe in history. To learn more about the spill’s health effects, I spoke with Dr. Gina Solomon, an Associate Clinical Professor of Medicine at the University of California, San Francisco, and Senior Scientist at the Natural Resources Defense Council. Dr. Solomon was on the Louisiana coast during …

Achieving a 90 minute door-to-balloon time in STEMI patients

John E. Brush, MD

Conditions and Diseases

September 23, 2011

At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention.

One target that caught my interest was for achieving a door-to-balloon time of less than 90 minutes in STEMI patients. As an interventional cardiologist who …

Discussing a colostomy in a patient with rectal cancer

Sid Schwab, MD

Conditions and Diseases

September 21, 2011

Sturdy and thickly-built, long since widowed, cheery in a sardonic sort of way, tough and opinionated, Flora’s European roots ran deep; she’d been an Italian farm girl, and she’d rather be in her garden than anywhere else. The only reason she agreed to come inside and go to the doctor was that her bowel movements had finally gotten too painful, and too bloody to ignore. Which she had been doing, …

Exercise can help treat fibromyalgia

William R. Yates, MD

Conditions and Diseases

September 20, 2011

What is fibromyalgia and what exactly what does exercise have to do with the treatment and long-term outcome of the condition? A recent study published in Medicine & Science in Sports & Exercise is helpful in understanding the relationship between fibromyalgia and exercise and how clinicians (and patients) might find better strategies for treatment.

Fibromyalgia is a clinically defined pain syndrome estimated to affect about 5 per cent of the general population with criteria for …

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Exercise can help treat fibromyalgia

The progress we have made in the diagnosis and treatment of cancer

J. Leonard Lichtenfeld, MD

Conditions and Diseases

September 20, 2011

An article released by the Centers for Disease Control and Prevention in their weekly publication Morbidity and Mortality Weekly Report provides an assessment of the progress we have made in the diagnosis and treatment of cancer.

Clearly, since 1971, we have made substantial advances in the cancer treatment. We have become a larger and older nation. …

ADHD and the lack of quality sleep

Steven Y. Park, MD

Conditions and Diseases

September 19, 2011

As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults …

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ADHD and the lack of quality sleep

MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss

mksap

Conditions and Diseases

September 17, 2011

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

An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, crowded …

Andrea Mitchell breast cancer thoughts

Gary Schwitzer

Conditions and Diseases

September 14, 2011

For the past 24 hours I’ve squirmed about whether to or how to criticize NBC’s Andrea Mitchell about her on-air announcement of her breast cancer diagnosis and treatment. How can you criticize someone who is dealing with what she – and so many other women – are dealing with? But it’s now clear that some breast cancer survivors and others who know the science are critical of the message …

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Andrea Mitchell breast cancer thoughts

Biology and biography: The Two-B Factor of depression

Deborah Serani, PsyD

Conditions and Diseases

September 12, 2011

An excerpt from Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing (Rowman & Littlefield Publishing Group).

To be human is to experience an array of different emotions. We can feel upbeat and hopeful, cool and unconcerned or frustrated and fearful in a given day—even in a given moment. The heart of human experience beats with moments of joy and flashes of sorrow, and with …

MKSAP: 25-year-old man with swelling of the feet and legs

mksap

Conditions and Diseases

September 10, 2011

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

A 25-year-old man is evaluated in the emergency department for swelling of the feet and legs. He has a 5-year history of HIV infection for which he has refused treatment.

On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 88/min, and …

When is the right time to introduce solid foods to an infant’s diet?

Michael Gonzalez, MD

Conditions and Diseases

September 7, 2011

Parents often wonder when is the appropriate time to introduce solid foods to their infant’s diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on Breastfeeding recommends starting complementary foods (rice cereal and baby foods) after six months of age and the Committee on Nutrition recommends the introduction of complementary foods between four to six …

Should teenagers be screened to prevent sudden cardiac death?

Chris Rangel, MD

Conditions and Diseases

September 6, 2011

It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 …

Phil Mickelson’s psoriatic arthritis explained

Michele R. Berman, MD

Conditions and Diseases

September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

The problem with early detection of disease in medicine

Dr. Joe Kosterich

Conditions and Diseases

September 5, 2011

Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine.

One of the mantras of modern medicine is that early detection is good. This seems logical enough.

However there is an underlying assumption. That is that there will be a worsening of the condition if it is not detected and that treatment will improve the situation. What would happen …

MKSAP: 20-year-old with fever, myalgia, headache, and a rash

mksap

Conditions and Diseases

September 5, 2011

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

A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.

On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 mm …