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.

Gastric bypass is not a short cut to treat obesity

Michael Kirsch, MD

February 24, 2011

Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.

As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …

Is alcohol good for me? The data behind drinking and your heart

Kevin

Conditions and Diseases

February 24, 2011

by Aditya Mattoo, MD

Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking …

Exercise to prevent cancer

Kevin

Conditions and Diseases

February 21, 2011

by Karen Basen-Engquist, PhD

The next time you’re on your couch contemplating whether to watch your favorite sitcom or get up and exercise, remind yourself that being active for at least 30 minutes every day can help reduce your chances of getting certain types of cancer.

Physical activity fights cancer because it reduces body fat, and lowers hormone levels that raise breast and endometrial cancer risks. It also keeps the digestive system …

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Exercise to prevent cancer

Tragedy of cancer in a small child

gcs15, MD

Conditions and Diseases

February 18, 2011

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead …

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Tragedy of cancer in a small child

Treatment guidelines pros and cons

David Williams

Conditions and Diseases

February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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Treatment guidelines pros and cons

Strategy and support is needed to quit smoking

Erin Marcus, MD

Conditions and Diseases

February 11, 2011

Tobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough.

L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.’s words, he was “sick and tired of being sick and tired.” But he didn’t do it alone; his success depended on …

Does screening and treating high cholesterol save money?

Richard Young, MD

Conditions and Diseases

February 10, 2011

A commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”

The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. …

How anchoring leads to misdiagnosis

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

February 10, 2011

Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient’s words into clinical terms.

Case study #1

Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a …

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How anchoring leads to misdiagnosis

Closed loop bowel obstruction in your surgical partner

Sid Schwab, MD

Conditions and Diseases

February 8, 2011

“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were half-way through a thyroid operation and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, and Doug, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best surgeon …

Do stroke centers improve patient outcomes?

Harlan M. Krumholz, MD

Conditions and Diseases

February 8, 2011

Another good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading.

The article, titled “Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality,” focuses on the New …

The AIDS crisis in Zambia

Dr. Chris Nickson

Conditions and Diseases

February 7, 2011

Wednesday, December 1st was World AIDS Day — a day to raise awareness for the ongoing AIDS pandemic around the world and to remember the past. As a trainee intern I spent 3 months in Zambia, a time that really opened my eyes up to what AIDS was doing to the world. Much has changed since then, antivirals have arrived in Zambia for instance, yet the disaster continues: 1 in …

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The AIDS crisis in Zambia

Kernels of humor in a tragic cancer story

Colleen Kelly Mellor

Conditions and Diseases

February 5, 2011

I didn’t always recognize its importance. I mean when I was younger, I thought that being attractive, slim, athletic, articulate were sure-fire antidotes to one’s suffering a life of mediocrity. I just never recognized the value of something I took for granted, my sense of humor. And then life happened.

When I was 36, my husband (who was older by 12 years) was diagnosed with lung cancer. Inoperable, incurable, his type …

Stressful life events in suicide attempts and completed suicides

William R. Yates, MD

Conditions and Diseases

February 5, 2011

The role of stressful life events in suicide attempts and completed suicides has been a key area of study in the epidemiology of mental disorders. Although suicidal behavior often occurs in the context of acute and chronic stressor, this does not prove a causal link. We all could probably report serious life stressors throughout out lives and these could be interpreted as a reason for suicidal behavior. So these associations …

Finding out the cost of lab tests is a real challenge for patients

Brad Wright, PhD

Conditions and Diseases

February 4, 2011

In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.

Fortunately, when I started graduate school, my father insisted that I …

Kids with allergies can die in school

Gina, RN

Conditions and Diseases

February 3, 2011

Like many other parents of kids with allergies, I was very dismayed to see this article, titled, Allergic boy, 7, suffers two heart attacks after teacher hands him chocolate nut in class, last week. It seems a boy of 7 was accidentally given a chocolate candy containing a hazelnut, to which he is allergic. After biting into the candy, he realized immediately that he shouldn’t have it and …

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Kids with allergies can die in school

Treating a patient in a small town versus a big city

StorytellERdoc, MD

Conditions and Diseases

February 1, 2011

I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.

I …

Laryngopharyngeal reflux disease and a complex case or chronic cough

Steven Y. Park, MD

Conditions and Diseases

February 1, 2011

Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.

A 49 year old healthy woman presented to …

Focus advance care planning on outcomes

Kevin

Conditions and Diseases

January 31, 2011

by Drew Rosielle, MD

The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.

That is, instead of thinking of ACP as patients pre-specifying “if X …

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Focus advance care planning on outcomes

Help your doctor formulate an accurate differential diagnosis

Stewart Segal, MD

Conditions and Diseases

January 31, 2011

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …

Where an extremely premature baby immediately receives care matters

Jennifer Gunter, MD

Conditions and Diseases

January 28, 2011

When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.

A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …