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.

Chronic cough from laryngeal sensory neuropathy (LSN)

Christopher Chang, MD

September 30, 2010

Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.

Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.

In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …

The story of vitamin D and its association with other diseases

PalMD

Conditions and Diseases

September 27, 2010

Vitamin D is a fascinating molecule with a fascinating story.

Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health. These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri. Other vitamin deficiencies were found …

Many doctors order tests rather than do a history and physical

Robert Centor, MD

Conditions and Diseases

September 25, 2010

“Take a good history, do a good exam.”

I have not contributed to my treasure of quotes with this title. No one reading the headline well hit their head and mutter, “Wow!” Yet one can wonder about the lack of careful history taking and basic physical examination skills.

This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine.

You should read the …

10 reasons why doctors over-order tests

Kevin

Conditions and Diseases

September 24, 2010

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

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10 reasons why doctors over-order tests

Cycling helps this patient with a sarcoma

Kevin

Conditions and Diseases

September 23, 2010

by Kristina Fiore

Jennifer Goodman Linn, 39, has been through five surgeries and six rounds of chemotherapy since 2004, trying to control the sarcoma that keeps growing in her abdomen.

Goodman Linn has what her doctors call a rare form of a rare cancer — an MFH sarcoma, also known as an undifferentiated high grade pleiomorphic sarcoma. It’s remained confined to her retroperitoneal …

Marginal treatments at a high emotional cost from families

Marya Zilberberg, MD, MPH

Conditions and Diseases

September 22, 2010

My father passed away about two weeks ago after battling a brain tumor for some time.

Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of …

When patients are willing to share their stories

Bruce Campbell, MD

Conditions and Diseases

September 22, 2010

We say we exchange words when we meet. What we exchange is souls.
-Minot J. Savage

It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic cases. I was in the mood to buy but was baffled by the array of options in front of me. This was not going to be as simple as I had thought.

A young …

How you can avoid skin cancer risk

Juliet K. Mavromatis, MD

Conditions and Diseases

September 22, 2010

Skin cancer is the most common form of cancer diagnosed in the United States.

There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million cases in the United States per year. Although, these types typically do not metastasize, they can be quite disfiguring, particularly after resection when they occur on the face. On a population …

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How you can avoid skin cancer risk

Why the expansion of Alzheimer’s may not be helpful

George Lundberg, MD

Conditions and Diseases

September 22, 2010

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.

Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.

It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …

10 cancer signs women shouldn’t ignore

Karen Lu, MD

Conditions and Diseases

September 22, 2010

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If you’re relatively young and healthy, gynecologic cancers probably aren’t on your radar. But they should be.

This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical cancer. In general, gynecologic cancers occur more frequently in women after menopause, although they can occur in younger women. While all women …

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10 cancer signs women shouldn’t ignore

Prevention is the best influenza protection

William Schaffner, MD

Conditions and Diseases

September 21, 2010

For years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually.

This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths is too wide to continue using that single number. Based on a lot more seasons (1976-2007), the average is closer to 24,000 with a range of about 3,300 to …

How can anyone deny scientifically sound treatment for breast cancer?

Jackie Fox

Conditions and Diseases

September 20, 2010

I just don’t understand how someone can live in this day and age and deny the effectiveness of scientifically sound medical treatment when dealing with breast cancer. I was completely flummoxed when I came across the in-depth and thoughtful post “A horrifying breast cancer ‘testimonial’ for ‘holistic’ treatment” on Respectful Insolence, written by a surgeon and scientist who uses the pen name Orac.

Like others who came before and surely will come after …

When does a headache need to be seen at the hospital?

Chaim Colen, MD

Conditions and Diseases

September 20, 2010

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As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache? When should I go to the hospital?”

A headache is considered to be pain located anywhere in the region of the upper …

Social anxiety assumptions and their solutions

Srini Pillay, MD

Conditions and Diseases

September 20, 2010

Social anxiety refers to the fear of being around people due to the threat of embarrassment.

People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire. They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …

Do all people with disturbing behavior have a psychiatric illness?

Jeffrey Knuppel, MD

Conditions and Diseases

September 18, 2010

“Hey Doc, this guy needs some help.”

I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”

I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.

But, one of the questions that always pops into my …

Are Alzheimer’s disease screening tests ready for the public?

Naomi Freundlich

Conditions and Diseases

September 18, 2010

In April, an independent panel established by the National Institutes of Health came to the disheartening conclusion that currently, there is nothing to prevent or delay the progress of Alzheimer’s disease in those of us who are destined to join the 5 million Americans currently suffering from this dreaded ailment.

The panel found that: “Although numerous interventions have been suggested to delay Alzheimer’s disease, the evidence is inadequate to conclude that …

For autism, vaccination is the simple answer that is tragically wrong

Amy Tuteur, MD

Conditions and Diseases

September 17, 2010

It is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccination is presently unknown.

Vaccine rejectionists never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. Vaccine rejectionists always insist that vaccines …

There is no alternative medicine, only unproven medicine

George Lundberg, MD

Conditions and Diseases

September 17, 2010

There is no Alternative Medicine.

Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.

So I went to Mr. Google in 2010 and entered … Alternative Medicine … and clicked — 41,200,000 results; entered Complementary and Alternative Medicine, click — 3,210,000 results; entered CAM, click — 191,000,000 results, but that’s not fair; CAM can stand for many unrelated topics.

Let’s …

Chronic prostatitis is a public health problem

Arnon Krongrad, MD

Conditions and Diseases

September 17, 2010

by Arnon Krongrad, MD

David was afraid. After years of peregrinations with pain, he had exhausted all the options. David knew he wasn’t crazy. The problem was the doctors: They had no more treatments for chronic prostatitis. The doctors did not want to see him.

Chronic prostatitis is a public health problem. Contrasted with fibromyalgia, autism, and breast cancer, however, nobody talks about it. President Obama declared …

Can scientific knowledge overcome uncontrollable food behavior?

Susan Biali Haas, MD

Conditions and Diseases

September 16, 2010

I’ve struggled almost my whole life with food. During my late teens I was obsessed with dieting and calorie-counting, which turned into compulsive eating and a powerful addiction to sugary, fatty foods in my 20’s and 30’s – even though I had both a medical degree and a degree in dietetics (human nutrition).

Obviously, having scientific knowledge about food and health isn’t enough to help someone control their uncontrollable behavior around …