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.

Health decisions are not entirely based on evidence based data

Kathy Kastner

September 15, 2010

“Science tells us nothing about the individual.”

So said Dr. Susan Pinker, psychologist and author. This perfectly articulated truth puts into perspective popular thinking: To make a decision, the most important thing is evidence-based information: all you need is science. To this I say, that’s a bunch of hooey. Science tells us nothing about the individual. Thank you Dr. Pinker.

Creating the expectation that health decisions are entirely based on evidence-based information …

Does the DSM-5 medicalize normal behavior?

MedPage Today

Conditions and Diseases

September 14, 2010

by John Gever

Just about everyone catches colds, and just about everyone who gets one is able to go to work and cook their meals, and they nearly always recover within a few days whether or not they take anything for it. That’s normal.

So, is the advice to take aspirin “medicalizing normal behavior”? Are drug companies that market decongestants and fever reducers “medicalizing normal behavior”?

The answer …

Why you need the pertussis vaccine, especially if you have children

Roy Benaroch, MD

Conditions and Diseases

September 12, 2010

A reader wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?”

I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update.

Pertussis, also called “whooping cough,” is bad news. For children and …

Contraceptive pill prices have a huge price range

Leslie Ramirez, MD

Conditions and Diseases

September 10, 2010

Do you know that the price of a contraceptive pill in Chicago pharmacies varies from $9 (Trinessa, aka generic Tricyclen, at Target pharmacy) to $84 (Loestrin 24 at Kmart pharmacy) a month? That means, over the course of the year, depending on what pill you take and where you shop, you could drop as little as $84 or — let me get my calculator here — $1008! These prices are if you pay out …

What is an adequate trial of an antidepressant?

Dheeraj Raina, MD

Conditions and Diseases

September 10, 2010

Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.

However, it’s worth looking at some guidelines.

A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …

Alzheimer’s disease needs better preventive strategies and treatments

William R. Yates, MD

Conditions and Diseases

September 8, 2010

The Alzheimer’s Association sponsors a journal titled Alzheimer’s & Dementia. In the March 2010 issue, they provide a report on facts and figures related to Alzheimer’s disease (AD).

I’m a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:

Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop …

Why are hearing aids so expensive, and reading glasses so cheap?

Randall S. Bock, MD

Conditions and Diseases

September 7, 2010

I am currently 53 years old, but I recently found an imperfection in my near-vision. I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the …

Some MRI places have good quality machines, others are obsolete

Doctor Grumpy, MD

Conditions and Diseases

September 7, 2010

“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.

Here is where the problem began. Everything about Dave’s exam and story pointed …

How to use your CPAP machine when traveling

Steven Y. Park, MD

Conditions and Diseases

September 6, 2010

One of the most common excuses for not wanting to use CPAP is that “I travel a lot.” Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant.

With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be …

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

September 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology at Beth Israel Deaconess Medical Center, along with an endocrine fellow, Laura Sweeney, MD.

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Acute gonorrhea in Congo

Yann Meunier, MD

Conditions and Diseases

September 5, 2010

Year: 1984

Setting: Ouesso, Congo
Position: Timber consortium medical expert

We landed in Brazzaville and took a private jet to Pointe Noire where we spent the night. The next day, the group is assigned six 4×4 Toyotas to take through the Mayombe Mountains, Brazzaville and the plateau to reach Ouesso near the Cameroon border.

The journey is eventful, particularly when I drove the pickup truck into a river from a bridge to avoid children …

Read more…

Acute gonorrhea in Congo

Preparing for gastric bypass surgery by eating more

Douglas Perednia, MD

Conditions and Diseases

September 2, 2010

Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.

This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with …

MKSAP: 62-year-old man is evaluated for an asymptomatic nodule

mksap

Conditions and Diseases

September 2, 2010

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

A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown.

MKSAP image © 2010, American College of Physicians, Medical ...

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The TPA time limit for acute stroke causes mass chaos in the ER

ER Stories, MD

Conditions and Diseases

September 1, 2010

I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.

First, one has to …

What is Glenn Beck’s macular dystrophy?

Michele R. Berman, MD

Conditions and Diseases

August 31, 2010

During a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America” tour, the Fox News pundit told the crowd:

“A couple of weeks ago I went to the doctor because of my eyes, I can’t focus my eyes…he did all kinds of …

Read more…

What is Glenn Beck’s macular dystrophy?

Watchful waiting pays off for a torn ACL

Merrill Goozner

Conditions and Diseases

August 30, 2010

“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.

My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in …

Whooping cough and pertussis tips you need to know

Jan Gurley, MD

Conditions and Diseases

August 30, 2010

As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.

Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass …

Root beer bonds a chemotherapy patient with his oncologist

Kevin

Conditions and Diseases

August 30, 2010

by Krupali Tejura, MD

I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.

To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …

Obesity is a complex problem that may not have simple solutions

Arya M. Sharma, MD

Conditions and Diseases

August 28, 2010

A single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.

In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).

The best description of complexity was the “simplified” one I found in …

Treating vitamin D deficiency requires caution

Kenneth Lin, MD

Conditions and Diseases

August 27, 2010

Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.

This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …

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