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.

Obesity in American children and adults continues to grow

Emily P. Walker

August 4, 2010

by Emily P. Walker

The number of obese adults in the U.S. continues to rise, despite a growing number of federal anti-obesity initiatives in the past two years, according to a new report.

The seventh annual “F as in Fat” report, released Tuesday by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation, found that obesity rates continued to rise in 28 states from 2007 through 2009.

Nationally, two-thirds of …

Breathe properly at night and learn to sleep better

Steven Y. Park, MD

Conditions and Diseases

August 4, 2010

Every time you see a depiction of someone sleeping on TV or in the movies, you’ll see the person sleeping on his or her back, and oftentimes, snoring.

The lay public, doctors, and even alternative and complementary practitioners naturally assume that you’re able to breathe properly at night. This couldn’t be further from the truth.

Evolutionary biologists and comparative anatomists have stated that speech and language development was ultimately detrimental to humans. …

Unread echocardiogram fallout at Harlem Hospital Center

Larry Husten, PhD

Conditions and Diseases

August 3, 2010

Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.

It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. …

The difficulty of regulating x-ray radiation in the ER

WhiteCoat, MD

Conditions and Diseases

August 2, 2010

A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.

The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed …

How adult smoking affects behavior in children

MedPage Today

Conditions and Diseases

August 1, 2010

by Nancy Walsh

Both maternal and paternal cigarette smoking can contribute to adverse chronic conditions — physical and psychological — in children, two large studies found.

Writing in the July issue of Pediatrics, Marie-Jo Brion, PhD, of the University of Bristol in England, and colleagues reported that children in two cohorts whose mothers smoked were more likely to have conduct/externalizing behavior problems than were those who had no prenatal tobacco exposure:

* British …

Watchful waiting is a powerful diagnostic tool

Michael Gonzalez, MD

Conditions and Diseases

July 31, 2010

Childhood is full of self-limited illnesses. Kids get sick and kids get better. The majority of childhood illnesses will get better on their own. Because of this, observation and “watchful waiting” is often the most useful diagnostic test at the pediatrician’s disposal.

Parents are often confused about the need for testing. Their experiences with adult medicine is typically full of lab tests and imaging studies. Unfortunately some parents equate the quantity …

Early dialysis may not improve kidney failure outcomes

MedPage Today

Conditions and Diseases

July 31, 2010

by Nancy Walsh

Planned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes, a multicenter randomized trial conducted in Australia and New Zealand found.

The hazard ratio for death among patients who had an early start of dialysis, when the estimated glomerular filtration rate (GFR) was 10 to 14 mL/min, was 1.04 (95% CI 0.83 to 1.30, P=0.75), according to Bruce A. Cooper, …

When a biopsy cannot completely rule out cancer

Jeffrey Parks, MD

Conditions and Diseases

July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

Diabetes is responsible for many heart disease deaths

Kristina Fiore

Conditions and Diseases

July 30, 2010

by Kristina Fiore

More than one in 10 heart disease deaths may be attributable to diabetes, researchers say.

In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

They reported their findings online in The Lancet and will present …

Cell towers do not increase childhood cancer risk

Crystal Phend

Conditions and Diseases

July 28, 2010

by Crystal Phend

Mobile phone base station towers boost cell reception, not childhood cancer risk, a British population-based study showed.

Children whose mothers lived near a high-output cell phone antenna mast while pregnant were no more likely to develop childhood cancer than those who lived farther away, found Paul Elliott, MBBS, PhD, of Imperial College London, and colleagues.

Exposure to an intermediate level of cell tower power output was associated with an adjusted …

Obesity should not require specialists to manage

Arya M. Sharma, MD

Conditions and Diseases

July 28, 2010

Medical school trains us to deal with a wide range of medical problems.

No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us …

Certified stroke centers and ischemic stroke treatment realities

Kevin

Conditions and Diseases

July 28, 2010

by John Fauber

Time is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center — a center that could administer clot-busting therapy quickly, and safely — was considered the surest way to “save brain.”

That was the concept behind the certified …

The art of medicine and whether computers can replace doctors

Eric Van De Graaff, MD

Conditions and Diseases

July 27, 2010

My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.

For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched …

Sometimes more expensive care is better treatment

Kevin

Conditions and Diseases

July 27, 2010

by James Gaulte, MD

A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.

A survey of “consumers” found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.

The idea that more care and more costly care gives inferior …

Defensive medicine forces residents to use test oriented care

a medical resident, MD

Conditions and Diseases

July 26, 2010

A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.

Is it true? Absolutely.

It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …

Chronic illness needs to be managed at home, not at the hospital

Shantanu Nundy, MD

Conditions and Diseases

July 25, 2010

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him…” [the ICU team laughs] …

“But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without that somebody …

Parents who want genetic testing for their children

Kristina Fiore

Conditions and Diseases

July 25, 2010

by Kristina Fiore

More than a third of parents who have been tested for genetic breast cancer risk say they’d support similar testing for their children — despite scant evidence of any benefit for young people, researchers have found.

In interviews with 246 parents who were tested for the BRCA1/2 mutation, 37% supported testing minors, compared with 55% who opposed screening, according to Angela R. Bradbury, MD, of Fox Chase Cancer Center …

Smoking, hypertension, obesity, and 7 other stroke risk factors

Kristina Fiore

Conditions and Diseases

July 22, 2010

by Kristina Fiore

There are 10 factors that appear to make up the vast majority of stroke risk, and half of those are modifiable, a large population study found.

Hypertension appears to be the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O’Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada.

“This is good news in the sense that the causes of …

Viagra for muscular dystrophy and publicity for accidental insight

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

July 22, 2010

by Jeoffry B. Gordon, MD, MPH

As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.

Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …

Watchful waiting may be appropriate for most prostate cancer cases

Crystal Phend

Conditions and Diseases

July 19, 2010

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

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