I used to whisper it into the dark, lying awake, watching the clock creep past 2 a.m. My body was exhausted, but my mind refused to stop sprinting, running a veritable marathon most of the night. When the sun finally pushed through the curtains, it didn’t feel like morning. It felt like failure, another day to muscle through on fumes.
Sometimes that was the hardest moment of the day. Little sleep …
For decades, cholesterol (LDL, HDL, triglycerides) has been the central focus of cardiovascular prevention. But in recent years, another player has emerged: lipoprotein(a), or Lp(a).
Many patients have never heard of it, yet research shows it may be one of the most important genetic risk factors for heart disease.
What is lipoprotein(a)?
Lipoprotein(a) is a particle in the blood similar to LDL cholesterol, but with an added protein called apolipoprotein(a). This structure makes …
They tell me the physician’s art lies in the stitching of skin,
the analysis of shadows on X-rays,
and interpreting numbers in a medical chart.
Yes, there is skill involved.
a steady hand, a quick eye,
and a good memory for pathways and procedures.
But I wonder.
where, in the span of 20-25 minutes,
is the art that cannot be quantified
or coded?
It’s found in the stillness of listening,
in the weight of one person’s story
resting in another’s hands.
A doctor …
Introduction: a crisis of pain
The opioid crisis is one of the most significant public health emergencies of our time, defined by staggering rates of addiction and overdose. Yet, behind the headlines is a story of profound and often overlooked human suffering. In an effort to save lives, public health policies were enacted to aggressively reduce opioid prescriptions. While well-intentioned, these policies have inadvertently precipitated a parallel crisis of iatrogenic harm, …
My son Gideon is almost 12 years old. He is funny in that sharp, unexpected way that catches you off-guard. He is deeply expressive and full of life. He gives love and joy more freely than most kids his age. He is curious and social. He is healthy, and I am grateful for it. We are endlessly proud of who he is.
And, our family constantly walks the edge of breaking …
When parents bring their children to the clinic, they often expect quick advice: “Eat healthy. Exercise more.” But after years in practice, I’ve learned those generic prescriptions rarely work. Families leave feeling uncertain, children feel pressured, and real changes at home are hard to sustain.
That’s why I focus on a family-centered, personalized approach. Nutrition is not just about a child; it’s about routines, traditions, and stresses that affect the whole …
When most people think of seizures, they picture someone falling to the ground with violent shaking, the dramatic scenes we’ve seen in movies and television. While these tonic-clonic seizures (previously known as grand mal seizures) do occur, the reality is that many seizures look nothing like what Hollywood portrays. They are often subtle, easily missed, and can be mistaken for daydreaming or unusual behavior.
More than 3 million Americans have active …
When people think about breast cancer, they picture middle-aged or older women. The pink ribbons, awareness campaigns, and even clinical guidelines overwhelmingly focus on adults. What’s almost never discussed is that, though rare, breast cancer can occur in teenagers. And when it does, the diagnosis is often delayed, with consequences that change a young life forever.
Breast cancer in adolescents is extremely uncommon, accounting for less than 1 percent …
My primary focus is on U.S. and international public health policy for treatment of severe chronic pain. I have been active for over 28 years as a health care writer and educator, with over 300 papers authored or co-authored in a mix of peer-reviewed journals and mass media.
I am a particular critic of what I believe to be the proven misdirection (a.k.a. “fraud“) committed by Federal and State …
I just read yet another article praising the new messiah of cardiology (Lipoprotein(a)) and urging every physician in America to start testing for it. The tone was familiar: solemn, scientific, and a little evangelical.
The message? “Measure Lp(a) once in every patient.”
The subtext? “Because we finally found the missing piece.”
If this feels like déjà vu, that’s because it is. We’ve been here before: first with total cholesterol, then LDL, then HDL …
I was diagnosed with type 1 diabetes mellitus in February 2024. Now it all made sense.
It all started in October 2020 when I passed out cold. I was rushed to the emergency room and 3 days later woke up to find I had a thyroid issue and lost 2 pints of blood. Four days later, after a blood transfusion, I was sent home. At that point, I thought I was …
As an internist and lipidologist, I’ve spent decades parsing data on statins, ezetimibe, PCSK9 inhibitors, and the endless parade of “LDL-lowering breakthroughs.” Yet the most potent, and perhaps the most underappreciated, intervention to prevent heart attacks each winter doesn’t come from a cardiology journal or a pharmaceutical rep. It comes from your local pharmacy fridge. For years, I’ve told my patients that getting a flu shot may prevent a heart …
A glass of wine with dinner. A cocktail on a Friday evening. A few beers over the weekend. For many of my patients, alcohol is woven seamlessly into daily life: a social lubricant, a way to unwind, even something they’ve been told might be “heart-healthy.”
Yet, in my clinic, I see the other side. A patient who comes in with fluctuating blood pressure, convinced their readings must be wrong. Another who …
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It’s been weeks since the news broke of UniQure’s trial successfully slowing the progression of HD, and I still find myself breaking down in tears. I have been going about my life, doing the groceries, going to the gym, cleaning the house, and the tears keep coming unexpectedly. I am happy about the news, but that is not how it feels in my body. I have come to realize …
Lipoprotein(a) [Lp(a)] was, until recently, an underrecognized cardiovascular risk factor. However, extensive research over the last 15 years (including vast genome-wide association studies) has confirmed an independent, causal link between elevated lipoprotein(a) levels and atherosclerotic cardiovascular disease (ASCVD). The science has shown that, despite their small size, Lp(a) particles can have a substantial health impact, and as many as one in every five individuals worldwide has elevated levels (defined as …
Teen girls are turning to chatbots, not for homework help, but for the questions they’re too afraid to ask anyone else. Not their parents. Not their teachers. Sometimes not even their closest friends. Instead, they whisper their fears into an empty chat box late at night, hoping the words land softly somewhere.
These aren’t silly or shallow questions. They’re small windows into a generation growing up online, trying to feel safe …
Tonight, my lab quietly changed what it considers a “normal” ApoB. On Monday, my patient’s ApoB of 98 mg/dL was comfortably green. On Tuesday, that same number was flagged high, a 30-point swing in the normal range overnight. No new evidence. No new trial. No public health crisis. Just a reference-range recalibration. And with that one quiet adjustment, millions of people who went to bed “normal” may wake up “abnormal.”
Reference …
Carrier screening has outgrown the language we still use to explain it. The rapid expansion of genetic testing has uncovered new layers of complexity in how conditions present, how results should be interpreted, and how patients experience and act on genetic information. To practice responsibly in this era of Genetic Carrier Screening 3.0, clinicians must understand not only what we are testing for, but how and why the results look …
Autism was never meant to be diagnosed in 15 minutes.
The original vision, born in war-torn Vienna and postwar Baltimore, called for deep observation, multidisciplinary insight, and time. But somewhere between the ideal and the insurance code, we lost the standard.
Today, families navigate a system built for speed, not truth. And children pay the price.
The ideal vs. reality
In theory, pediatricians perform routine developmental surveillance. Screenings like the M-CHAT happen at 18 …
I come to you with stories
I cannot name.
They press against my chest
waiting for a moment when
it feels safe
for them to be set free.
Pain is a language
I find difficult to speak aloud,
and the silence between us
feels like a waiting room
that will never empty,
pressing in on me,
catching my breath.
Two strangers,
white walls between us,
your eyes move toward the clock,
while mine look at my folded hands
resting in my lap.
I wonder
am I just a time …
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