Conditions

A surprising cause of rectal bleeding

Conditions
May 2, 2018

“I can’t stand the site of blood!”

We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.

If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …

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A pulmonary physician’s take on vaping

Conditions
April 27, 2018

Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device …

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The fall of the digital rectal exam

Conditions
April 16, 2018

For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.

As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …

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Reflections on school violence: a psychodynamic perspective

Conditions
April 15, 2018

The mental health community must increase its clinical acumen regarding complex psycho-pathology consisting of the avoidant personality, social impotence, and related rage. School violence has taken on epidemic proportions since two disturbed adolescents masterminded Columbine and became role models for the mentally ill young men who drive the new culture of school shootings.

While the profile of the school shooter has evolved over the last couple of decades, it’s worth considering …

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MKSAP: 41-year-old woman with burning epigastric and chest pain

Conditions
April 7, 2018

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

A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration …

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Learn typical community acquired pneumonia with a Medcomic

Conditions
March 26, 2018

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP.

The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, …

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What you should know about colon polyps

Conditions
March 22, 2018

When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …

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The challenge in oncology: balancing hope and reality

Conditions
March 14, 2018

asco-logo Part of the challenge in oncology is the balance between hope and reality, and that is probably the most important thing to strive for for patients living with metastatic disease. Often times, the important conversations relate to treatment options, goals of care, and patient preferences (i.e., how frequent the visits to the doctor and for …

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Don’t ignore ADHD in adults

Conditions
March 6, 2018

Eight-year-old Tommy has trouble paying attention in school, is always restless in class, unable to complete his tasks, hyperactive both in school and home and his teacher discusses the possibility of him having ADHD with his parents. They decide to take him to see a pediatric psychiatrist. After some analysis, he’s diagnosed with ADHD, prescribed with Ritalin and is on his way home with his medicine. Classic childhood ADHD story, …

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We are all aging every day. But mostly we ignore, do not recognize, or deny it.

Conditions
February 26, 2018

Part of a series.

We are all aging every day, but mostly we ignore, do not recognize or deny it. Then all of a sudden, we look in the mirror and realize that older age has found us. Even then each person deals with aging differently. There is Dr. Seuss’ “Cat in the Hat” who sees nothing but adversity in aging. There are others who accept aging but …

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Fixation error can be deadly in medicine

Conditions
February 26, 2018

John Grover is a nice guy. He’s fifty-five, short, a little chubby, and he has a neatly trimmed red beard. He’s the kind of guy whose eyes light up the moment you walk into the room; The kind of guy who remembers your kids’ names, their ages, and their interests. I’d met him a few times before. He’d come in once to refill his blood pressure medication because he couldn’t …

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It’s time to treat C. diff diarrhea

Conditions
February 20, 2018

For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors.  But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon.  This is our friend Clostridium difficile.

According to the CDC, there are about …

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How doctors should think: Heuristic thinking isn’t heretical

Conditions
February 14, 2018

Doctors are intelligent people, but are we good thinkers? And how should we think?

There are two basic kinds of thinking: analytic and intuitive. (And maybe good and bad, so that’s four.) Within medicine, analytic thinking can perhaps be best exemplified in the evidence-based movement, which began in the early 1990’s. It was a gilded age, full of promise, and bolstered by the reality that computers would give physicians instant access to the …

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Think twice before you give a hug

Conditions
February 10, 2018

I’m usually a hugger. When I see people I haven’t seen for a while or want to acknowledge someone in an open-hearted way, I often will automatically reach for a hug. Physical acknowledgment is usually perceived as a sign of warmth. But not always. In the last few years, I have noticed that this automatic hug can actually cause harm or insult even though my intent is not to.

I learned …

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MKSAP: 75-year-old man with very severe COPD

Conditions
February 3, 2018

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

A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He …

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Stop opioid addiction where it starts: in the hospital

Conditions
January 29, 2018

Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.

Even for people who’ve never struggled with drug abuse, studies …

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My husband was dying. I was being ignored.

Conditions
January 25, 2018

It was a long December.

A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.

He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.

His eyes haunted me as …

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A story of 2 torsions

Conditions
January 13, 2018

The kids were asleep, and I could hear a muted, distant moaning coming from our bedroom. It reminded me of labor pains, but there were three things making labor unlikely: my wife’s IUD, the absence of a gravid abdomen and the kind of unintentional celibacy that occurs between working parents raising two toddlers. I tried to ignore the moaning. In part, because it was a Sunday night, and the sound …

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Learn about Salter-Harris fractures with a Medcomic

Conditions
January 13, 2018

Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system.

Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate.

Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures.

Type III fractures occur through the …

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