He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats, to 40 beats, to that which is incompatible with life. The nurse pushed …
These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.
I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.
On physical examination, vital signs are …
Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate …
Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …
I was working a few days ago and pulled a tooth. Mind you, it’s not something I do with any regularity. However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues. That lower incisor was loose, and constantly in the way. Furthermore, it was painful.
I had seen her for something else in the emergency department. I took …
During my time in practice, I had at least eight patients who came to me sure they had systemic lupus erythematosus, also commonly called SLE or lupus. This is an autoimmune disease, characterized by joint pain, that can affect almost any organ, including skin, kidneys, brain, and heart, and can even be fatal. In every case, they had been given this diagnosis because of a blood test called an ANA, …
Last month I saw Joan, a woman who has had low back pain for years. She’d been through the ringer like every other person in severe pain: countless procedures and medications. She continued to have daily pain that stopped her from staying focused at work, playing with her kids or being the spouse or friend she wanted to be. After our long consultation and review of her records my prescription …
There are roughly 15 percent of the nation’s children who suffer from a developmental-behavioral condition or about 1 in 6 children. Unfortunately, many of those children often do not get the help they need.
Children with developmental and behavioral challenges can easily be missed, especially when the behaviors are more subtle or impacts on function are not evident daily, such as with a …
A man in his fifties is wheeled into the emergency department on a gurney hoping he’ll still be around to cheer from the sidelines at his daughter’s next soccer game. A little girl on the pediatric floor upstairs simply hopes her tummy stops hurting. A woman in the clinic explains her puzzling symptoms and hopes that this is the specialist who will finally be able to ascertain why she hasn’t …
Some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions.
I recall a child with severe abdominal pain. He had tried numerous medicines and had had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere …
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Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend three kid-size meals and 1 to 2 snacks to help them get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you …
As a sports medicine orthopaedic surgeon, I often see patients with complaints at their elbow. One of the more common diagnoses is tennis elbow, otherwise known as lateral epicondylitis. Surprisingly, most of my patients with this condition don’t even play tennis! Many types of repetitive arm movement can lead to tennis elbow. It all has to do with the tendons in our arms.
Tendons are the structures that hold muscle to …
As medical professionals, one of the most challenging things to do is to motivate a patient to make changes in their lives. We passionately want the best for our patients, and it is sometimes so difficult for us to be able to connect with and inspire them to take the next step on a path to disease prevention and longevity. The solution? Enter Lebron James and Tom Brady.
It is no …
When it comes to communication in the hospital setting, I have seen many iterations. My favorite version was at the VA on the inpatient medicine unit. Every morning, we all met in the medicine team room to discuss patients on the floor. The team’s social worker, nurses, residents, students, and the attending ran down the list to identify individual patient goals, what’s needed for safe and effective discharges home, and …
“Grandma fell and we’re in the emergency room. She’s very distressed and does not look good. I’m going to put the doctor on the phone.”
I could hear my mother’s voice strain on the other end of the phone line as I braced myself for my conversation with the emergency department physician.
The emergency physician told me that though the work-up was still developing, my grandmother was in respiratory distress, and that …
The Brazilian butt lift (BBL) is a procedure that enhances the buttocks through fat transfer. Excess fat is harvested from other areas of the body including the abdomen, hips, lower back and thighs through liposuction. BBL is a popular procedure for those seeking to enhance their bodies. However, with the recent reports of patient deaths from undergoing BBL, many have now labeled it as the most dangerous cosmetic procedure.
Dangers of …
As more patients and clinicians are searching for holistic approaches to health care, Ayurveda, or the traditional medical system of India, has been gaining popularity in the Western world. Unfortunately, many allopathic physicians still view this system as “quackery” because of its focus on the “intangibles” of health. However, Ayurveda has contributed immensely to the foundations of modern medicine, which many may not know. Sushruta was an Indian scholar and …
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