Conditions

Diagnosed with prostate cancer? You must ask these 10 questions.

Conditions
December 20, 2018

Prostate cancer often presents unique challenges to patients and physicians alike. It can be indolent and non-aggressive — or life-threatening and everything in between. Unlike most cancers that have a dedicated roadmap for treatment for prostate cancer revolves around opinions and biases.

To help patients navigate the landmine of prostate cancer, I’ve compiled a list of 10 basic questions to ask when diagnosed with prostate cancer. Here they are:

1. “What is …

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A clinician’s guide to microbiome testing

Conditions
December 17, 2018

The intestinal microbiota, also commonly known as the ‘‘gut microbiome’’ is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and even nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods …

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A surgeon mistakes a kidney for a tumor. How can this happen?

Conditions
December 3, 2018

A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred?

The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide …

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Lewy body dementia and a farewell to a physician’s father

Conditions
November 20, 2018

When I finished my training, I was taught that the vast majority of dementia was Alzheimer’s disease, with occasional cases of multi-infarct dementia as well as odd syndromes such as Kreutzfeld-Jacob disease and genetic, traumatic, toxic and tumor-related syndromes. Parkinson’s disease, we were taught, caused a tremor and freezing up of a person’s movements and only very rarely was associated with any kind of memory loss.

These teachings helped us modern …

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Everything you ever wanted to know about croup

Conditions
November 20, 2018

Imagine this scenario. Your two-year-old son has had a runny nose for a day or two and an occasional cough, but seemed no worse to you that everyone else in his preschool class. Two hours after you put him to bed you hear him coughing, only this cough is like none you have ever heard from him before. It sounds like a barking seal at the circus — a brassy, …

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How technology removes the pain point from diabetes management

Conditions
November 17, 2018

There is a wealth of information about your health circulating in your blood. For people with diabetes, accessing that information can be a matter of life or death.

For nearly 30 years, the prevailing technology for checking the blood sugars of someone with diabetes has been the fingerstick. People with diabetes are often asked to stick their fingers and check their blood multiple times a day to assess whether their blood …

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MKSAP: 79-year-old man with a sacral ulcer

Conditions
November 3, 2018

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

A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Although his lymphoma has responded well to therapy and he is without evidence of active disease, he required hospitalization three times for chemotherapy-associated complications during his treatment course. He has been …

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ACL injuries in middle-age athletes

Conditions
October 10, 2018

Over the last 20 years, physical fitness as a means to improve overall health has increased among the over-40 set. This is great, right? Yes, absolutely. Athletes who remain active as they age do a better job than non-athletes in retaining lean muscle mass. They also show improved bone density, bone structure and bone strength. However, what physicians are seeing are injuries related to the increased level of activity.

One area …

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It’s the physician’s job to think of worst-case scenarios

Conditions
October 3, 2018

I saw two patients with a chief complaint of bubbles in their urine this month.

One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK.

Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV …

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A breakdown of your pathology report

Conditions
September 27, 2018

I’m a pathologist and the main way I communicate to the outside world — to your doctor and ultimately to you, the patient is via the pathology report. But the short missives I send from behind the microscope lack any excitement and can fall short of full communication.

Here’s the usual story:

Skin left scapula, biopsy

Nodular basal cell carcinoma

Negative for perineural invasion

Margin status: Positive

Doesn’t sound real interesting, does it?

How about a more …

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A physician with congenital heart disease

Conditions
September 21, 2018

Everyone always jokes with doctors, “What happens if you get sick?” Some of us laugh off the question. The busy schedule of health care often means our own health comes last. However, what happens when it’s a chronic disease that requires treatment? Then the answer to this question is a little different.

I am a family medicine physician dealing with congenital heart disease (CHD). Saying that someone has congenital heart disease …

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Words can hurt those on benzodiazepines

Conditions
September 20, 2018

There exists a large, mostly-underground, growing community consisting of those iatrogenically harmed by benzodiazepines. Guilty only of following doctors orders, these patients are marginalized and misunderstood. This has been enabled, at least in part, by poor terminology.

Recently on Twitter, Michael P. Hengartner and Marnie Wedlake both posted critical questions in response to a benzodiazepine news story:

In response to …

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10 things a pediatric oncologist wants you to know

Conditions
September 17, 2018

1. Cancer is not rare.  Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think.   Outside of my work, I can think of 3 people who I know personally that had a childhood cancer.  A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate.   My guess is that you also know someone from church, a coworker’s …

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The existential benefits of ginger ale

Conditions
September 14, 2018

On a curiously warm morning last February, the minister arrived at my childhood home to guide my father to the other side. When he approached the bedside where all of us were gathered around with the Eagles Pandora radio humming in the background, my dad emerged from a semi-conscious state and sat up as best as he could. “Listen. I am not dying,” he declared. As an early-career researcher focused …

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The problem with extreme social media challenges

Conditions
September 6, 2018

Trends or challenges have been a part of the fabric of social media for a long time. They have ranged from the benign ice bucket challenge (which raised millions for research on amyotrophic lateral sclerosis) to the highly dangerous Tide pod challenge (which involved eating laundry detergent capsules). All of these internet phenomena involved videotaping an individual who performed a bizarre physical action for the …

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MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus

Conditions
September 1, 2018

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

A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and …

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Food allergy: Death is not our only fear

Conditions
August 28, 2018

Recently, a respected allergist reassured his audience: the mortality rate for food allergy is very low. The risk of dying in a car crash is much greater than the risk of dying from food allergy. The implication seemed to be that the anxiety around food allergy is misplaced. Though any loss of life is too great; statistically, food allergy deaths are rare. To the food allergy community, it just doesn’t …

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