Oncology and hematology

Fish oil and prostate cancer: Go beyond the headlines

David L. Katz, MD

August 12, 2013Aug 12, 20134

I suppose it may help diffuse any relevant tensions to get the punch line out of the way: I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement (krill oil in my case). We will, as well, continue using various omega-3 supplements in varying doses for specific therapeutic purposes in my clinic.

And now, let’s turn to the …

Real physician voices, twice a week

Free, and one click to unsubscribe.

The very best physicians do not judge their patients

August 10, 2013Aug 10, 201315

It occurs to me there are several keys to being an excellent physician. One must love science, enjoy hard work, have the courage to make tough decisions, carry a modicum of intelligence and suffer angst at receiving 94% on an organic chemistry test. In addition, the very best physicians, those we admire and to whom we flock, have a secret weapon. They do not care.

I do not mean that they …

MKSAP: 58-year old woman with fatigue and weight loss

mksap

August 10, 2013Aug 10, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes…

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

A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history.

Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 …

Can prayer heal the sick?

Can prayer heal the sick?

Michael Kirsch, MD

August 8, 2013Aug 8, 201310

Faith and reason entered my medical universe recently. A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her…

Faith and reason entered my medical universe recently.

A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related …

Read more…

Patient voices

Good doctors are those who genuinely care about patients

Robert Spencer, MD

August 7, 2013Aug 7, 201368

Helpless. That is how I felt when my mother found out she had a fibroid the size of a cantaloupe living in her uterus. In my role as a medical student I might have dismissed the finding as nothing serious, telling my patient, “Don’t worry, it could be much worse.” But as a loving son I was not quite as cavalier. At first my mother resolved to ignore the fibroid, …

Do you worry about the diseases you learn in medical school?

Hans Duvefelt, MD

August 7, 2013Aug 7, 20132

It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was Morbus Crohn, chart notes …

Drugs and prescribing

E-cigarettes: Are they effective? Are they safe?

Deep Ramachandran, MD

August 7, 2013Aug 7, 20132

Electronic cigarettes are here, settling over the country, quite literally, like a fine white fog. Smokers in turn, have been turning to them as a tool to help them quit, though the device manufacturers are not allowed to market them that way in U.S. It seems intuitive that a device that mimics the action of smoking but without the combustion and …

Medical education

You may not remember me, but you changed me

Ilana Yurkiewicz

August 7, 2013Aug 7, 201313

You may not remember me, but when I asked how you were, you said, “alive.” A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that…

You may not remember me, but when I asked how you were, you said, “alive.”

A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.

You may not remember …

Melanoma refuses to abide the laws of general civilization

Samyukta Mullangi

August 6, 2013Aug 6, 201312

The man who had been seated in room 2 by the medical assistant had been seen 6 months previously for a small, pigmented lesion behind his left ear, which a punch biopsy subsequently proved to be malignant melanoma in situ. He was sent to the Mohs surgeon in the interim who carefully excised just as much skin as was absolutely necessary and …

Exercise is a powerful tool in the fight against cancer

August 1, 2013Aug 1, 20136

If you had cancer, how good would a treatment have to be, how much would it have to help, for you to use it? How about if it gave you a 5% better chance of cure? A 10% chance? How…

If you had cancer, how good would a treatment have to be, how much would it have to help, for you to use it? How about if it gave you a 5% better chance of cure? A 10% chance? How about a 20% chance to be beat the disease using a treatment without side effects that is free? “Sign me up,” you say? Nonetheless, only 8% of breast cancer patients …

Lessons learned from a family meeting

Lessons learned from a family meeting

Don S. Dizon, MD

July 29, 2013Jul 29, 20134

Recently, my family experienced the loss of someone very dear- Uncle Peter. Peter was an ex-Marine, father of three men, and patriarch of my spouse’s family; not to mention, husband to my wonderful and artistic Aunt Helene. He had been admitted to an outside hospital with leg ischemia and was transferred to a tertiary facility. Unfortunately, things did not turn out …

Read more…

The unwritten contract: Cancer cannot be beaten any other way

July 27, 2013Jul 27, 20135

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

July 26, 2013Jul 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what…

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

Drugs and prescribing

The Supreme Court on Myriad: Will it stifle innovation?

Nicole D. Kling, PhD

July 26, 2013Jul 26, 2013

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy. The lawsuit revolved around patents owned by…

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy.

The lawsuit revolved around patents owned by Myriad related to its BRACAnalysis test, which assesses the likelihood that a person will develop certain cancers, including breast cancer, by searching the DNA for disease-causing …

Medical education

Discovering medicine’s unrehearsed harmony

Ron Li

July 24, 2013Jul 24, 2013

There is something deeply satisfying about hitting the right note on the violin. On the rare occasion when my left hand is perfectly positioned and my bow arm is applying the perfect amount of pressure on the violin string, the resulting note that resonates from the wooden belly of the instrument is, for lack of a better word, perfect.

My favorite piece that …

A guide to giving bad news to patients

A guide to giving bad news to patients

July 22, 2013Jul 22, 20136

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.

A …

Read more…

Drugs and prescribing

News on cancer breakthroughs: Curb your enthusiasm

Christopher Johnson, MD

July 20, 2013Jul 20, 2013

Hardly a day goes by when some news outlet does not report, often breathlessly, some new breakthrough in cancer research. We need to turn a skeptical eye on most of these reports, particularly those that contain information about very preliminary research findings. The always astute Gary Schweitzer gives a good perspective on this in his HealthNewsReview.org; it’s a good site to bookmark if you follow the medical news.

…