Endocrine care

Stop comparing depression to diabetes

Stop comparing depression to diabetes

Claudia M. Gold, MD

August 5, 2014Aug 5, 201411

At the recent gubernatorial candidates forum on mental health, Martha Coakley repeated the oft-heard phrase that depression is like diabetes. Her motivation was good, the idea being to reduce the stigma of mental illness, and to offer “parity” or equal insurance coverage, for mental and physical illness. However, I am concerned that this phrase, and its companion, “ADHD is like diabetes,” will, in fact, have the exact opposite effect.

A recent New …

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Health policy

What happens in the VA health system matters to all of us

David Mokotoff, MD

May 26, 2014May 26, 20145

Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like …

MKSAP: 32-year-old woman is evaluated for increased hair growth

May 24, 2014May 24, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a…

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

A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a 5-year history of hypothyroidism. Her only medication is levothyroxine.

On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/72 mm Hg, and pulse rate is 80/min; …

Despite positive trends, diabetes care has a long way to go

Albert Fuchs, MD

May 6, 2014May 6, 20145

The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leading cause of kidney failure and of blindness in adults.

A study performed by researchers at the …

Drugs and prescribing

The shocking ingredient in natural medicine

Pamela Wible, MD

April 3, 2014Apr 3, 201435

So you think your medicine is natural. Ever wonder what’s inside? A product can be labeled “natural” if the main ingredient is from an animal, plant, or mineral. Arsenic, horse urine, and cow brain are natural. But are they natural…

Insulin was discovered in 1922. Until the 1980s, all insulin was …

MKSAP: 59-year-old woman with type 2 diabetes mellitus and hyperlipidemia

March 22, 2014Mar 22, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well.…

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

A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin.

Physical examination findings and vital signs are normal. BMI is 27.

Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an …

MKSAP: 33-year-old woman with amenorrhea and galactorrhea

February 8, 2014Feb 8, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 33-year-old woman is evaluated for a 5-month history of amenorrhea and a 3-month history of galactorrhea. The patient says her menstrual cycles were…

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

A 33-year-old woman is evaluated for a 5-month history of amenorrhea and a 3-month history of galactorrhea. The patient says her menstrual cycles were normal before onset of amenorrhea. She takes no medication.

On physical examination, vital signs are normal. Visual field findings are normal. Bilateral galactorrhea is noted.

Results of laboratory studies show …

Health policy

Let’s learn from No Child Left Behind: Measuring quality in healthcare

Luis Collar, MD

January 20, 2014Jan 20, 201421

As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers.

But in an age where science, technology, and health policy …

Pizza or insulin: What does our society value more?

Vipan Nikore, MD

January 11, 2014Jan 11, 20148

Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels …

How many patients can a doctor safely see a day?

Luis Collar, MD

December 31, 2013Dec 31, 201335

Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness”…

With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …

You can’t legislate doctor-patient relationships

J. Russell Strader, MD

December 8, 2013Dec 8, 20132

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn't recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I…

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok. She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell …

Diabetes: More than a word, much more than a diagnosis

Bernadette Sheridan, MD

November 30, 2013Nov 30, 2013

As a family doctor based in Brooklyn, New York, who has served the needs of my community since completing residency in 1982, I find myself with a unique privilege and opportunity to observe disease and wellness, the effects of lifestyle, policy and the collective efforts of myself and others, as we attempt to keep our patients well and affect the statistical bottom line. I’m typing this as I also think …

Diabetes raise special concerns in the homeless

Duc Chung, MD

November 25, 2013Nov 25, 2013

Diabetes is an emerging national crisis. It is the leading cause of heart disease and stroke and the 7th leading cause of death in the United States. According to recent data from the Centers for Disease Control and Prevention (CDC), an estimated 25.8 million people are affected with diabetes with a staggering 79 million more living at high risk for the disease, a stage known as pre-diabetes. Unfortunately, about a third …

How young eyes are devastated by diabetes

Erin K. Walsh, MD

November 16, 2013Nov 16, 2013

Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly. In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they …

MKSAP: 38-year-old woman with increasing fatigue and weight gain

November 2, 2013Nov 2, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning…

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

A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 …

Drugs and prescribing

Remember the side effects of needed drugs that go untaken

David L. Katz, MD

September 12, 2013Sep 12, 20137

You probably already know that what you do know about your medicine could kill you. You may not know that what you don't know could do so as well. Hold that somber thought -- we'll get back to it. You,…

You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought — we’ll get back to it.

You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating …

A 15 minute office visit cannot dispel a year’s worth of confusion

Karan Chhabra

September 8, 2013Sep 8, 201315

Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, "Are you in…

“Yes sir, I’m a medical student.”

He eyed my drink and asked, “Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few …