I chose endocrinology to be my lifelong profession out of love for the complex interactions of endocrine glands and intricate feedback loops. I take pride in preventing medical complications, prolonging life expectancy, and providing complex care to type 1 and type 2 diabetics. At times, this field of work requires spending hours — either with the patient or before or after patient visits — counseling, examining blood glucose data and …
A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.”
As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves.
Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a …
Busy primary care physicians have a lot on their plates. But when it comes to helping people with diabetes learn how to improve their health, they don’t have to do it all themselves. Diabetes self-management education and support (DSMES) programs, led by a diabetes educator, can provide vital assistance by helping people with diabetes maintain a healthy weight, quit smoking, begin an exercise routine and integrate other self-management behaviors into …
I recently had a patient whose blood sugar was well controlled until he lost his health insurance. He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin. His diabetes had been well controlled. Now, almost a year later, his hemoglobin A1C was 14, or double what it should be. The HbA1C measures sugar control over the last three months.
I just had a conversation with a physician and faculty member at my school. He started the conversation like this: “It’s alright if you disagree with me, and I can disagree with you too. Good academic discourse should allow people to disagree with each other.”
He then allowed me to question him and explain my perspectives for over an hour as he explained his answers, helped clarify some points, and gave …
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 …
A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …
As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …
As a medical student, I have big shoes to fill. I feel that void in my foot-space at all times. These shoes are expensive, and they are monstrously huge. We’re talking circus-clown, Shaquille O’Neal, Andre the Giant shoes. I feel awkward in these size 24s. I’m stumbling and scuffing them, but I’m not even close to calling it quits. These shoes are staying on. I am trying as hard as …
A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …
How would you like to double your chances of winning the lottery? Just buy two tickets!
Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment?
Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk.
I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are …
A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.
On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.
I was offered my choice of bisphosphonates after breaking my shoulder and ended up with a diagnosis of osteoporosis. I initially opted for Reclast, a drug that only requires one dose a year albeit by IV infusion. I made an appointment to get the drug several weeks later. I wanted to have time to research my options. After reading as much as I could during that time, I made an …
It’s amazing how quickly my role changed from physician to patient, thanks to a silent assailant: osteoporosis.
I went to the gym in the morning before work 12 days ago, as I often do now that my children are all grown up and out of the house. First, a couple of light sets of leg exercises served as a warm-up, and then I started a set with a barbell on my …
“To be trusted is a greater compliment than to be loved.”
– George MacDonald
As we adjust her position on the surgical table, I spot some short, vertical scars on the front of her neck. The parallel slashes sit directly over her enlarged thyroid — a goiter — and appear to have been deliberately placed. There are two sets of scratches, one set on either side of the neck, nearly identical in length and evenly …
“Your wife has gestational diabetes.” My heart stopped when my wife’s physician called to tell me this. “I want you to tell her because it’ll be easier to give it some time and let it sink in. Tell her to call me if she has any questions.” But I had questions — about a million.
My brother wears a scar around his neck. It represents his second surgery for papillary thyroid cancer. The first started off the same way. Ugly, red and angry. Curving like an ominous smile around his neck, like a noose. That’s how it felt too — the lump in his throat growing as he sat quietly, alone in a doctor’s office. It’s interesting how physical scars are a visual manifestation of …
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
Josh Green’s novel — and recent film — The Fault In Our Stars (TFIOS) is a new classic of young adult fiction, deservedly famous, and it’s easy to see why. The story is simultaneously deeply sad and really funny, mostly due to the narrator, Hazel. She is an intensely likable 16-year-old, who charms you even while she explains, stoically, that she is dying of thyroid cancer that has spread to …
