Gastroenterology

Gastroenterologists and physicians writing on KevinMD about digestive disease: colonoscopy and when to stop screening, celiac disease and gluten, the liver, pancreatic enzyme insufficiency, the tests marketed for leaky gut, and what patients are fed in hospitals. Board-review cases make up part of this archive. One maintained record draws on this archive: Cancer: what physicians say, in their own words.

What does it mean to be a good patient?

Colleen Crone

Patient

November 10, 2013

As a healthcare writer, I often spend large chunks of the day reading about medical conditions. I often joke when starting work that it’s only a matter of time before I notice signs of the condition in myself. I remember being convinced I had gallstones for a while until I finished working on a gallbladder surgery multimedia program. Suddenly, the symptoms that had been preoccupying me for several weeks vanished.

I …

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What does it mean to be a good patient?

MKSAP: 32-year-old woman with progressive jaundice

mksap

Conditions and Diseases

November 9, 2013

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

A 32-year-old woman is evaluated for a 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has …

How do I stay human in a system comprised of superhuman demands?

Jenna Cottral

Medical Education

October 27, 2013

When we die, we die alone. Regardless the number of those who surround our deathbed, we experience our last breath alone. Our last feeling of pain. Our last moment of hope. Our last words, our parting gift to the sentient world as we depart the duress of consciousness. The ethereal message leaves our lips to pierce the very tangible aroma of Clorox and human excrement. The hearts of the healthy, …

Obamacare covers screening colonoscopies, with a catch

Stephen C. Schimpff, MD

Conditions and Diseases

October 25, 2013

“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) …

Sub-internship: The small stones are under my guardianship

Shara Yurkiewicz

Medical Education

October 8, 2013

On my second day of fourth year, I had to make a decision.

“Mr. K would like Miralax,” read the nurse’s page.

A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …

Would every profession consent to returning fees for mistakes?

Michael Kirsch, MD

Physician

September 20, 2013

Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …

A gastroenterologist dishes on unnecessary colonoscopies

Michael Kirsch, MD

Physician

September 9, 2013

We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.

We are the scope doctors.

We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …

Selling colonics to detoxify is false advertising

Sophie M. Balzora, MD

Conditions and Diseases

September 8, 2013

Every major city has its well-advertised and well-anticipated spa week. This wonderful week of facials, massages, and rest and relaxation all at discounted prices is enough to get even the most cynical and uptight of my fellow New Yorkers giddy with excitement. With the advent of the juice cleanse craze on the scene, another cleanse that is again gaining attention is colon hydrotherapy, better known as the “colon cleanse, or …

Drugs that are not FDA approved: Is there a time to prescribe them?

Juliet K. Mavromatis, MD

Medications

September 3, 2013

Here’s an interesting clinical dilemma brought to my attention by another physician.

She was asked to refill a prescription for a drug called domperidone to help a patient with lactation. Domperidone is not FDA approved in the United States for any indication. However, in Europe and in Canada it is approved as a promotility agent for patients with a condition called gastroparesis, which causes the stomach to empty very slowly and results in …

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

Physician

August 26, 2013

acls

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

MKSAP: 51-year-old man with increased fatigue and decreased exercise tolerance

mksap

Conditions and Diseases

August 24, 2013

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

A 51-year-old man is evaluated for a 6-month history of increased fatigue and decreased exercise tolerance. He is otherwise well with no significant medical history.

On physical examination, temperature is 37.3 °C (99.1 °F), blood pressure is 115/75 mm Hg, pulse rate is 76/min, and respiration rate is 14/min. The abdomen is soft with no …

C difficile in children: Do probiotics help?

Christopher Johnson, MD

Conditions and Diseases

August 13, 2013

The intestines, particularly the large intestine, are teeming with bacteria. They are piled on each other as dense as the above photomicrograph shows. The huge majority of them are what we call friendly bacteria: they live inside us, feeding off the rich stew of food we eat, but cause no disease. In fact, their presence is important to our health because they crowd out bacteria that cause disease — the …

MKSAP: 19-year-old woman with progressively worsening diarrhea

mksap

Conditions and Diseases

August 11, 2013

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

A 19-year-old woman is evaluated for a 3-month history of progressively worsening diarrhea, abdominal pain, and weight loss. Her brother was diagnosed with Crohn disease at age 16 years.

On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/65 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. Abdominal examination …

Can prayer heal the sick?

Michael Kirsch, MD

Physician

August 8, 2013

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 …

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Can prayer heal the sick?

How no shows hurt private practice doctors

Michael Kirsch, MD

Physician

August 1, 2013

I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling …

The bar for becoming a stool donor just got higher

Michael Edmond, MD, MPH

Conditions and Diseases

July 29, 2013

Recently, I have spent a lot of time talking to patients, trying to explain why I’ve had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge bureaucratic hurdle to getting a much needed therapy for patients with recurrent or intractable C. difficile infection.

Even before the FDA did this, there were already hurdles for patients who are really suffering …

The wacky world of prescription prior authorizations

Lucy Hornstein, MD

Medications

July 26, 2013

It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up.

I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different …

Should a patient’s financial concerns influence physician decisions?

Michael Kirsch, MD

Physician

July 17, 2013

I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures. These folks need care that may be unaffordable. Medical diagnostic testing is expensive. Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.

This absurdity is often …

Sedasys for anesthesia: Can a machine guide sedation?

Karen S. Sibert, MD

Physician

July 16, 2013

Movie buffs and science fiction fans certainly remember HAL, the computer in 1968’s hit movie “2001: A Space Odyssey”. Considered one of the greatest villains in film history, HAL was capable of reasoning and language processing to assist the astronauts on their space mission. Ultimately, however, HAL decided that its best course of action was to kill all the astronauts. “I am …

Health care price transparency should receive bipartisan support

Bob Doherty

Health Policy

July 12, 2013

Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …

Gastroenterology

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