Two months into my private practice career, I was assigned a “no doc” patient, a term referring to a child without a regular physician. This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six-week-old son. He is your responsibility now.”
If I have learned anything over the last 15 years, …
Doctors can be heroes or villains
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is evaluated for right-sided chest discomfort and cough of 2 weeks’ duration. His chest discomfort is described as a vague, painful sensation on the right. The cough occasionally produces a small amount of sputum; he reports no hemoptysis or shortness of breath. He has felt feverish with mild fatigue but …
MKSAP: 45-year-old man with cough and right-sided chest discomfort
I recently read a book by Dr. Barbara Natterson-Horowitz a UCLA cardiologist who also happens to be a consultant for the Los Angeles Zoo. In her book Zoobiquity, Dr. Natterson-Horowitz demystified the story of HIV (Human Immunodeficiency Virus) transmission from monkeys in West and Central Africa to humans. Most physicians today, including me, have a limited knowledge of zoonosis (the science surrounding bugs that can be from animals to humans) …
Let’s talk about sex — with our patients
Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week. She felt something was not quite right and asked me for advice.
“Trust your instinct, go get him, and bring him home.”
She brought him to my clinic the following day. He looked mildly ill. His vitals were stable; he was fatigued, slightly dehydrated, …
The story of a rare, serious complication of mononucleosis
On November 18, the World Health Organization (WHO) declared that Zika will no longer be classified as a public health emergency, while maintaining that the epidemic remains “a highly significant and long-term problem,” and emphasizing that this change in designation did not represent a downgrade, but rather an escalation in its long-term importance.
Most major news outlets rushed to report the news, with headlines focusing on the end of the emergency …
How the press coverage of the WHO Zika designation change hurt us
It is selfish of a leader of a nation to drop dead during office. Jawaharlal Nehru, India’s first prime minister, died suddenly at 74, apparently from a ruptured aneurysm. His aneurysm, allegedly, had something to do with Edwina Mountbatten, the wife of Lord Mountbatten, the last Viceroy of India. Shortly after Nehru’s death, Pakistan attacked India. Nehru’s replacement, Lal Bahadur Shastri, died mysteriously in Tashkent two years after Nehru’s death, …
The circus surrounding Hillary’s pneumonia
September is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.
Earlier this …
Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care
She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have.
Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days. And finally said their …
A miracle in the intensive care unit
It is a master of stealth, stretching less than half an inch long and weighing in at 2.5 milligrams with as estimated air speed of 1 to 1.5 miles per hour. It is virtually soundless in flight, registering zero decibels from ten feet. Its tracking systems hone in on targets by detecting infrared radiation from warm bodies, chemicals such as carbon dioxide and lactic acid, body odors from as far …
Military tests of the Zika virus mosquito
We’ve heard it before: Antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking.
Docs overprescribe because it’s fast, it’s easy, and it (might) increase patient satisfaction and return visits. That’s led to a cycle of reinforcing expectations from patients — who, after all, keep feeling better after the antibiotics. Of course, they do. …
Antibiotics: Maybe it’s time to just say no
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. Medical history is …
MKSAP: 28-year-old man exposed to pulmonary tuberculosis
In the wake of the horrific Orlando shootings, there has been renewed attention given to the U.S. Food and Drug Administration’s (FDA) so-called ban on blood donations from gay men. A congressman called the ban discriminatory, and demanded it’s repeal — a call joined by the American Medical Student Association.
I can understand how many gay men feel. I often donated blood at various American …
Limiting gay men donating blood: Discriminatory or rooted in science?
Bacteria are rapidly becoming resistant in our antibiotic-loving society. This statement is a fact. We are facing a threat not only to our country, but to the world.
I have a proposal to make: over-the-counter antibiotics.
(Insert tongue-in-cheek here.)
Will this help us deal with the falsely popular notion that antibiotics are a cure-all? I don’t know, but here’s something I do. I’ve had patients storm out because I’ve said no, and I …
Why not make antibiotics over the counter?
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It’s difficult to turn to any major media outlet without being confronted with the latest breaking information on Zika virus infection. The images of newborns from Brazil with excessively small heads are searing. To most of the U.S. population, the Zika virus epidemic in South and Central America is mainly a travel concern. But to the millions of people living in areas from the Caribbean to Central and South America, …
Zika virus infection in semen: A call to action and research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.
On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and …
MKSAP: 30-year-old woman with right antecubital fossa and biceps pain
An excerpt from Seductive Delusions: How Everyday People Catch STIs.
Dear Ashley,
Your blood count and mono test did not show any signs of mononucleosis infection. Unfortunately, however, your throat swab was positive for gonorrhea. Please schedule an appointment today in urgent care so you can be treated with the appropriate shot of antibiotics. We have openings at 10:50 a.m., 11:20 a.m., and 3:30 p.m. Let us know what …
How everyday people catch sexually transmitted infections
It’s still flu season, although the flu gods have shown a bit more mercy than in years past. So many variables determine whether each winter brings a relatively mild flu season, a “flunami,” or something in between. I’m a country boy doing primary care in the city, and I have only a modest understanding of which influenza strain is circulating, the concepts of antigenic drift and shift, and how the …
An ounce of influenza vaccine is worth at least a few tons of Tamiflu
The Zika virus in the news these days reminds us of another microcephaly-causing virus which scourged our world in the not-so-distant past. In the years right before we were born (the late 1960s), the virus rubella routinely swept through the United States and the rest of the world. The airborne germ rubella, just like the Zika virus, caused most people just a mild illness that they usually never even knew that they …
The future of Zika virus? How rubella provides clues.
I recently told you of my admiration for Dr. Mona Hanna-Attisha, the Michigan pediatrician and epidemiologist whose strong research and advocacy was able to finally bring a shining light to the problem of lead in the water supply of Flint.
Continuing with a theme, I now bring you the story of Dr. Adriana Melo of Campina Grande, Brazil.
Dr. Melo is an OB-GYN who subspecializes in maternal-fetal medicine (MFM), the …
This inspiring doctor proved Zika virus doubters wrong
1. Zika is an infectious disease caused by a virus and transmitted by mosquitoes. It is one of four worrisome viral infections that have spread rapidly across the world recently including dengue, chikungunya, and West Nile virus, all of which are transmitted by mosquitoes or ticks. The most dangerous mosquito type is the one that spreads yellow fever (Aedes).
2. Though Zika is mostly spread by mosquito bites, there is emerging …
10 simple facts about Zika virus
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