Neurology

Neurologists and physicians writing on KevinMD about the brain: dementia and Alzheimer's disease and the biomarkers that now find it early, stroke and what recovery really allows, autism, Parkinson's disease, gait and balance as vital signs, and caring for a spouse or parent with a neurological illness. Three maintained records draw on this archive: Aging and dementia: what physicians say, in their own words, Heart disease: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

Here’s why you can’t resist eating that dessert

Peter Ubel, MD

Conditions and Diseases

July 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our …

Our health system doesn’t serve the developmentally challenged

Arshya Vahabzadeh, MD

Health Policy

July 17, 2014

I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue.

My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans …

Thoughts about suicide post-stroke: A most difficult intervention

Kyle Bernard

Patient

July 15, 2014

The interview had lasted fifteen minutes so far, and we’d made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora’s medical history together.

A year earlier, Leora, in her mid-fifties, …

Streamlining the process to approve new drugs can save lives

Nathan Fountain, MD

Medications

July 14, 2014

My heart sinks each time I see the subject line in this too common email I receive in my medical practice: “Sad news: Matthew was fine when he went to bed last night but his mother found him dead in bed this morning.” Matthew (not his real name) had epilepsy with seizures that persisted despite use of currently available antiseizure medications.

We started Matthew’s evaluation when the latest antiseizure medication had been …

Parenting a child with autism

Kathleen O’Grady

Patient

July 11, 2014

It was an ordinary summer day. People were milling on the main thoroughfare, bikes zig-zagging through traffic, cafés and pubs spilling onto the sidewalk, patrons sipping their way through a lazy Friday afternoon.

We were ordinary that day too. Just another family, managing the hectic jumble of kids’ lessons, bills, our careers, endless streams of birthday parties, too little sleep and the occasional date night out.

But it was all shattered with …

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Parenting a child with autism

The advance directive impact of PET scans in vegetative states

Ruth Macklin, PhD

Physician

June 13, 2014

One typically thinks of advances in medical science and technology as having unalloyed benefits. The ability to cure illness, the mitigation of pain and the possibility of making diagnoses that are more accurate are some of the uncontroversial results of medical progress. Yet as a new study of vegetative states demonstrates, such advances can raise ethical quandaries for physicians and the families of patients diagnosed as vegetative.

An $8,000 hospital bill added to my already growing debt

Sammy Ta

Patient

May 21, 2014

The clock read 9:30pm and in front of me was dozens of notes, PowerPoint slides, and practice exams to review before 8am. The all-too-familiar finals week all-nighter beckoned, and though I’ve had my fair share of experiences with studying until the sun rose, I decided to forgo the typical mug of coffee and take some over-the-counter caffeine pills instead. My friend proclaimed that they would help more than any energy …

Playing a game of Russian roulette with his life

Sarah E. Smith, MD

Physician

May 13, 2014

Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician.

“Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face. Vitals stable. Sugar fine. Oriented but postictal. Didn’t take his meds.”

Approximately my age, the backboarded man’s chin bears a ribbon of red laces.

“Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, …

Recognize and minimize the concussion damage from youth sports

Robert Pearl, MD

Conditions and Diseases

May 7, 2014

Concussion expert Dr. A. Chainey Umphrey has assessed the damage youth sports can inflict. He has seen it ruin lives.

It happens in one form or another every day: A high school senior leaps to head a soccer ball. She takes an elbow from an opposing player going for the same ball. Woozy, she shakes it off and stays in the game.

Six months later, her blistering headaches have subsided but she still experiences …

Autism treatment requires a collaborative patient-doctor relationship

Amy Kelly

Patient

May 6, 2014

My family’s world changed instantly upon receiving Annie’s diagnosis of apraxia and autism spectrum disorder (ASD) a day before her second birthday. Hearing three words, “she has autism,” we suddenly faced a lifetime of uncertainty. I knew that I had to embrace my role as a mother of a child with autism, and as an autism champion — and more critically, find a physician that I could form a trusted …

How an email list changed a man’s life forever

Lucy Hornstein, MD

Physician

April 10, 2014

The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food.

He lived alone, hated his job, saw few people, had no friends — so he told me at every visit. His visits …

Is autism diagnosed more frequently? Making sense of a recent study.

Wendy Sue Swanson, MD

Conditions and Diseases

April 4, 2014

Headlines soared recently with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years.

“Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr. Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: …

An ICU physician’s work is never done

Harlan R. Weinberg, MD

Physician

April 2, 2014

If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …

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An ICU physician’s work is never done

MKSAP: 24-year-old woman with painful muscle spasms

mksap

Conditions and Diseases

March 30, 2014

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

A 24-year-old woman is evaluated for a 3-week history of painful muscle spasms and twisting movements in the neck and trunk. She says that her neck feels as if it is being pulled backward. She also reports general restlessness and an inability to keep still. Her medical history is notable for asthma, …

Baseball players’ heads finally getting the attention they deserve

Andrew Wilner, MD

Conditions and Diseases

March 23, 2014

The smell of the grass, the crack of the bat and the roar of the crowd … baseball season is back. As spring training gets into full swing, a new Major League baseball rule takes effect. Though contact will still be allowed at home plate, base runners will no longer be allowed to intentionally run into a catcher.

The rule is intended to protect players from injuries, especially head injuries. Concussions …

The difficulty in diagnosing autism: Feeling like judge and jury

Lisa Shulman, MD

Conditions and Diseases

March 20, 2014

I recently fulfilled my civic responsibility by completing a stint on jury duty. Somehow I had never previously been summoned. Being the Law & Order junkie that I am, I was kind of awestruck by my first up-close exposure to the court system.

I sat erect and at attention in the courtroom, listening to the judge charge us prospective jurors. I even became slightly teary when he spoke of the important role we …

I saw my intellectual exercise as something I hadn’t before

Shara Yurkiewicz

Medical Education

March 4, 2014

There was a very large lesion in his left frontal lobe, and no one knew what it was.

He had been admitted earlier that day, after a neighbor found him in the hallway, confused and covered in urine. Now he sat in his bed quietly, while we stared at his brain and the bright spot that didn’t quite resemble something.

It can’t be tissue death from a stroke, insisted one resident. It …

Alzheimer’s disease is the uninvited guest

Natalie Wilcox

Conditions and Diseases

February 17, 2014

Alzheimer’s disease is the uninvited guest that crashes all of my family gatherings. It relentlessly pursues my grandfather’s brain, unraveling more threads from the tapestry of his memory each year. Although it causes him no physical pain, it sows guilt, sorrow, frustration, and a sense of deep loss in all of us.

Like all diseases, this one seems entirely unfair. My grandfather was a sharp attorney, a witty, silly champion of …

As journals proliferate, so do authors

Skeptical Scalpel, MD

Medical Education

February 14, 2014

New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money.

Authoring journal articles is not only enhancing to one’s CV (the old “publish or perish” cliché), it is required by residency review committees as evidence of “scholarly …

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As journals proliferate, so do authors

People with overt disabilities: Are we more forgiving of their behavior?

Maria Yang, MD

Physician

January 27, 2014

Everyone noticed him before we boarded the plane. He asked the airline representative at least three times to confirm that he had a seat. He looked like an adult, but the tone of his voice was that of a child.

“Yes, you have a seat, Michael. It’s 7B.”

Grey cargo pants covered his short legs. The sleeves of his striped polo shirt collected below his elbows, making his arms look even shorter …