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.
When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story). The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …
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Restless legs syndrome in children: How the kids see it
In early 1996, I sat down at my computer looking for help.
My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will be shorter, we were told. He will have seizures and other problems, they said, but it’s hard for us to say what or how bad those problems will be. We were …
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We need a doctor-family partnership on the Internet
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present “most of the time.” She has a 15-year history of type 2 diabetes mellitus; she also has a history of hypertension, gastroparesis, and chronic kidney disease. Medications are insulin glargine, insulin …
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MKSAP: 53-year-old woman with a 4 month history of tremor
As an oncology nurse, I see more and more people fighting—and winning—the battle against cancer these days thanks to earlier detection and a variety of new treatment approaches. But, like many healthcare professionals, I also see many cancer survivors struggle with the underappreciated long-term health effects often referred to as the “price of survival.”
Cancer-related neuropathy is a common long-term health effect impacting a third of cancer survivors. It can result …
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Helping cancer survivors fight neuropathy
Mr. Omer had once held a position of social prominence, a moral influence on the lives of individuals and communities. Until one year ago. A construction accident changed everything. He suffered injuries that left him in control of only one side of his body and his mind functioning as a 5-year old child.
Most recently, he had resided in an extended rehabilitation nursing facility, until yesterday.
When the nurse tried to arouse …
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We have kept Daddy out of heaven with what we have already done
Media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer’s Disease. Most Americans are familiar with Alzheimer’s because it is so common (President Reagan had it), so devastating, and without a cure. This new study gives hope to people who have or are at risk for the disease.
Recently at the Alzheimer’s Association International Conference 2012 in Vancouver, researchers presented the …
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IVIG for Alzerheimer’s: Cost is a barrier
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting. He noticed that he could not seem to sit up straight and could not walk without assistance. The patient denies confusion, motor weakness, hearing loss, dysarthria, diplopia, fever, or paresthesias. …
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MKSAP: 79-year-old man with vertigo
Years ago, I spotted an acquaintance I hadn’t seen in a while. The conversation was odd. A few times, I would ask a question and he would begin to respond, only to trail off into silence and stare blankly into space. He would remain frozen until the moment I said something else, whereupon he would act normally. He seemed completely oblivious to the fact that he had trailed off and …
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Thought blocking and the privilege of becoming a doctor
Recently, as I finished up a visit with one of my patients who has migraine, she asked me the following: “My 10 year old daughter gets headaches. Is it possible that she has migraines too? I had headaches as a child and was always told it was nothing to worry about, but now I have headaches several times a month. Is there anything I can do to prevent this from …
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What can be done for children with migraine headaches?
It felt good to stuff the stethoscope back into my pocket and slip into the emergency department last night. The constant ringing of phones, beeping of cardiac monitors, and distant wail of inbound EMS units was a welcome cacophony compared to the isolated silence of the library study rooms. Sweeping the curtain back as we stepped into the first patient room, the hours of frustration with biochemical pathways and embryological derivatives …
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Patients are more than multiple choice questions
Nothing will force you to live life on your own terms faster than almost losing it.
In 2008, I was on fire. My husband and I had just moved, bought a house, adopted a dog – and I started my own consulting business while continuing to write and act in my spare time. Life was crazy because I was trying to live all of my dreams – at the same time.
While …
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Adaptation can be painful, but it can also be a gift
Tonight a 17 year-old boy came to the emergency room complaining of headache. As I entered his room, in my usual hurry to do an assessment as expeditiously as possible, so as to get on to the next case and attempt to avoid the inevitable backup of patients so common in our ER, I was struck by the vulnerable demeanor of the patient before me. The triage nurse’s report assured …
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Every emergency medicine shift teaches something
Pain, in any form, can present a difficult challenge for even the most astute pain physician. The complexity of treating neuropathic or nerve pain stems from a variety of reasons, ranging from the lack of an obvious source of the pain to the inability of the patients to explain what ails them, to a arduous history that was poorly managed with the wrong medications, allowing the pain to progress to …
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Thinking differently about treating neuropathic pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the …
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MKSAP: 27-year-old man with a marked change in overall behavior
The problem with phone medicine is that you have to trust what you hear and act accordingly. Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses. Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone.
Patient’s mom: “My son is sick. He’s throwing up and has a …
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The limits of telephone medicine
In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn’t relax, and I was always irritated. Even a few days off didn’t help because of the mountain of phone calls and paperwork waiting for me upon return to work. I asked myself, is this burnout?
Coincidentally, I happened …
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How locum tenens can solve physician burnout
With all the media attention to concussion these days, most people are familiar with the term “concussion” and know what it means. If you’re not involved in the medical field, and you never watch CNN or ESPN, fine. You might not be in the loop. But it is extremely alarming when we still see the lack of awareness in the medical field.
I don’t mean to speak ill of other specialties, …
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The lack of concussion awareness in the medical field
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
