MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'and treatment'. Sat, 03 Sep 2011 02:35:59 +0100 http://www.medworm.com/index.php?rid=5103339&cid=t_430009_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-specialty-specific-apps-are-coming-on-the-market%2F2011.08.06 The explosive growth of medical applications for smartphones, launched by the  debut of the innovative Apple iTunes App store in 2008, promises to fundamentally change the physician’s tool set. While many specialties have always been heavily dependent on technology, such as radiology and cardiology, the ubiquity of these small, interconnected computers means that every physician will soon have access to a broad array of software and hardware to help them perform their daily work. At iMedicalApps.com, we have been reviewing the most interesting medical apps on the market today as well as watching for trends in mobile medical technology. The most popular categories thus far have been clinical reference and utility apps.  Some of the largest download numbers have been for apps that provid... Better Health blogs http://www.medworm.com/rss/comments.php?id=5103339 Sat, 06 Aug 2011 16:00:33 +0100 5103339 http://www.medworm.com/index.php?rid=4464445&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F_yeiH7ClVa8%2Fstrategy-support-needed-quit-smoking.html by Erin Marcus, MDTobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough.L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.’s words, he was “sick and tired of being sick and tired.” But he didn’t do it alone; his success depended on the help of a counselor, smoking cessation classes, nicotine replacement patches and the support of a friend. Here are some things that helped L.J., as well as tips from Dr. Mary Mites-Campbell, a nurse with years of experience helping people quit.(...)Read the rest of Strategy and support is needed to quit smokingNo comment | Tags: Drugs, Patient | Category: Diagno... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4464445 Fri, 11 Feb 2011 20:00:55 +0100 4464445 http://www.medworm.com/index.php?rid=4459904&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F5HNysZ_yHsA%2Fscreening-treating-high-cholesterol-save-money.html by Richard Young, MDA commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. This is an extremely common misconception among most people in healthcare, physicians included. Therefore the American people believe the same thing.(...)Read the rest of Does screening and treating high cholesterol save money?No comment | Tags: Drugs, Heart, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4459904 Thu, 10 Feb 2011 20:00:33 +0100 4459904 http://www.medworm.com/index.php?rid=4459909&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F6KWcCRl7duc%2Fanchoring-leads-misdiagnosis.html by Jerome Groopman, MD and Pamela Hartzband, MDAnchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient’s words into clinical terms.Case study #1Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a cardiologist on staff at New York Hospital. He told us about the case of a 65-year-old man from Quito, Ecuador, who came to see him yearly for an “annual physical examination.” The patient, Dr. Solomon said, “was always asymptomatic, and had mild hypertension, mild dyslipidemia, was over... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4459909 Thu, 10 Feb 2011 12:00:48 +0100 4459909 http://www.medworm.com/index.php?rid=4455266&cid=t_430009_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-who-attempted-to-have-whistleblowing-nurses-prosecuted-is-put-on-probation%2F2011.02.09 From an AP article in the Dallas-Fort Worth Star-Telegram: AUSTIN — Texas medical regulators on Friday placed on probation a West Texas doctor involved in the unsuccessful prosecution of two nurses who complained anonymously that the physician was unethical and risking patients’ health. The Texas Medical Board technically suspended Dr. Rolando G. Arafiles Jr. but allowed him to continue to practice medicine while on probation for four years if he completes additional training. The board also said Arafiles must be monitored by another physician and submit patient medical and billing records for review. The monitor will report his or her findings to the board. In the mediated order signed in Austin, the board concluded that Arafiles failed to treat emergency room patients properly, did... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455266 Wed, 09 Feb 2011 14:00:20 +0100 4455266 http://www.medworm.com/index.php?rid=4450239&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F2EQH3eoePkg%2Fclosed-loop-bowel-obstruction-surgical-partner.html by Sid Schwab, MD“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were half-way through a thyroid operation and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, and Doug, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best surgeon I’d ever seen. Suddenly, he was definitely off his game.We managed to get through the operation. Doug had an appendectomy teed up to follow, but instead of showing up to get it going, he’d gone to the ER, from which I got a call telling me Doug was down there being evaluated, and requesting that I do his case. Introducing myself to the patient, explaining the stra... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4450239 Tue, 08 Feb 2011 20:00:34 +0100 4450239 http://www.medworm.com/index.php?rid=4450242&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FLOyLWhhE_0g%2Fstroke-centers-improve-patient-outcomes.html by Harlan M. Krumholz, MD, SMAnother good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading.The article, titled “Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality,” focuses on the New York State Stroke Center Designation program — a collaboration among the New York State Department of Health, the American Heart Association (AHA), and the New York State Quality Improvement Organization. Starting in 2004, the program allowed New York hospitals to apply for certification as a “stroke cente... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4450242 Tue, 08 Feb 2011 16:00:38 +0100 4450242 http://www.medworm.com/index.php?rid=4445738&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FSYEyLoE4FPQ%2Faids-crisis-zambia.html by Chris Nickson, MB ChBWednesday, December 1st was World AIDS Day — a day to raise awareness for the ongoing AIDS pandemic around the world and to remember the past. As a trainee intern I spent 3 months in Zambia, a time that really opened my eyes up to what AIDS was doing to the world.  Much has changed since then, antivirals have arrived in Zambia for instance, yet the disaster continues: 1 in 8 Zambians are HIV positive and the burden of AIDS has now persisted for 3 decades.This is what I wrote about my experience and views on the AIDS crisis in Zambia back in 2002.(...)Read the rest of The AIDS crisis in Zambia1 comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4445738 Mon, 07 Feb 2011 20:00:15 +0100 4445738 http://www.medworm.com/index.php?rid=4438876&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FNt-0Gf1C0Zg%2Fstressful-life-events-suicide-attempts-completed-suicides.html by William R. Yates, MDThe role of stressful life events in suicide attempts and completed suicides has been a key area of study in the epidemiology of mental disorders.  Although suicidal behavior often occurs in the context of acute and chronic stressor, this does not prove a causal link.  We all could probably report serious life stressors throughout out lives and these could be interpreted as a reason for suicidal behavior.  So these associations could simply be a coincidence and not have anything to do with suicidal behavior.(...)Read the rest of Stressful life events in suicide attempts and completed suicides1 comment | Tags: Patient, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4438876 Sat, 05 Feb 2011 12:00:08 +0100 4438876 http://www.medworm.com/index.php?rid=4436705&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FXYPOs7JyzCA%2Ffinding-cost-lab-tests-real-challenge-patients.html by Brad WrightIn the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.Fortunately, when I started graduate school, my father insisted that I have health insurance. As a healthy 24 year old, I didn’t see the need, but he agreed to foot the bill for a high-deductible insurance policy to cover me in the event of catastrophic illness. Except for four physician office visits subject only to a $35 co-payment, my policy offered no benefits until I spent $3,000 out of my own pocket. With my sinuses thr... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4436705 Fri, 04 Feb 2011 20:00:21 +0100 4436705 http://www.medworm.com/index.php?rid=4433043&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FfU5KfqAbV-g%2Fkids-allergies-die-school-responding-criticism.html by Gina, RNLike many other parents of kids with allergies, I was very dismayed to see this article, titled, Allergic boy, 7, suffers two heart attacks after teacher hands him chocolate nut in class, last week.   It seems a boy of 7 was accidentally given a chocolate candy containing a hazelnut, to which he is allergic.  After biting into the candy, he realized immediately that he shouldn’t have it and spit it out.  Despite quick treatment with an EpiPen after symptoms started, he ended up in pretty bad shape on life support after suffering a couple of cardiac arrests.I read with interest the comments that the public left on that article.  As I’ve seen before with other peanut allergy articles (namely those that discuss banning peanuts on airplanes), this issue was very pol... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4433043 Thu, 03 Feb 2011 19:00:12 +0100 4433043 http://www.medworm.com/index.php?rid=4424178&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FSTGm0Fbx9Eo%2Ftreating-patient-small-town-big-city.html by StorytellERdoc, MDI usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.I also thoroughly enjoy the different ER setting that working in a small hospital provides when compared to the trauma center I have been a part of for fourteen years. People are more appreciative, it seems, and less demanding. People are respectful. There seems to be a more heartfelt connection between the small town folks and the ER staff versus the big city dwellers who demand everything on their terms w... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4424178 Tue, 01 Feb 2011 20:00:19 +0100 4424178 http://www.medworm.com/index.php?rid=4424180&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FxNwMervHG4k%2Flaryngopharyngeal-reflux-disease-complex-case-chronic-cough.html by Steven Y. Park, MDChronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.A 49 year old healthy woman presented to me with a 4 month history of chronic cough only at night. She wasn’t bothered by it, but her husband was. She had tried all the routine allergy and cough suppressing medications, with no improvement. I examined her and found that the posterior portion of her larynx was inflamed and erythematous. She had classic laryngopharyngeal reflux disease,... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4424180 Tue, 01 Feb 2011 18:00:52 +0100 4424180 http://www.medworm.com/index.php?rid=4424181&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FKC00s4y6eOk%2Fpeople-injure-surroundings.html by Yann Meunier, MDYear: 1986 Place: Lome, Togo Position: Consultant in tropical diseases, Pitie-Salpetriere Hospital in ParisI have been sent to West Africa by a French multinational drug company to share information from recent clinical trials about a new anti-emetic compound.It is late November and I am in Togo, midway through a tour that includes Senegal, Ivory Coast, Cameroon, Gabon and Congo. The day I land in Lome, I take a much-needed break by hitting the tennis courts with a local physician. We have to settle an old score. He beat me the last time I was in town and it cannot be my last showing. Next to us, two French architects are intensely competing as well. They reached the Togolese capital that same morning for an international congress and are enjoying the summer-like weather... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4424181 Tue, 01 Feb 2011 16:00:49 +0100 4424181 http://www.medworm.com/index.php?rid=4419060&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FiFTc6DUkv8A%2Ffocus-advance-care-planning-outcomes.html by Drew Rosielle, MDThe Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes.  Good one for the teaching file.That is, instead of thinking of ACP as patients pre-specifying “if X happens, then I want Y,” thinking about it more as helping patients and their loved ones prepare for the decisions they’ll be faced when the time comes — helping them think about end of life decision-making or about what are acceptable outcomes of therapy.  My own drastic condensation of what they propose is focusing the planning on outcomes as oppose... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4419060 Mon, 31 Jan 2011 16:00:39 +0100 4419060 http://www.medworm.com/index.php?rid=4419062&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FZ5ymgwyxnew%2Fdoctor-formulate-accurate-differential-diagnosis.html by Stewart Segal, MDLast night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians.  Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list.  While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct diagnosis is made and the patient recovers.The differential diagnosis (DD) is one of the cornerstones of modern medicine.(...)Read the rest of Help your doctor formulate an accurate differential diagnosis1 comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4419062 Mon, 31 Jan 2011 12:00:39 +0100 4419062 http://www.medworm.com/index.php?rid=4411473&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FVUdrLDJl36I%2Fextremely-premature-baby-immediately-receives-care-matters.html by Jennifer Gunter, MDWhen you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also do much better when they are born in the hospital where they will receive their neonatal care.(...)Read the rest of Where an extremely premature baby immediately receives care mattersNo comment | Tags: Hospital, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4411473 Fri, 28 Jan 2011 20:00:57 +0100 4411473 http://www.medworm.com/index.php?rid=4411474&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FlTGkYjZ9UR0%2Fintegrity-discipline-respect-kung-fu-control-eating.html by Melanie Lane, MDAbout seven months ago, I began training kung fu with my family.  Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic.  Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses me on the intention I have set for my training.  After class one day, it came to me: what would it be like to eat like a black belt?When I look at the master instructor, head instructor, instructors, and black belts at our school, I think of many things, but three qualities stand out – integrity, discipline, and respect.  I decided to apply all three... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4411474 Fri, 28 Jan 2011 18:00:02 +0100 4411474 http://www.medworm.com/index.php?rid=4411475&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FfDHYDtnYVhw%2Ftdap-vaccine-rise-whooping-cough.html by Linda Pourmassina, MDI recently went to the American College of Physicians Chapter Meeting in Seattle and came away with a lot of great information, including a significant change in immunization of adults against pertussis (whooping cough).When patients need a booster of tetanus immunization, we often give it in combination with a vaccine to protect against pertussis. As you may know, tetanus is a life-threatening infection by a bacteria that can cause severe muscle spasms and lockjaw. Immunization boosters for tetanus (Td) are given every 10 years to prevent the life-threating tetanus infection that can causes severe muscle spasms and lockjaw.(...)Read the rest of The Tdap vaccine and the rise in whooping cough1 comment | Tags: Primary care | Category: Diagnosis and treatment (Source:... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4411475 Fri, 28 Jan 2011 16:00:01 +0100 4411475 http://www.medworm.com/index.php?rid=4389164&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FaxVEdmOcOHQ%2Fobesity-classified-brain-disease.html by Michele R. Berman, MDMany of our most popular stories are about diets and weight management.Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over their food consumption and exhibit other behaviors (e.g. tolerance, withdrawal)  that may meet diagnostic criteria (see below) for substance dependence.(...)Read the rest of Should obesity be classified as a brain disease?5 comments | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4389164 Sun, 23 Jan 2011 16:00:17 +0100 4389164 http://www.medworm.com/index.php?rid=4382713&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FMS0zgyJ4VUQ%2Fmenopause-cancer-women.html by Therese Bevers, MDMenopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.How does menopause affect a woman’s cancer risk? Menopause does not cause cancer. But your risk of developing cancer increases as you age. So women going through menopause have a greater chance of developing cancer because they’re older.(...)Read the rest of Menopause and cancer: What women should know2 comments | Tags: Cancer, Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblo... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4382713 Fri, 21 Jan 2011 14:00:57 +0100 4382713 http://www.medworm.com/index.php?rid=4382714&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FfONSMfY0Qzg%2Fmental-illness-college-student.html by Emily Gibson, MDAlong with millions of Americans, I’ve tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings were chilling indeed.  As a college health physician, I and my colleagues all have known progressively destabilizing students like Jared, have tried valiantly to keep them in school while coordinating complex therapy and medical treatment and we all have, at times, failed to turn things around.(...)Read the rest of Mental illness in the c... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4382714 Fri, 21 Jan 2011 12:00:20 +0100 4382714 http://www.medworm.com/index.php?rid=4360907&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FZY4qxPKz2yg%2Fhistorical-perspective-alternative-medicine.html by Roberta BivinsAs a historian who writes about the controversial topic of ‘alternative medicine’, I get a lot of questions about whether this or that therapy ‘works’. Sometimes, these questions are a test of my objectivity as a researcher. My questioners want to know whether I am ‘believer’, or a fan of alternative medicine, or have any stake in promoting or disdaining a given medical system. Other people are asking simply for advice: is it worth trying acupuncture, say, or homeopathy for a particular condition? From either angle, such questions ask me to take a stand on whether homeopathy is quackery, or whether I believe in acupuncture channels, or chiropractic manipulation.(...)Read the rest of A historical perspective of alternative medicine2 comments | Tags: Patient | Ca... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4360907 Tue, 18 Jan 2011 16:00:13 +0100 4360907 http://www.medworm.com/index.php?rid=4360911&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2Fis6DoqOD2To%2Fblood-test-designed-results.html by Lukas Zinnagl, MDEither as a patient or as a physician there’s a very high chance that you’ve ever got your hands on a simple blood test.These range from very basic ones to complex ones with multiple pages and are substantial to any cinlical evaluation. Blood tests are probably one of the most performed tests in a clinical environment with direct patient contact. Also, if you’ve ever seen a typical blood test from the hospital’s laboratory then you’ll notice that they more look like a movie script than an informative medical report. Since the computer arrived in nowadays healthcare the form and design of these reports hardly changed.(...)Read the rest of Your blood test and the need for better designed results2 comments | Tags: Patient, Primary care | Category: Diagnosis and t... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4360911 Tue, 18 Jan 2011 12:00:02 +0100 4360911 http://www.medworm.com/index.php?rid=4349468&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FJ9mp6NX_grw%2Fconcussion-child.html by Christopher Johnson, MDWhen it comes to football season,  it’s time to think about sports injuries. We frequently have children admitted to the PICU (or to what we call the intermediate or step-down unit) for observation, typically overnight, who have struck their head. They have had concussions. What is a concussion, and what does it mean for the child?The term itself is centuries old, but even thirty-five years ago, when I was in training, the actual definition of concussion was a bit vague. What was usually meant was that the patient got hit on the head and either lost consciousness briefly or at least wasn’t quite himself for some period of time afterward. These days we’re more precise than that, but concussion is still a somewhat inexact term. This is mainly because of our i... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4349468 Fri, 14 Jan 2011 16:00:13 +0100 4349468 http://www.medworm.com/index.php?rid=4349470&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FTwHEMA3t9CQ%2Fobesity-crossroads-relative-health-medical-illness.html by Shantanu Nundy, MDAt the end of a busy afternoon, Mrs. MJ was exactly the kind of case I needed.Two of my patients had come in late but needed to be seen and another was acutely short of breath and refusing to be admitted to the hospital. The chaos had put me almost an hour behind schedule, and I still had to return to the wards to round on my cancer patients. Fortunately Mrs. MJ was on time and at 52 years old “incredibly healthy” (in a relative manner of speaking). The last time I saw her was a year ago when she presented as a new patient. Other than some hypertension and weight issues she was fine.(...)Read the rest of Obesity and the crossroads between relative health and medical illness1 comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4349470 Fri, 14 Jan 2011 12:00:54 +0100 4349470 http://www.medworm.com/index.php?rid=4337864&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FvOsz7fekVlU%2Fintubating-combative-patient.html by Ralph Gordon, MDHow many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” if the patient is kicking, screaming, biting and spitting is unlikely to yield any clinically useful information. Getting an extremely agitated patient to a CT scanner could be a great challenge.(...)Read the rest of Intubating the combative patient3 comments | Tags: Hospital, Patient, Specialist | Cat... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4337864 Tue, 11 Jan 2011 20:00:49 +0100 4337864 http://www.medworm.com/index.php?rid=4337866&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FaQGAKSlRR-g%2Fdoctor-diagnosis-obvious.html by WarmSocksI’m thankful that I don’t have to research symptoms on the internet, diagnose myself, and come up with my own treatment.  All I have to do is go to my doctor and describe my symptoms.  My doctor can listen to my symptoms, match them up to what he knows, ask questions to pinpoint what might be going on, order appropriate tests, and recommend a treatment plan.Odds are, when people get sick, that their very common symptoms have a very common cause.  Occasionally problems arise because medical schools teach, “When you hear hoofbeats, think horses, not zebras,” and sometimes doctors interpret this as “zebras don’t exist.”(...)Read the rest of See the same doctor when the diagnosis isn’t obvious2 comments | Tags: Patient | Category: Diagnosis and treatment (So... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4337866 Tue, 11 Jan 2011 16:00:46 +0100 4337866 http://www.medworm.com/index.php?rid=4330950&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FpOLIieMPCvw%2Fhpv-test-doctors-testing-guidelines.html by Brian Jackson, MD and Brian Shirts, MD, PhDWe’ve heard a lot of talk lately about personalized medicine (i.e., using advanced diagnostics to guide customized therapy).A great deal of research is going into creating new molecular and genetic tests. But whether the health care system is prepared to actually generate value from these advanced diagnostics remains an open question. Our group’s research, presented in a new study published in the Journal of Pathology Informatics, finds that one relatively new test is widely misused in ways that drive up costs without benefiting patients.(...)Read the rest of HPV test: Doctors are still not following testing guidelinesNo comment | Tags: Cancer, Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4330950 Tue, 11 Jan 2011 14:00:00 +0100 4330950 http://www.medworm.com/index.php?rid=4330954&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FPkNxI92M6rI%2Falzheimers-disease-diagnosis-criteria-critical-review.html by Ken Covinsky, MDGenerally, Alzheimer’s disease is diagnosed only after patients have progressed to major levels of cognitive impairment that results in substantial problems in daily functioning. But the brain changes that result in cognitive impairment start years, if not decades, before patients become symptomatic. So, wouldn’t it make sense to try to diagnose Alzheimer’s Disease in patients who have the brain changes, before they have clinical symptoms?The answer would be yes if two conditions were met. First, there needs to be methods to accurately predict who is likely to get Alzheimer’s Disease. Second, there needs to be reason to believe this early diagnosis will help the patient. Basically, this means treatments to prevent or slow down the development of Alzheimer’s... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4330954 Mon, 10 Jan 2011 20:00:09 +0100 4330954 http://www.medworm.com/index.php?rid=4326880&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F3m0t7Z00SeE%2Fdisconnect-knowledge-stis-behaviors-reduce-risk.html by PalMDIn my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion.“In my opinion” is one of the most dangerous phrases in science.  But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies.  Attitudes toward HIV have been studied, especially in the early period of the pandemic and on non-US populations, but finding recent data on STIs in the U.S.  is a frustrating endeavor.  Much of the data that are out there are on adolescents, and while this age group has a high STI rate, we are finding that certain older populations are at increasing risk.(...)Read the rest of Dis... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4326880 Sun, 09 Jan 2011 16:00:04 +0100 4326880 http://www.medworm.com/index.php?rid=4322468&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FrSUujL6Qhps%2Fcommon-common-diagnosis-rare.html by Michael Aaronson, MDDuring my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: “When you hear hoofbeats, think of horses not zebras!” He would also frequently use: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” What did my mentor, the Sage of HCMC, mean by this?From Wikipedia: “Zebra is a medical slang term for a surprising  diagnosis. Although rare diseases are, in general, surprising when they are encountered, other [common] diseases can be surprising in a particular person and time, and so “zebra” is the broader concept.”(...)Read the rest of Common things are common, except when the diagnosis is rare3... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4322468 Fri, 07 Jan 2011 16:00:11 +0100 4322468 http://www.medworm.com/index.php?rid=4318280&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FetCYDmwyjBw%2Fmksap-74yearold-man-gradually-progressive-dyspnea.html Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 74-year-old man is evaluated for a 5-year history of gradually progressive dyspnea and dry cough without wheezing or hemoptysis. For the past 2 years he has had pain and occasional swelling in both knees. He has not had fever or lost weight. He smoked one pack of cigarettes a day from the age of 18 to 60 years. He worked as an insulator for 40 years.Physical examination shows no digital clubbing or cyanosis. Auscultation of the lungs reveals bilateral end-inspiratory crackles. Pulmonary function testing shows:Total lung capacity: 67% of predictedResidual volume: 72% of predictedFVC: 65% of predictedFEV1: 75% of predictedFEV1/FVC ratio: 89%Dlco: 52% of predictedHis chest radiogra... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4318280 Thu, 06 Jan 2011 15:00:54 +0100 4318280 http://www.medworm.com/index.php?rid=4318282&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FTofNu2rye3I%2Fradiation-risks-ct-scans-underestimated-patients.html by Kevin Pho, MDRadiation from CT scans needs to be better taught to patients, as their risks are real.It’s the best way to help curb the rampant ordering of these tests.  Unfortunately, we aren’t doing a very good job.In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation.(...)Read the rest of Radiation risks from CT scans are underestimated by patients2 comments | Tags: Patient, Radiology | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4318282 Thu, 06 Jan 2011 13:29:11 +0100 4318282 http://www.medworm.com/index.php?rid=4304875&cid=t_430009_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffalse-positives-in-medical-tests-how-they-can-kill-patients%2F2011.01.03 I’ve written in the past that more medicine and tests do not necessarily reflect better care. There is no test that is 100 percent specific or sensitive. That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”). It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses. But false positives can be just as dangerous. Consider this frightening case report from the Archives of Internal Medicine: A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed... Better Health blogs http://www.medworm.com/rss/comments.php?id=4304875 Mon, 03 Jan 2011 18:00:49 +0100 4304875 http://www.medworm.com/index.php?rid=4304846&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FzkGHyZy1IVI%2Fpermanent-makeup-risks-dangers.html by Orly Avitzur, MD“She just got permanent eye liner and eyebrow augmentation—looks fab,” emailed one of my closest friends last month, about her coworker. “I am seriously considering permanent liner/eyelash augmentation. Do you have any interest in doing this with me?”I understood the appeal … I’d never have to reapply makeup after showering at the gym, save time on my morning routine and enhance features like thinning lashes and brows. Although we had gone together for facials, brow waxings, and a variety of hair and nail treatments, and teamed up for several ridiculous diets and exercise fads over the years, this one scared me. “It’s permanent, basically, a tattoo, right?Hold off until I review the literature …” I wrote ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4304846 Sun, 02 Jan 2011 16:00:46 +0100 4304846 http://www.medworm.com/index.php?rid=4302099&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F7Ifajdo3dhM%2Flessons-learned-asthma-therapy.html by Juliet K. Mavromatis, MDAs a kid I had allergies and asthma.Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My allergies led to frequent nosebleeds, which got me sent to the nurse’s office in school. Some nose bleeds were bad enough so that I was sent home from school. For years I was in and out of doctors’ offices frequently, when my attacks were severe enough to require treatment with epinephrine injections to afford me some relief. Otherwise, I remained perpetually wired on a daily cocktail of ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4302099 Fri, 31 Dec 2010 20:00:57 +0100 4302099 http://www.medworm.com/index.php?rid=4300515&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FeBLqiJrGs-8%2Fmandate-vaccines-california.html by William Schaffner, MDThe California pertussis epidemic is on track to be the biggest in the state since 1958. As of mid-June, there were 910 confirmed cases, some 600 more suspected cases and five deaths, all in infants younger than 3 months. There’s also this: California is one of a handful of states that does not require the tetanus-diphtheria and acellular pertussis booster for middle school entry.Why doesn’t California have a mandate in place for middle school entry? From a public health standpoint, there’s a clear case in favor of it. Pertussis immunity wanes after the childhood vaccination series ends. Adolescents are not only susceptible to pertussis, but they are a transmission vector for vulnerable infants. The clinical illness may not be a major concern for adolescen... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4300515 Thu, 30 Dec 2010 18:00:50 +0100 4300515 http://www.medworm.com/index.php?rid=4298592&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FHtvHtJ4P0Ls%2Fattention-deficit-disorder-anxiety-disorder.html by Srini Pillay, MDAre you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?Your problem may not be a problem with your attention. In fact, it may be that the primary problem resides elsewhere in your brain.(...)Read the rest of Your attention deficit disorder may be an anxiety disorder1 comment | Tags: Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4298592 Wed, 29 Dec 2010 18:00:07 +0100 4298592 http://www.medworm.com/index.php?rid=4294559&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FRN2MzIPwos0%2Fct-scans-xrays-draw-patients-risk-overutilization.html by Michael Kirsch, MDMany patients erroneously believe that x-rays and CAT scans have no risk.In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are.  In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t puncture an organ or a blood vessel, as a surgeon or a gastroenterologist can. Imaging studies do not cause direct damage, but they may lead patients onto the medical battlefield.These diagnostic tests are an insidious force that draws patients into a spiral of direct risk and medical overutilization.(...)Read the rest of CT scans and x-rays dr... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4294559 Tue, 28 Dec 2010 20:00:16 +0100 4294559 http://www.medworm.com/index.php?rid=4294560&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FNtayP-QI2bg%2Ffalse-positives-kill-patients.html by Kevin Pho, MDI’ve written in the past that more medicine and tests do not necessarily reflect better care.There is no test that is 100% specific or sensitive.  That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”).It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses, but false positives can be just as dangerous.(...)Read the rest of How false positives can kill patientsNo comment | Tags: Heart, Malpractice, Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4294560 Tue, 28 Dec 2010 18:02:49 +0100 4294560 http://www.medworm.com/index.php?rid=4272252&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F-OPxnqQo4yI%2Fnatural-lifespan-woman-designed-give-birth.html by Amy Tuteur, MDAdvocates of alternative health attribute all sorts of fantastical properties to the human body. The body supposedly “knows” how to live a long healthy life; the body is supposedly “designed” to work perfectly. The tenets of natural childbirth philosophy also invoke these fantastical properties. The body “knows” how to give birth; a woman’s body is “designed” to give birth.On their face these claims are obviously false. The body doesn’t “know” anything and the body is certainly not designed by anyone. It is the product of millions of years of evolution with the many trade offs that evolution requires. At a deeper level, claims about what the body “knows” or is “designed” to do r... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4272252 Sun, 19 Dec 2010 20:00:56 +0100 4272252 http://www.medworm.com/index.php?rid=4265580&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FW0cfVzvBKKI%2Fgiving-children-probiotics.html by Wendy Sue Swanson, MDI’m becoming more of a believer in giving children probiotics. Not for everything and not for everyone; I really don’t think we should put them in the water.Probiotics, essentially live “good” bacteria we use to supplement our diet (usually Lactobacillus Acidophilus in the US), are becoming more and more available and recommended by more and more physicians. The role microbes play in our health is a hot topic. Probiotics are thought to improve intestinal health by restoring/elevating levels of  helpful bacteria while concurrently diminishing the population of harmful ones.Bacteria in the intestine are a normal part of our digestive health, but population counts of  bacteria living in our gut may be altered by illness, antibiotic use, ingested/modified food... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4265580 Sat, 18 Dec 2010 16:00:02 +0100 4265580 http://www.medworm.com/index.php?rid=4258793&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FXogQc1anNXI%2Finfant-resuscitation-ed.html by VeronicaB, MDA baby died today;  a very small infant.  One minute I’m excited by the end of my overnight shift quickly approaching, and the next I am hearing the words you never want to hear come over the radio, “En route to home for infant not breathing.”  I think the whole ED staff stopped for a minute waiting for the next report.Then we begin to organize.  Prepare a room, grab the pediatric resuscitation cart, where’s the Broselow tape, get respiratory alerted.  The on-coming attending arrives, and I tell him what is going on.(...)Read the rest of Infant resuscitation in the ED1 comment | Tags: Emergency | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4258793 Tue, 14 Dec 2010 12:00:33 +0100 4258793 http://www.medworm.com/index.php?rid=4258795&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F_I-sL2jUXv4%2Fsolving-treatment-resistant-depression.html by Dheeraj Raina, MDAbout 60% of patients suffering from depression do not find any benefit from their first antidepressant. Up to 20% of patients find depression impossible to overcome even after 1 year. Assertive treatment of depression from the get go is essential to helping recover from depression.Psychiatrists don’t have a shared definition of treatment resistant depression. However, most would agree that your depression may be treatment resistant if it has not resolved almost completely after adequate trials of at least 2 separate treatments.You, with your doctor and/or therapist, must then consider the following strategies to beat it.(...)Read the rest of Solving treatment resistant depression4 comments | Tags: Drugs, Patient | Category: Diagnosis and treatment (Source: Kevin,... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4258795 Mon, 13 Dec 2010 20:00:32 +0100 4258795 http://www.medworm.com/index.php?rid=4253076&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F3tMNcqvnWEM%2Fobesity-patients-victims.html by David Gratzer, MDCall it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.(...)Read the rest of Obesity patients are not victims2 comments |... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4253076 Mon, 13 Dec 2010 14:00:57 +0100 4253076 http://www.medworm.com/index.php?rid=4253080&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F4iskapJmvDc%2Ffind-treat-lice-children.html by Roy Benaroch, MD“Dr. Roy, you’ve got to help me!”The most heartfelt pleas I ever hear from parents are for three things:The three year old who won’t use the potty—so can’t register for school.The 15 month old who still isn’t sleeping through the night.The school-aged girl(s) with recurrent lice.Parents hate the idea that their child has lice. They’re icky, they’re crawly, and even talking about them makes everyone in the room start scratching. But parents and schools need to keep this in perspective. Head lice do not transmit any human disease. They have nothing to do with poor parenting or unsanitary living conditions. In many parts of the world, lice are essentially considered normal things that normally live on just about everyone’s head.(...)Read the rest of How ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4253080 Sun, 12 Dec 2010 18:00:07 +0100 4253080 http://www.medworm.com/index.php?rid=4237834&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FHnzM_LNU82c%2Fpercy-harvin-sleep-apnea-affected-migraine-headaches.html by Diana E. LeeIt sounds like NFL Wide Receiver Percy Harvin (Minnesota Vikings) is one of the luckier chronic migraine patients out there.He was actually able to identify a specific reason for his drastically increased number of migraine attacks (sleep apnea) and implement a treatment that seems to be helping (CPAP). He is performing solidly and confidently and taking contact without any issues.(...)Read the rest of Percy Harvin and how sleep apnea affected his migraine headachesNo comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4237834 Tue, 07 Dec 2010 20:00:40 +0100 4237834 http://www.medworm.com/index.php?rid=4237838&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FoatNv6Gp6UM%2Fplaying-hurt-return-football-concussion.html by Gregory Bratton, MD The September issue of Journal Watch General Medicine included an article from the American Academy of Pediatrics about new criteria for diagnosis and management of concussions in children and adolescents.Shortly after this issue was published, a segment aired on ESPN regarding a confrontation between the head football coach at Texas Christian University and its team physician over holding a player out of the game due to a concussion.(...)Read the rest of Playing hurt and when to return to football after a concussion1 comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4237838 Tue, 07 Dec 2010 12:00:51 +0100 4237838 http://www.medworm.com/index.php?rid=4233120&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FDEgPRp5f8AQ%2Ftemperament-perfectionism-anorexia-nervosa.html by William R. Yates, MDTemperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development.  Felt to have significant genetic components, temperament is also potentially influenced by environmental factors.There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.(...)Read the rest of Temperament of perfectionism in anorexia nervosaNo comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4233120 Mon, 06 Dec 2010 16:00:36 +0100 4233120 http://www.medworm.com/index.php?rid=4230122&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2Fih817bC_awc%2Fredundant-tests-waste-health-care-dollars.html by Doctor Grumpy, MDB12.Sounds simple, huh?1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.To me, it’s also a good example of what’s wrong in health care.(...)Read the rest of Redundant tests waste health care dollars3 comments | Tags: Hospital, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4230122 Sun, 05 Dec 2010 16:00:09 +0100 4230122 http://www.medworm.com/index.php?rid=4230126&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FPm0o529Xa5E%2Fpriapism-indicative-spinal-cord-injury-trauma.html by StorytellERdoc, MDIt had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into a magnificent tree. It was unclear if the driver had been thrown from the vehicle or eased out of it by witnesses at the scene.(...)Read the rest of Priapism is indicative of spinal cord injury in traumaNo comment | Tags: Emergency, Hospital | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4230126 Sat, 04 Dec 2010 18:00:45 +0100 4230126 http://www.medworm.com/index.php?rid=4230127&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F_hNsHeVvJWI%2Fsleepbreathing-immune-system-colds.html by Steven Y. Park, MDHave you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is similar to your immune system over-reacting to typical typical allergens like dust or pollens. So if you make your immune system even stronger, your cold will get worse.(...)Read the rest of Sleep-breathing, your immune system, and coldsNo comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4230127 Sat, 04 Dec 2010 16:00:28 +0100 4230127 http://www.medworm.com/index.php?rid=4225155&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F3NTA9EwiBJs%2Fappendicitis-children-radiation-exposure-ct-scans.html by Skeptical Scalpel, MDRecently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular chest x-rays. The implications of this large dose of radiation are that an increase in cancer rates may arise in the future, especially if the CT scan is performed in a child.(...)Read the rest of Appendicitis in children and radiation exposure from CT scans3 comments | Tags: Patient, Radiology | Category: Diagnosis and treatmen... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4225155 Fri, 03 Dec 2010 18:00:50 +0100 4225155 http://www.medworm.com/index.php?rid=4214013&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FQMHsY_klfqs%2Freassurance-ct-scan-emergency-department.html by Kevin Pho, MDThere’s little question that CT scans are on the rise, especially in the emergency department.A recent paper from Radiology put a number to the increased frequency of the test, concluding,CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was used 2.7 million times.To anyone working in the medical profession, it’s hardly a surprise.(...)Read the rest of The reassurance of a CT scan in the emergency department5 comments | Tags: Emergency, Patient, Radiology | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4214013 Tue, 30 Nov 2010 13:45:04 +0100 4214013 http://www.medworm.com/index.php?rid=4205918&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FhQPz1Eg48-k%2Fcolds-teach-immune-system-fight-future-viruses.html by Michael Gonzalez, MDViral upper respiratory illnesses, or common colds, are by far the most frequent illness I see in my office.It is called the common cold because it is, well, common. I typically can make the diagnosis with a high degree of certainty based on the pattern and the timing of the symptoms. Deciphering cold symptoms and knowing when to worry is what a pediatrician does more often than anything else, and I believe parents can learn how to do this as well. If a parent can get a handle on what a common cold looks like, they can certainly save some co-pays and visits to the doctor. You see, there is no real treatment for the common cold. I know, I know, this is the great failure of modern medicine.(...)Read the rest of Colds teach the immune system how to fight future virusesN... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4205918 Sat, 27 Nov 2010 20:00:00 +0100 4205918 http://www.medworm.com/index.php?rid=4205920&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FnSUB_5T-_SQ%2Ftravel-tips-panic-free-vacation.html by Stephen R. Blumberg, PhDIf you are like many Americans, you are planning or getting ready to take a summer vacation. Sounds very exciting. Aruba. A cross-country jaunt. Or a short trip overnight to the coast!What is exciting for the panic-free community can be agony for a panic sufferer. Why?The core fear is being trapped far from safetyWhether it is traveling on a cruise ship, airplane, highway driving, train or bus, the core fear of panic disorder is being trapped far from a place of safety. If you are like many panic attack victims, you may have relied on avoidance or escape to a place of perceived safety as your method of panic relief.(...)Read the rest of Travel tips for a panic free vacationNo comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medic... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4205920 Sat, 27 Nov 2010 16:00:36 +0100 4205920 http://www.medworm.com/index.php?rid=4196980&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F8l2Cx_-_Tpw%2Fbedbug-rashes-prevent-rid-bedbugs.html by Michele R. Berman, MDThere’s a new bunch of bloodsuckers running rampant in cities all over the country.No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and more cities across America. And despite what is commonly thought about them, bedbugs do not exist only in the poorest sections of town, they are showing up at 5-star hotels.(...)Read the rest of Bedbug rashes, and how to prevent and get rid of bedbugsNo comment | Tags: | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4196980 Wed, 24 Nov 2010 18:00:00 +0100 4196980 http://www.medworm.com/index.php?rid=4196987&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FCIFQQMiAdpY%2Fdiabetes-leg-amputations-mcallen-texas.html by Merrill GooznerThe Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.(...)Read the rest of Diabetes and leg amputations in McAllen, Texas3 comments | Tags: Diabetes, Health reform, Medicare | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4196987 Tue, 23 Nov 2010 16:00:16 +0100 4196987 http://www.medworm.com/index.php?rid=4196989&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FohlP6nfUyTc%2Fnoninvasive-fat-removal-plastic-surgery.html by Anthony Youn, MDOne of the hottest things in plastic surgery is noninvasive fat removal.I’ve mentioned on Rachael Ray Show that fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it.  I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis?  Does this device actually remove fat without surgery or needles?(...)Read the rest of Noninvasive fat removal in plastic surgery3 comments | Tags: Specialist, Surgery | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4196989 Tue, 23 Nov 2010 12:00:46 +0100 4196989 http://www.medworm.com/index.php?rid=4190087&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FcGUvoYuYt5c%2Fdepression-behavioral-problem-mental-illness.html by Joe Kosterich, MBBSIt has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.The number of Americans prescribed an antidepressant doubled between 1996 and 2005 and those being treated took more tablets. Yet there is nothing to show that the population is better off. In fact the suicide rate has risen.It is interesting to note that $1 billion is spent each year on promoting anti depressants. Between 1999 and 2005 the amount spent on direct to consumer advertising nearly quadrupled.(...)Read the rest of Depression and whether a beha... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4190087 Mon, 22 Nov 2010 12:00:57 +0100 4190087 http://www.medworm.com/index.php?rid=4179271&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FyJ0shuYWC7Y%2Fteaching-dr-oz-nosebleeds.html by Christopher Chang, MDA reader informed me that Dr. Oz did a TV show recently on nosebleeds.I took a look at the video clip and it is my opinion that some information Dr. Oz conveyed is not entirely correct. Again, I should stress that this is just my opinion and I’m sure there will be many who may feel differently.(...)Read the rest of Teaching Dr. Oz about nosebleedsNo comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4179271 Thu, 18 Nov 2010 20:00:26 +0100 4179271 http://www.medworm.com/index.php?rid=4175621&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FSE_zSmZ_Ikc%2Fmultivitamin-vitamin-fish-oil-day.html by Mary L. Brandt, MDThere is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.That’s the ideal, but not the reality for a lot of us.  I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults to take a low dose multivitamin, 1000 units of Vitamin D and 1000 mg of fish oil every day.  I’m certainly not an expert, so you may want to take the following with a grain of salt, but here’s my take on this advice.(...)Read the rest of Taking a multivitamin, vitamin D and fish oil every day4 comments | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4175621 Wed, 17 Nov 2010 12:00:24 +0100 4175621 http://www.medworm.com/index.php?rid=4167907&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FOvYp4yKS_hQ%2Fneoplastic-epidural-spinal-cord-compression-oncologic-emergency.html by Ralph Gordon, MDThere are very few oncologic emergencies. Neoplastic epidural spinal cord compression is one of them. The delay in diagnosis and treatment is often explained by the non-specific nature of the presenting signs and symptoms.The patient developed urinary retention a couple of weeks prior to presentation. On the morning of admission he was fully functional. Later he sat down to have a cup of coffee and boom – he couldn’t feel his legs. He couldn’t get up either.(...)Read the rest of Neoplastic epidural spinal cord compression is an oncologic emergencyNo comment | Tags: Cancer, Hospital, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4167907 Mon, 15 Nov 2010 18:00:17 +0100 4167907 http://www.medworm.com/index.php?rid=4159165&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FRD2TNzOYq24%2Fpapillary-carcinoma-thyroid-young-people.html by George Lundberg, MDCancer is a really bad diagnosis and I hope I never get one. But I was taught a long time ago that if I had to get a cancer, a papillary carcinoma of the thyroid would be a good one to get.An article in the World Journal of Surgery in June 2010, selected as highly credible by McMaster PLUS, bears that out.(...)Read the rest of Papillary carcinoma of the thyroid in young people1 comment | Tags: Cancer, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4159165 Fri, 12 Nov 2010 14:00:43 +0100 4159165 http://www.medworm.com/index.php?rid=4151667&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2Ft5tme1b1o1g%2Fmksap-44yearold-man-chronic-joint-pain.html Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a 12-year history of plaque psoriasis. His current medications include acetaminophen for joint pain, topical hydrocortisone and calcipotriene ointments, and a tar-based shampoo> He does not drink alcoholic beverages and has no history of liver disease.On physical examination, vital signs are normal. There are large erythematous plaques with an overlying silvery scale on the elbows, knees, sacrum, and scalp. The wrists are swollen and warm bilaterally, and there is bilateral synovitis of the metacarpophalangeal joints. There are effusions on both knees. The... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4151667 Wed, 10 Nov 2010 18:41:50 +0100 4151667 http://www.medworm.com/index.php?rid=4142718&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FAJFBWF9tWHc%2Fquestions-early-diagnosis-alzheimers-disease.html by Juliet K. Mavromatis, MDAlzheimer’s disease made headlines recently, first with news about a new biomarker test that is able to diagnose the disease with increased accuracy, then with a follow-up story detailing the collaborative model of data-sharing that contributed to the success of recent research.(...)Read the rest of Questions about the early diagnosis of Alzheimer’s diseaseNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4142718 Mon, 08 Nov 2010 12:00:00 +0100 4142718 http://www.medworm.com/index.php?rid=4142721&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2F1P5RzqS9Kd8%2Ftotal-body-scans-scam.html by Michael Kirsch, MDFolks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for patients to grasp. A critical principle of proper diagnostic testing can be summarized in a single sentence.If an individual is unlikely to have the medical condition under consideration, then a diagnostic test that yields a positive result is likely to be a false reading.(...)Read t... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4142721 Sun, 07 Nov 2010 18:00:01 +0100 4142721 http://www.medworm.com/index.php?rid=4133583&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FBHh0ZGsHMjc%2Ftinnitus-highlights-poor-doctor-patient-communication.html by Martin Young, MBChB, FCS(SA)I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus,  an annoying perception of sound that comes from somewhere within their heads.  Not many of these patients are referred to me – most come of their own accord for a second opinion.  What they tell me their doctor said is a lesson in how not to communicate with patients, and I think worth repeating here.The most common doctor diagnosis, treatment and reassurance is a curt, “You’ve got tinnitus, and there’s nothing you or we can do.  Learn to live with it.”(...)Read the rest of Tinnitus highlights poor doctor patient communication4 comments | Tags: Patient, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Me... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4133583 Thu, 04 Nov 2010 11:00:17 +0100 4133583 http://www.medworm.com/index.php?rid=4124945&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FKevinMd-MedicalWeblog%2F%7E3%2FaHJXfgp1Na4%2Fcase-reports-continue-important-journal-publication.html by Vineet Arora, MDI am teaching a new course entitled “Turning your Clinical Cases into Scholarly Work.”I hope to draw on my own experiences through the years mentoring students and residents in writing up several clinical cases, but also in making diagnoses.  In preparing for this course, I have also learned quite a bit about the controversy surrounding case reports and the challenges that they face in today’s healthcare system.(...)Read the rest of Case reports continue to be an important part of journal publicationNo comment | Tags: Hospital, Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4124945 Mon, 01 Nov 2010 15:00:32 +0100 4124945 http://www.medworm.com/index.php?rid=4097836&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fhealth-benefits-genomic-discovery.html by W. Gregory Feero, MD, PhDRecent high-profile articles in the lay press have criticized the lack of immediately tangible health benefits from genomics research investment.Expectations for immediate clinical benefit from genomic discovery, fueled by both scientists and the media, have outstripped even the blistering pace of genomic discovery. The gap between discovery and application is particularly notable in general medical practice, where only a handful of evidence-based applications, such as genetic counseling/testing for hereditary breast and ovarian cancer syndromes, have entered routine care.(...)Read the rest of Few health benefits from genomic discovery1 comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4097836 Sat, 23 Oct 2010 17:00:30 +0100 4097836 http://www.medworm.com/index.php?rid=4077191&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fcritical-reporting-system-life-saving.html by George Lundberg, MDWe at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.We determined that it was the laboratory’s responsibility to recognize such a value and, after validation of the finding, to notify a clinician who will take responsibility for the result and initiate corrective action.(...)Read the rest of Is the critical value reporting system truly life saving?1 comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4077191 Mon, 18 Oct 2010 13:00:48 +0100 4077191 http://www.medworm.com/index.php?rid=4077195&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fcommon-throat-problems-sleep-apnea-sufferers-face.html by Steven Y. Park, MDIf you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.(...)Read the rest of Common throat problems that sleep apnea sufferers faceNo comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4077195 Sun, 17 Oct 2010 17:00:30 +0100 4077195 http://www.medworm.com/index.php?rid=4073961&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fmksap-70yearold-man-history-systolic-murmur-presents-exertional-dyspnea.html Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is on no medications.On physical examination, his blood pressure is 120/70 mm Hg and pulse is 75/min and regular. The jugular venous pulse contour demonstrates a prominent a wave and the carotid pulses are normal. On cardiac examination, there is a parasternal impulse and a systolic thrill. The apical impulse is not displaced. An ejection click in close proximity to the S1 is heard along the left sternal border and second left intercostal ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4073961 Sat, 16 Oct 2010 16:02:49 +0100 4073961 http://www.medworm.com/index.php?rid=4065313&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Flab-test-numerical-result.html by George Lundberg, MDA couple of centuries ago, when I was a graduate student in biochemistry and later a med tech, we thought about a lab test as a CBC or a blood sugar that produces a numerical result. Period.Later, I learned and wrote that there were at least nine separate vital steps in the performance of a laboratory test and that the analysis that produces a result was important but that so were the other eight.(...)Read the rest of Why a lab test is more than a numerical result1 comment | Tags: Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4065313 Wed, 13 Oct 2010 15:00:59 +0100 4065313 http://www.medworm.com/index.php?rid=4060589&cid=t_430009_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftoo-much-data-can-it-overwhelm-doctors-and-harm-patients%2F2010.10.12 One of the supposed strengths of electronic medical records is better tracking of test data. In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily. But a recent study, as written in the WSJ Health Blog, says otherwise. Apparently, a study performed in 2007 found: VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4060589 Tue, 12 Oct 2010 17:00:11 +0100 4060589 http://www.medworm.com/index.php?rid=4060532&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fdata-overwhelm-physicians-harm-patients.html by Kevin Pho, MDOne of the supposed strengths of electronic medical records is better tracking of test data.In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily.But a recent study, as written in the WSJ Health Blog, says otherwise.(...)Read the rest of Too much data can overwhelm physicians and harm patients1 comment | Tags: Health IT, Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4060532 Tue, 12 Oct 2010 14:20:11 +0100 4060532 http://www.medworm.com/index.php?rid=4055672&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fphysician-decisions-based-strictly-cochrane.html by George Lundberg, MDFirst, a disclosure. I am President and Board Chair of the not-for-profit Lundberg Institute in California, which is dedicated to Archie Cochrane.What would happen if we in American healthcare actually followed the teachings of the revered Archie Cochrane? I’m sorry. You don’t know what those teachings are? … and you don’t even know who Archie Cochrane was? Oh my …(...)Read the rest of If physician decisions were based strictly on Cochrane4 comments | Tags: Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4055672 Mon, 11 Oct 2010 13:00:37 +0100 4055672 http://www.medworm.com/index.php?rid=4053267&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Ftime-diagnostic-tool.html by Edward Pullen, MDI can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to be persistent and progressively more intense.  Symptoms of an infection tend to come on more quickly, evolving over hours to days, and usually becoming progressively worse at least initially.  Symptoms of ischemia — of an organ not being perfused by freshly oxygenated arterial blood — tend to come on over a minute or more, last at least several minutes, and resolve gradually... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4053267 Sun, 10 Oct 2010 19:00:02 +0100 4053267 http://www.medworm.com/index.php?rid=4053274&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fchief-complaint-match-ultimate-diagnosis.html by ER Stories, MDMost times a patient that is triaged with a specific chief complaint ultimately have a diagnosis that appears to relate to that complaint. Such as “chest pain” often results in a diagnosis of “unstable angina” or “pulmonary embolus.”Occasionally, something will be a little different like “back pain” turns out to be “biliary colic” or “myocardial infarction.”  Still, those are not surprising.However, once and a while you have a chief complaint (or something that the triage RN writes down) that does not appear to match the ultimate diagnosis you reach at all.  In retrospect, if you just read the triage note or chief compliant, you really can’t believe that the diagnosis was what it turned out to be.  Here are some examples that I reca... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4053274 Sat, 09 Oct 2010 15:00:46 +0100 4053274 http://www.medworm.com/index.php?rid=4045042&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fparents-concerned-lump-child.html by Michael Gonzalez, MDI was recently scanning an online forum about pediatric health concerns. (What can I say?  I sometimes need inspiration.) There was one thread within the forum that was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be evaluated.(...)Read the rest of When parents should be concerned about a lump on their child1 comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4045042 Fri, 08 Oct 2010 17:00:12 +0100 4045042 http://www.medworm.com/index.php?rid=4040510&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fearly-diagnosis-panic-disorder-improve-quality-care.html by Stephen R. Blumberg, PhDAs a panic disorder specialist, I take an active responsibility in helping my patients feel confident that their physical complaints have no organic etiology. My day is filled with my patient’s reporting symptoms of heart palpitations, shortness of breath, chest pressure, rubbery legs, lightheaded feelings, inner trembling, numbness and tingling in the extremities, lump in the throat, knot in the stomach and head pressure, to name a few. Each set of physical symptoms create a catastrophic health worry. For example, heart pounding and shortness of breath often prompt worry about heart disease.   Numbness and tingling and head pressure create worry about neurological disease.  Lump in throat and knot in the stomach set off worries about throat cancer and stom... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4040510 Thu, 07 Oct 2010 11:00:22 +0100 4040510 http://www.medworm.com/index.php?rid=4031165&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fready-genetic-analysis.html by Jan Gurley, MDYou may be wondering why Stanford Medical School’s new genetic interpretation class – the one that offers medical students the opportunity to study their own genes – has made the news. After all, what better genes are there to study than your own? And if you were a medical student, wouldn’t you want to have your medical school subsidize 80% of an $800 test as part of your curriculum – isn’t that kind of like a “free” healthcare kickback?But people whose work includes genetic counseling, or people who themselves have undergone genetic testing for a serious disorder, will likely beg to differ. And usually in very strong terms. The fact is, looking at your own genes is not at all like that Bio 101 lab we all remember where we got to look at our own cellular sp... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4031165 Tue, 05 Oct 2010 15:00:15 +0100 4031165 http://www.medworm.com/index.php?rid=4025600&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F10%2Fchildren-difficult-simply-toxic.html by Claudia M. Gold, MDAs a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient’s description of her “rude and defiant” teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such difficulty. The conclusion Dr. Friedman draws from this and other similar stories, is that perhaps these are simply “toxic” children.I find this conclusion horrifying. Dr. Friedman’s piece brought to mind two children from my pediatric practice who were described in similarly negative terms. These negative characterizations were openly discussed in fron... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4025600 Sat, 02 Oct 2010 19:00:05 +0100 4025600 http://www.medworm.com/index.php?rid=4018130&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fordering-lab-tests-raise-costs-quality-impact.html by George Lundberg, MDWhy do physicians order lab tests? As reported in JAMA some years ago from a survey of hundreds of resident physicians at the Los Angeles County/University of Southern California Medical Center, the traditional reasons are: diagnosis 37%, monitoring 33%, screening 32%, previous abnormal result 12%, prognosis 7%, education 2%, and medicolegal (at this large public hospital) only 1%. Okay, that all makes some sense.In order to confirm these findings, I began to ask the same question of many groups of clinical and laboratory workers over three continents during Socratic teaching sessions on how to use the clinical laboratory correctly. And I began to get very different answers.(...)Read the rest of How ordering lab tests may raise costs with little quality impactNo comme... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4018130 Thu, 30 Sep 2010 13:00:31 +0100 4018130 http://www.medworm.com/index.php?rid=4018131&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fchronic-cough-laryngeal-sensory-neuropathy-lsn.html by Christopher Chang, MDLaryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All these patients reportedly had a full workup with everything being normal and as such, was diagnosed with LSN. These patients were being solely treated with neuropathic medications and nothing else.(...)Read the rest of Chronic cough from laryngeal sensory neuropathy (LSN)4 comments | Tags: Specia... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4018131 Thu, 30 Sep 2010 11:00:36 +0100 4018131 http://www.medworm.com/index.php?rid=4003210&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fscreen-healthy-patients-vitamin.html by PalMDVitamin D is a fascinating molecule with a fascinating story.Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health.  These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri.  Other vitamin deficiencies were found to be a bit more complicated: vitamin B12 deficiency was found to cause a type of anemia, dementia, and spinal cord problems.(...)Read the rest of The story of vitamin D and its association with other diseasesNo comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4003210 Mon, 27 Sep 2010 15:00:23 +0100 4003210 http://www.medworm.com/index.php?rid=4001678&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fdoctors-order-tests-history-physical.html by Robert Centor, MD“Take a good history, do a good exam.”I have not contributed to my treasure of quotes with this title.  No one reading the headline well hit their head and mutter, “Wow!”  Yet one can wonder about the lack of careful history taking and basic physical examination skills.This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine.You should read the entire post and the link to the article that stimulated it.  How does a post with that title stimulate me to write about history and physical examination.(...)Read the rest of Many doctors order tests rather than do a history and physicalNo comment | Tags: Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevi... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=4001678 Sat, 25 Sep 2010 17:00:41 +0100 4001678 http://www.medworm.com/index.php?rid=3998909&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2F10-reasons-doctors-overorder-tests.html by Neel Shah, MDWhat are the top reasons doctors over-order tests? 1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo. 2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion. (...)Read the rest of 10 reasons why doctors over-order tests4 comments | Tags: Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3998909 Fri, 24 Sep 2010 13:00:10 +0100 3998909 http://www.medworm.com/index.php?rid=3993799&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fmarginal-treatments-high-emotional-cost-families.html by Marya Zilberberg, MD, MPHMy father passed away about two weeks ago after battling a brain tumor for some time.Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of florid hallucinations alternating with pharmacologically achieved stupor, he came out of it remarkably cognitively intact, still able to quote poetry and sing Italian opera arias in their entirety.Although he was now unable to use his legs, he eagerly accepted the prospect of getting back on his feet by working hard in physical therapy. And though th... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3993799 Wed, 22 Sep 2010 19:00:53 +0100 3993799 http://www.medworm.com/index.php?rid=3993803&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fexpansion-alzheimers-helpful.html by George Lundberg, MDYou probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.(...)Read the rest of Why the expansion of Alzheimer’s may not be helpful4 comments | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3993803 Wed, 22 Sep 2010 13:00:35 +0100 3993803 http://www.medworm.com/index.php?rid=3987001&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fprevention-influenza-protection.html by William Schaffner, MDFor years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually.This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths is too wide to continue using that single number. Based on a lot more seasons (1976-2007), the average is closer to 24,000 with a range of about 3,300 to 49,000 influenza deaths per year.This wide range is not surprising.(...)Read the rest of Prevention is the best influenza protectionNo comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3987001 Tue, 21 Sep 2010 11:00:36 +0100 3987001 http://www.medworm.com/index.php?rid=3987002&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fpreoperative-evaluation-lead-unnecessary-tests-waste-money.html by Kevin Pho, MDWhat’s one of the biggest culprits for the rise of unnecessary medical testing?Preoperative evaluation.Before most patients undergo surgery or an invasive procedure, they are normally sent to their primary care physicians for a “preoperative evaluation.”  This is a visit to determine if they are medically stable enough to undergo the operation.Tests like bloodwork, an EKG, or a chest x-ray are frequently ordered.  For those with suspicion of coronary artery disease, a stress test is sometimes considered, based on the patient’s symptoms.According to a recent study, however, may of these tests may be unwarranted.  Not only do they waste money, they also can potentiate further, more invasive, studies that stem from incidentilomas.(...)Read the rest o... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3987002 Mon, 20 Sep 2010 20:00:37 +0100 3987002 http://www.medworm.com/index.php?rid=3987006&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fheadache-hospital.html by Chaim Colen, MDAs a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache? When should I go to the hospital?”A headache is considered to be pain located anywhere in the region of the upper neck or head.  It is one of the most common locations of pain in the human body and can have many difference causes.  There are three major categories of headaches which include primary headaches, secondary headaches, and cranial neuralgias which can be associated with facial pain.(...)Read the rest of When does a headache need to be seen at the hospital?No comment | Tags: Hospital, Specialist | Cat... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3987006 Mon, 20 Sep 2010 13:00:50 +0100 3987006 http://www.medworm.com/index.php?rid=3983373&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fsocial-anxiety-assumptions-solutions.html by Srini Pillay, MDSocial anxiety refers to the fear of being around people due to the threat of embarrassment.People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire.  They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists at baseline whether they are being social or not.(...)Read the rest of Social anxiety assumptions and their solutionsNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3983373 Mon, 20 Sep 2010 11:00:21 +0100 3983373 http://www.medworm.com/index.php?rid=3981997&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fpeople-disturbing-behavior-psychiatric-illness.html by Jeffrey Knuppel, MD“Hey Doc, this guy needs some help.”I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.But, one of the questions that always pops into my head is whether the situation is one in which I can actually help. I certainly would not expect officers to make this decision, but it’s a point I must consider.(...)Read the rest of Do all people with disturbing behavior have a psychiatric illness?No comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3981997 Sat, 18 Sep 2010 17:00:40 +0100 3981997 http://www.medworm.com/index.php?rid=3981998&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Falzheimers-disease-screening-tests-ready-public.html by Naomi FreundlichIn April, an independent panel established by the National Institutes of Health came to the disheartening conclusion that currently, there is nothing to prevent or delay the progress of Alzheimer’s disease in those of us who are destined to join the 5 million Americans currently suffering from this dreaded ailment.The panel  found that: “Although numerous interventions have been suggested to delay Alzheimer’s disease, the evidence is inadequate to conclude that any are effective.” Members rejected scientific evidence supporting the influence of nutritional supplements, herbal products, dietary factors, pharmaceuticals, medical conditions or even environmental exposures on the risk of contracting Alzheimer’s.(...)Read the rest of Are Alzheimer’s disease s... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3981998 Sat, 18 Sep 2010 15:00:51 +0100 3981998 http://www.medworm.com/index.php?rid=3980785&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fautism-vaccination-simple-answer-tragically-wrong.html by Amy Tuteur, MDIt is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccination is presently unknown.Vaccine rejectionists never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. Vaccine rejectionists always insist that vaccines cause autism, vague “damage to the immune system” or unspecified neurologic injury.(...)Read the rest of For autism, vaccination is the simple answer that is tragically wrongNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Me... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3980785 Fri, 17 Sep 2010 17:00:11 +0100 3980785 http://www.medworm.com/index.php?rid=3980788&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Falternative-medicine-unproven-medicine.html by George Lundberg, MDThere is no Alternative Medicine.Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.So I went to Mr. Google in 2010 and entered … Alternative Medicine … and clicked — 41,200,000 results; entered Complementary and Alternative Medicine, click — 3,210,000 results; entered CAM, click — 191,000,000 results, but that’s not fair; CAM can stand for many unrelated topics.Let’s try quackery on Mr. Google, click — “only” 818,000 results.(...)Read the rest of There is no alternative medicine, only unproven medicine9 comments | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3980788 Fri, 17 Sep 2010 13:00:02 +0100 3980788 http://www.medworm.com/index.php?rid=3980789&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fchronic-prostatitis-public-health-problem.html by Arnon Krongrad, MDDavid was afraid. After years of peregrinations with pain, he had exhausted all the options. David knew he wasn’t crazy. The problem was the doctors: They had no more treatments for chronic prostatitis. The doctors did not want to see him.Chronic prostatitis is a public health problem. Contrasted with fibromyalgia, autism, and breast cancer, however, nobody talks about it. President Obama declared this to be National Prostate Cancer Awareness Month, but not National Chronic Prostatitis Awareness Month. Pennsylvania declared this to be Women in Pain Awareness Month, but the men were left out. Given the ruinous impact of chronic prostatitis, the omissions seem cruel. Why is it like this?(...)Read the rest of Chronic prostatitis is a public health problem2 comments | Ta... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3980789 Fri, 17 Sep 2010 11:00:27 +0100 3980789 http://www.medworm.com/index.php?rid=3976454&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fscientific-knowledge-overcome-uncontrollable-food-behavior.html by Susan Biali, MDI’ve struggled almost my whole life with food. During my late teens I was obsessed with dieting and calorie-counting, which turned into compulsive eating and a powerful addiction to sugary, fatty foods in my 20’s and 30’s – even though I had both a medical degree and a degree in dietetics (human nutrition).Obviously, having scientific knowledge about food and health isn’t enough to help someone control their uncontrollable behavior around food – you need to understand the real roots of compulsive eating patterns, something I was never taught in medical school and only really began to understand and heal from in the last few years.(...)Read the rest of Can scientific knowledge overcome uncontrollable food behavior?No comment | Tags: Patient | Category: Diagnosi... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3976454 Thu, 16 Sep 2010 11:00:20 +0100 3976454 http://www.medworm.com/index.php?rid=3972877&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fhealth-decisions-based-evidence-based-data.html by Kathy Kastner“Science tells us nothing about the individual.”So said Dr. Susan Pinker, psychologist and author. This perfectly articulated truth puts into perspective popular thinking: To make a decision, the most important thing is evidence-based information: all you need is science. To this I say, that’s a bunch of hooey. Science tells us nothing about the individual. Thank you Dr. Pinker.Creating the expectation that health decisions are entirely based on evidence-based information diminishes completely the ordeal of the decision-making journey: frantic, frightening, fraught and oftimes the cause of additional upset when made final.(...)Read the rest of Health decisions are not entirely based on evidence based data2 comments | Tags: Patient | Category: Diagnosis and treatment (... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3972877 Wed, 15 Sep 2010 15:00:40 +0100 3972877 http://www.medworm.com/index.php?rid=3972878&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fconsumers-easy-direct-access-genetic-tests.html by George Lundberg, MDShould consumers have easy, direct access to genetic tests? So asked a recent survey on MedPage Today. After nearly 1,000 people voted, the tally was: Yes 37%; No 30%; it depends on the test 32%.Of course this survey is “unscientific,” meaning anyone who sees it may (or may not) vote so there is obvious selection bias. Nonetheless, since the number voting is hefty, it is worth looking at.I am impressed that the wisdom of the aggregate is split almost exactly three ways. Very interesting. I can agree with all 3 groups.(...)Read the rest of Should consumers have easy, direct access to genetic tests?3 comments | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3972878 Wed, 15 Sep 2010 13:00:54 +0100 3972878 http://www.medworm.com/index.php?rid=3968968&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fpatients-accurate-information-prognosis.html by Kevin Pho, MDWhy are doctors so bad at predicting how long a patient has to live?That’s the interesting question posed by John Schumann, an internal medicine physician who blogs at GlassHospital, recently in Slate.There are many reasons why doctors evade the question of prognosis:We don’t like to be wrong; we don’t want to take away hope for survival or good quality of life in the time that remains; and we just aren’t adequately trained to do it. And our reluctance to make such guesses means that when we do try to predict the future, we’re pretty lousy at it.(...)Read the rest of Patients need more accurate information on their prognosis1 comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3968968 Tue, 14 Sep 2010 14:27:46 +0100 3968968 http://www.medworm.com/index.php?rid=3968969&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fdsm5-medicalize-normal-behavior.html by John GeverJust about everyone catches colds, and just about everyone who gets one is able to go to work and cook their meals, and they nearly always recover within a few days whether or not they take anything for it. That’s normal.So, is the advice to take aspirin “medicalizing normal behavior”? Are drug companies that market decongestants and fever reducers “medicalizing normal behavior”?The answer is yes, if you accept the logic offered by some critics of DSM-5, the upcoming revision of the Diagnostic and Statistical Manual of Mental Diseases.(...)Read the rest of Does the DSM-5 medicalize normal behavior?6 comments | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3968969 Tue, 14 Sep 2010 13:00:06 +0100 3968969 http://www.medworm.com/index.php?rid=3961790&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fpertussis-vaccine-children.html by Roy Benaroch, MDA reader wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?”I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update.(...)Read the rest of Why you need the pertussis vaccine, especially if you have childrenNo comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3961790 Sun, 12 Sep 2010 17:00:27 +0100 3961790 http://www.medworm.com/index.php?rid=3954163&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fadequate-trial-antidepressant.html by Dheeraj Raina, MDSince there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.However, it’s worth looking at some guidelines.(...)Read the rest of What is an adequate trial of an antidepressant?No comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3954163 Fri, 10 Sep 2010 11:00:46 +0100 3954163 http://www.medworm.com/index.php?rid=3946383&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Falzheimers-disease-preventive-strategies-treatments.html by William R. Yates, MDThe Alzheimer’s Association sponsors a journal titled Alzheimer’s & Dementia.  In the March 2010 issue, they provide a report on facts and figures related to Alzheimer’s disease (AD).I’m a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop the progression of AD.(...)Read the rest of Alzheimer’s disease needs better preventive strategies and treatmentsNo comment | Tags: Patient, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3946383 Wed, 08 Sep 2010 17:00:57 +0100 3946383 http://www.medworm.com/index.php?rid=3942732&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fhearing-aids-expensive-reading-glasses-cheap.html by Randall S. Bock, MDI am currently 53 years old, but I recently found an imperfection in my near-vision.  I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the grand sum of $10.00. That comes out to less than $1.50 per pair. I keep one set by my bedside, one in the kitchen, one at my office, one in the car — they’re always at hand.(...)Read the rest of Why are hearing aids so expensive, and reading glasses so cheap?7 comments | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3942732 Tue, 07 Sep 2010 19:00:10 +0100 3942732 http://www.medworm.com/index.php?rid=3942733&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fmri-places-good-quality-machines-obsolete.html by Doctor Grumpy“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.Here is where the problem began. Everything about Dave’s exam and story pointed to something serious in his neck. But the tests were normal.(...)Read the rest of Some MRI places have good quality machines, others are obsoleteNo comment | Tags: Radiology, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3942733 Tue, 07 Sep 2010 17:00:08 +0100 3942733 http://www.medworm.com/index.php?rid=3942734&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fstop-eating-obese.html by George Lundberg, MDWe all know that obesity is a huge and growing (no puns intended) problem in the U.S. and most other developed countries.The proven harmful consequences of obesity to the individual and the public health, as well as to the national treasuries, are devastating. The solutions are both simple and complex.For most adults who are of normal weight (BMI under 25), simply maintain your normal weight. If you are overweight (BMI 25 to 30), consider this a wake-up call and act now, before you become obese. Stop eating.(...)Read the rest of Stop eating before you become obese9 comments | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3942734 Tue, 07 Sep 2010 15:00:03 +0100 3942734 http://www.medworm.com/index.php?rid=3938297&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fcpap-machine-traveling.html by Steven Y. Park, MDOne of the most common excuses for not wanting to use CPAP is that “I travel a lot.” Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant.With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be done with relative ease. People use CPAP on planes, and even go camping with it. With the FAA’s recent ruling and instructions on carrying and using CPAP on airlines, it’s become even easier to travel with CPAP machine. I know there are various types of PAP devices, but for the sake of simplicity, I’ll call ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3938297 Mon, 06 Sep 2010 19:00:46 +0100 3938297 http://www.medworm.com/index.php?rid=3938299&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fmultiple-assessments-needed-face-repeated-testing.html by Jerome Groopman, MD and Pamela Hartzband, MDAt a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology at Beth Israel Deaconess Medical Center, along with an endocrine fellow, Laura Sweeney, MD.Case study: Polycystic ovarian syndrome suspectedThe patient was a 19-year-old art student at a local university. She was seen by a nurse practitioner at the student health services after a prolonged menstrual period lasting more than 10 days. Prior to this, her menses were regular and had lasted no more than five days. She also complained of increased facial hair.(...)Read the rest of Multiple assessme... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3938299 Mon, 06 Sep 2010 15:00:17 +0100 3938299 http://www.medworm.com/index.php?rid=3935779&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Facute-gonorrhea-congo.html by Yann Meunier, MDYear: 1984 Setting: Ouesso, Congo Position: Timber consortium medical expertWe landed in Brazzaville and took a private jet to Pointe Noire where we spent the night. The next day, the group is assigned six 4×4 Toyotas to take through the Mayombe Mountains, Brazzaville and the plateau to reach Ouesso near the Cameroon border.The journey is eventful, particularly when I drove the pickup truck into a river from a bridge to avoid children playing carelessly. It was quite a shock when we hit the riverbed and half the vehicle got stuck in the mud amidst running water. Nevertheless, after repairs and four days of challenging terrain, mostly in the equatorial forest, we arrive at our destination where I have to survey the medical facilities and produce a report.(...)Read th... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3935779 Sun, 05 Sep 2010 17:00:12 +0100 3935779 http://www.medworm.com/index.php?rid=3929173&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fpreparing-gastric-bypass-surgery-eating.html by Douglas Perednia, MDThinking is hard work.  This is why so few people bother.  At least voluntarily.  So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.This comes up as a result of a conversation that I had with a patient the other day.  A pleasant, obese gentleman.  He had been struggling with his weight and type 2 diabetes for some time, and there were now some early indications of some potentially serious long-term complications.  He mentioned to me that he was working hard to prepare for gastric bypass surgery.   I asked him how he was doing that.(...)Read the rest of Preparing for gastric bypass surgery by eating more2 comments | Tags: Health refo... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3929173 Thu, 02 Sep 2010 17:00:40 +0100 3929173 http://www.medworm.com/index.php?rid=3929174&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Fmksap-62yearold-man-evaluated-asymptomatic-nodule.html Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown. MKSAP image © 2010, American College of Physicians, Medical Knowledge Self-Assessment Program (MKSAP® 15)Which of the following is the most likely diagnosis?A) Basal cell carcinoma B) Pyogenic granuloma C) Seborrheic keratosis D) Squamous cell carcinoma(...)Read the rest of MKSAP: 62-year-old man is evaluated for an asymptomatic noduleNo comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3929174 Thu, 02 Sep 2010 16:53:03 +0100 3929174 http://www.medworm.com/index.php?rid=3924826&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F09%2Ftpa-time-limit-acute-stroke-mass-chaos-er.html by ER Stories, MDI hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.First, one has to establish 100% what the exact time of onset was. This is not easy most of the time. I would say about 80% of “acute” strokes brought in by EMS turn out to not be within that window. It takes more than just saying “when did the symptoms start?”(...)Read the rest of The TPA time limit for acute stroke causes mass chaos in the ER5 comments | Tags: Emergency, Hospital, Spec... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3924826 Wed, 01 Sep 2010 11:00:20 +0100 3924826 http://www.medworm.com/index.php?rid=3920768&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fglenn-becks-macular-dystrophy.html by Michele R. Berman, MDDuring a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America” tour, the Fox News pundit told the crowd:“A couple of weeks ago I went to the doctor because of my eyes, I can’t focus my eyes…he did all kinds of tests and he said, ‘you have macular dystrophy …you could go blind in the next year. Or, you might not.”The term “macular dystrophy” can be confusing because, according to Dr. Robert Enzenauer, macular dystrophy is a disease of the cornea of the eye whereas “macula” is a term that refers to the retina.(...)Read the rest of What is Glenn Beck’s macular dystrophy?No com... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3920768 Tue, 31 Aug 2010 15:00:50 +0100 3920768 http://www.medworm.com/index.php?rid=3920769&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Ffundamentally-approach-treating-glioblastoma-multiforme.html by George Lundberg, MDOnly rarely does an experienced editor get a spine tingle from a new paper. For the first time ever, today, I predict that a Nobel Prize for medicine will be awarded to J. Martin Brown, DPhil, Oxford, a professor at Stanford University School of Medicine.Professor Brown and his colleagues have discovered and reported a fundamentally new approach to the treatment of solid tumors, beginning with the devastating glioblastoma multiforme.Here is how it goes: Tumors need blood in order to grow. Powerful radiation can kill many cancer cells. It also kills the cancer’s blood vessels. How then do any surviving cancer cells regrow after radiation if they have no blood supply? Where do the nutrient blood vessels come from?(...)Read the rest of A fundamentally new approach ... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3920769 Tue, 31 Aug 2010 13:00:35 +0100 3920769 http://www.medworm.com/index.php?rid=3914910&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fwatchful-waiting-pays-torn-acl.html by Merrill Goozner“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in a small gym on the north side of Chicago. The sports medicine orthopedist who treated me (”best in the city, he handles some of the Bulls players,” I was assured by a sports writer friend) said I had two choices. He could conduct arthroscopic surgery and clean out the dangling ends of the central shock absorber of the k... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3914910 Mon, 30 Aug 2010 17:00:23 +0100 3914910 http://www.medworm.com/index.php?rid=3914911&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fwhooping-cough-pertussis-tips.html by Jan Gurley, MDAs a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass them on to friends and co-workers – because an epidemic of knowledge is a good thing to spread around:1. Hey, you got vaccinated, and your kids did too – doesn’t that mean you’re protected? Um, no. Pertussis (the medical name for whooping cough) vaccines are actually kind of puny, and don’t last that long. Strange, bu... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3914911 Mon, 30 Aug 2010 15:00:01 +0100 3914911 http://www.medworm.com/index.php?rid=3914913&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Froot-beer-bonds-chemotherapy-patient-oncologist.html by Krupali Tejura, MDI am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: they are in for a battle.(...)Read the rest of Root beer bonds a chemotherapy patient with his oncologist2 comments | Tags: Cancer, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3914913 Mon, 30 Aug 2010 11:00:04 +0100 3914913 http://www.medworm.com/index.php?rid=3913111&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fobesity-complex-problem-simple-solutions.html by Arya M. Sharma, MDA single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).(...)Read the rest of Obesity is a complex problem that may not have simple solutions4 comments | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3913111 Sat, 28 Aug 2010 15:00:31 +0100 3913111 http://www.medworm.com/index.php?rid=3911641&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Ftreating-vitamin-deficiency-requires-caution.html by Kenneth Lin, MDVitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has always been thought to play an important role in keeping bones strong, researchers are suggesting that low levels may increase one’s risk for a variety of diseases, including cancer and cardiovascular disease.(...)Read the rest of Treating vitamin D deficiency requires cautionNo comment | Tags: Drugs | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical W... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3911641 Fri, 27 Aug 2010 17:00:06 +0100 3911641 http://www.medworm.com/index.php?rid=3911643&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fwomen-endometriosis-motherhood-elusive.html by Lone HummelshojEarlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated 7.5 million women in the U.S. — one in 10 — are affected by endometriosis during their reproductive years.Since endometriosis is one of the biggest causes of infertility, too many women will never experience the joy of motherhood — and for them “Mother’s Day” becomes a day of grieving for the children they never had.(...)Read the res... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3911643 Fri, 27 Aug 2010 13:00:49 +0100 3911643 http://www.medworm.com/index.php?rid=3907545&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fmedicalization-increases-treatment-harm-patients.html by James Baker, MD“Medicalization” is the process of turning problems into diagnoses and people into patients.According to Dr. Gilbert Welch, “It encourages more of us to be anxious about our health and undermines our confidence in our own bodies. It leads people to have too much treatment — and some of them are harmed by it.”“Alcohol dependence” and “attention deficit hyperactivity disorder (ADHD)” are among the issues that some call problems and others call medical disorders.(...)Read the rest of Medicalization increases treatment and can harm patients4 comments | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3907545 Thu, 26 Aug 2010 15:00:24 +0100 3907545 http://www.medworm.com/index.php?rid=3895827&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fplacebo-therapy-surgery-medication.html by PalMDThe New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients.  This is both true and overly simplistic.(...)Read the rest of Is placebo a therapy, like surgery or medication?No comment | Tags: Patient, Primary care, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3895827 Mon, 23 Aug 2010 13:00:35 +0100 3895827 http://www.medworm.com/index.php?rid=3895828&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Ffetal-heart-rate-monitoring-importance.html by Nicholas Fogelson, MDContinuous fetal heart rate monitoring is at its core an almost laughable idea.We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings.  OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign?  Would we do it with an adult?  Of course not, but there are people who do.  In fact, there are entire countries where this is a major methodology for determining the etiology of illnesses.(...)Read the rest of Fetal heart rate monitoring is given too much importance1 comment | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3895828 Mon, 23 Aug 2010 11:00:20 +0100 3895828 http://www.medworm.com/index.php?rid=3891649&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fprevent-recurring-urinary-tract-infections-utis.html by Michael Aaronson, MDI have helped scores of women with frequent, recurring urinary tract infections (UTIs) over the years.First, involvement of your primary care provider is critical. “Must not miss” disorders need to be considered prior to going forward with the recommendations given below.Second, how do you define recurrent urinary tract infection? Most define recurrent UTI when a woman has 2 or more symptomatic urinary tract infections in 6 months or 3 or more symptomatic UTIs over 12 months. What makes this definition less precise is the fact that the degree of discomfort in the woman usually is the determining factor that leads her to present to her primary care provider. Frustration usually motivates the woman to act.(...)Read the rest of Prevent recurring urinary trac... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3891649 Sun, 22 Aug 2010 17:00:54 +0100 3891649 http://www.medworm.com/index.php?rid=3885288&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fordering-test-result.html by Bruce Campbell, MDInsanity: Doing the same thing over and over and expecting different results. - Albert Einstein As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We wanted to investigate our patients’ illnesses and, just as importantly, we wanted to be prepared for any question with which our professors might surprise us during Attending Rounds.(...)Read the rest of Before ordering a test, know what to do with the resultNo comment | Tags: Hospital | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3885288 Thu, 19 Aug 2010 17:00:54 +0100 3885288 http://www.medworm.com/index.php?rid=3876580&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fheart-health-depends-healthy-behaviors.html by John Mandrola, MDEveryone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology — or maybe because of it — many continue to fail miserably on the front end, that is prevention.(...)Read the rest of Heart health depends on healthy behaviors1 comment | Tags: Heart, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3876580 Tue, 17 Aug 2010 17:00:35 +0100 3876580 http://www.medworm.com/index.php?rid=3865217&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fdepressed-elderly-risk-dementia-alzheimers-disease.html by John GeverElderly people who are depressed may be at twice the risk of developing dementia or Alzheimer’s disease over time — but it’s unclear whether depression causes dementia or vice versa, researchers said.(...)Read the rest of Depressed elderly at risk for dementia or Alzheimer’s diseaseNo comment | Tags: Medicare, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3865217 Fri, 13 Aug 2010 15:00:49 +0100 3865217 http://www.medworm.com/index.php?rid=3861962&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fdraw-person-test-pain-management-diagnosis.html by Leonard R. Friedman, MDIn diagnosing areas of chronic pain for adult pain management, I have come across a helpful test which I have unable to peer review.It is the Draw a Person test.  Pain management physicians have not used this easily identifiable test to evaluate the subconscious of the patient.  This is done by asking the patient to draw a male and a female, with clothes, on a sheet of regular copy paper.  These pictures can be faxed to other parties for further verification and ideas.(...)Read the rest of Draw a Person test to help with pain management diagnosisNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3861962 Thu, 12 Aug 2010 13:00:18 +0100 3861962 http://www.medworm.com/index.php?rid=3858102&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fmissed-diagnosis-er.html by 911Doc, MDWNL is doctor shorthand for “within normal limits”. Saves a bunch of time when checking the boxes on the physical exam. The temptation is to write “WNL” whenever possible, and, therefore, it often ends up meaning “We Never Looked”.A homeless gentleman presented to my ER a few months ago. He had been hit in the head with a beer bottle. He had a suturable laceration to his scalp to prove it. He was in a lot of pain, but it was his neck (not his forehead) that hurt him.(...)Read the rest of Missed diagnosis in the ER, and the need to lookNo comment | Tags: Emergency, Hospital | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3858102 Wed, 11 Aug 2010 19:00:34 +0100 3858102 http://www.medworm.com/index.php?rid=3858103&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fprevent-treat-mosquito-bites-children.html by Roy Benaroch, MDSummer has already begun, and LeeAnn has already had enough of mosquitoes. She wants to know, “Does taking Vitamin B1 really help keep mosquitoes from biting? How much is safe for children?”I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that mosquitoes are a vital part of the food chain, and essential to the ecosystem.I hate those bloodsuckers. The mosquitoes, I mean. Not the teachers.(...)Read the rest of How to prevent and treat mosquito bites in childrenNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3858103 Wed, 11 Aug 2010 17:00:19 +0100 3858103 http://www.medworm.com/index.php?rid=3858105&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fosteoporosis-screening-guidelines-uspstf.html by Todd NealePostmenopausal women of any age with a 10-year fracture risk equal to or greater than that of a 65-year-old woman and no other osteoporosis risk factors should be screened for the disease, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).The 2002 USPSTF guidelines recommended routine screening only for women ages 65 and older, as well as women ages 60 to 64 with an increased risk for osteoporotic fractures. The current guidelines contain no recommendation for or against screening in younger women.(...)Read the rest of New osteoporosis screening guidelines from the USPSTFNo comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3858105 Wed, 11 Aug 2010 15:00:50 +0100 3858105 http://www.medworm.com/index.php?rid=3858106&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fcolonoscopy-screening-options-colon-cancer.html by Erin Marcus, MDIt’s exceedingly uncommon for a healthy middle-aged man to walk into his doctor’s office and demand a colonoscopy. But even though he lacked a family history, Stanley Thornton, an African-American engineer who was then in his mid-40’s, wouldn’t take no for an answer.“I was concerned that African-Americans do get colorectal cancer earlier, and I said, ‘hey, let me lead by example,’” he said recently. “We argued about it for a month or two. He felt I should wait until I was 50.”(...)Read the rest of Colonoscopy and other screening options for colon cancerNo comment | Tags: Cancer, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3858106 Wed, 11 Aug 2010 13:00:18 +0100 3858106 http://www.medworm.com/index.php?rid=3854476&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fcyberbullies-common-victims.html by John GeverSo-called cyberbullies share many of the psychosocial features as their victims — and in fact many bullies were also victims themselves, researchers from Finland said.A population-based cross-sectional study surveyed more than 2,000 seventh- and ninth-graders in two Finnish communities and found that cyberbullies had higher than average rates of self-perceived difficulties in life, headache, feeling unsafe at school, and perceiving teachers as uncaring, among other problems, reported Andre Sourander, MD, PhD, of Turku University, and colleagues.(...)Read the rest of What cyberbullies have in common with their victimsNo comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3854476 Tue, 10 Aug 2010 15:00:23 +0100 3854476 http://www.medworm.com/index.php?rid=3848832&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fmale-hormone-treatment-testosterone-replacement-concerns.html by A Country Doctor, MD One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala. He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school. (...)Read the rest of Male hormone treatment and testosterone replacement concerns 2 comments | Tags: Drugs, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3848832 Mon, 09 Aug 2010 17:00:22 +0100 3848832 http://www.medworm.com/index.php?rid=3848834&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fvideo-games-linked-attention-problems-children.html by Michael Smith It’s not just TV — video games are also associated with an increased risk of attention problems in children, researchers said. A large study found that children who spent more than three hours in front of a computer or television screen — whether playing video games or watching TV — were significantly more likely to have attention problems, according to Edward Swing, MS, of Iowa State University in Ames, Iowa, and colleagues. (...)Read the rest of Video games are linked with attention problems in children No comment | Tags: Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3848834 Mon, 09 Aug 2010 15:00:56 +0100 3848834 http://www.medworm.com/index.php?rid=3833410&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fmigraine-pain-comparable-torture.html by Diana E. Lee Last year, People published an interview with Cindy McCain, wife of U.S. Senator John McCain of Arizona. She revealed she has dealt with excruciating migraine attacks for about 15 years, including during her husband’s presidential campaign. Though she has never discussed them publicly before, she has chosen to talk about her situation now to help bring awareness to this disabling condition and all the people going through what she has been through. She presented the keynote speech at the International Headache Society meeting in Philadelphia. (...)Read the rest of Is migraine pain comparable to torture? No comment | Tags: Patient | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3833410 Sat, 07 Aug 2010 19:00:15 +0100 3833410 http://www.medworm.com/index.php?rid=3831306&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Ftestosterone-levels-treated-older-men.html by William R. Yates, MD I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men. One of the difficult questions facing clinicians is when is testosterone too low in older men. (...)Read the rest of Testosterone and when should low levels be treated in older men No comment | Tags: Drugs, Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3831306 Fri, 06 Aug 2010 19:00:54 +0100 3831306 http://www.medworm.com/index.php?rid=3831309&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Frandomized-controlled-clinical-trials-human-genome-project.html by George Lundberg, MD First, relevant disclosures: I work half-time as editor-at-large at MedPage Today in Little Falls, N.J., and I work half-time as editor-in-chief of Cancer Commons from CollabRx in Palo Alto. Many of you know that I was the editor at JAMA for 17 years and at Medscape for 10 years. You also know that I have been a strong advocate for evidence-based medicine (EBM) for decades and have trumpeted the large randomized controlled clinical trial as the “gold standard” for EBM. (...)Read the rest of Randomized controlled clinical trials and the Human Genome Project 1 comment | Tags: Cancer | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3831309 Fri, 06 Aug 2010 15:00:59 +0100 3831309 http://www.medworm.com/index.php?rid=3831311&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fmksap-35yearold-man-red-eye-acute-eye-pain.html Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated for red eye and acute onset of right eye pain. He wears contact lenses daily. Fluorescein staining is positive for corneal abrasion without a dendritic, or branching, pattern. He is instructed to stop wearing the contact lenses until the abrasion is healed. He calls the next day to report that the pain has worsened, even though he has not worn his contact lenses. On examination, compared with the previous day’s findings, the patient appears to be in more pain, visual acuity of the right eye is worse with Snellen’s test, and the abrasion is larger on fluorescein staining. The eye remains red, and there is a mucopurulent discharge. Which of the fo... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3831311 Fri, 06 Aug 2010 12:00:43 +0100 3831311 http://www.medworm.com/index.php?rid=3827008&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fattribution-error-patient-colon-cancer.html by Jerome Groopman, MD and Pamela Hartzband, MD Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital. The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the admitting physician that her symptoms began about two weeks after surgery. (...)Read the rest of Attribution error in a patient with colon cancer No comment | Tags: Hospital, Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3827008 Thu, 05 Aug 2010 19:00:29 +0100 3827008 http://www.medworm.com/index.php?rid=3827013&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fdoctors-ignore-social-factors-making-patient-diagnosis.html by Kevin Pho, MD A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis. Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.” (...)Read the rest of Doctors ignore social factors when making a patient diagnosis 3 comments | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3827013 Thu, 05 Aug 2010 12:00:37 +0100 3827013 http://www.medworm.com/index.php?rid=3822852&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fbacterial-resistance-chronic-antibiotics-problem.html by Jan Henderson, PhD Unlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem. The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the only thing that creates antibiotic resistance. Is there irrefutable scientific evidence that the overuse of antibiotics in raising livestock, for example, is harmful to human health? It’s not easy to prove direct cause and effect. If you feed a pig a steady diet of antibiotics, can you irrefutably prove that this result... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3822852 Wed, 04 Aug 2010 17:00:11 +0100 3822852 http://www.medworm.com/index.php?rid=3822853&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fminimize-patient-waiting-potential-cancer-diagnosis.html by Howard Luks, MD I received a very troubling phone call from a close friend recently. He underwent a study, at the age of 40, and the physician came out of the procedure and said, “you have a large tumor, do you want me to call a surgeon for you.” The purpose of this post is not to comment on the physician’s behavior or delivery techniques, but to define this very precarious and anxiety producing period my good friend now finds himself in. It is not uncommon for physicians to find a tumor or something wrong on an X-ray, MRI or colonoscopy, for instance. While the information can be delivered to the patient in various fashions, the interaction will place the patient and his family into the “Gray Zone,” which is an exceptionally uncomfortable place to be. (..... Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3822853 Wed, 04 Aug 2010 16:00:20 +0100 3822853 http://www.medworm.com/index.php?rid=3822854&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fobesity-american-children-adults-continues-grow.html by Emily P. Walker The number of obese adults in the U.S. continues to rise, despite a growing number of federal anti-obesity initiatives in the past two years, according to a new report. The seventh annual “F as in Fat” report, released Tuesday by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation, found that obesity rates continued to rise in 28 states from 2007 through 2009. Nationally, two-thirds of adults and nearly one-third of kids and teens are now overweight or obese. (...)Read the rest of Obesity in American children and adults continues to grow No comment | Tags: Patient, Primary care | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3822854 Wed, 04 Aug 2010 15:00:48 +0100 3822854 http://www.medworm.com/index.php?rid=3822855&cid=t_430009_85_f&fid=34587&url=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F08%2Fbreathe-properly-night-learn-sleep.html by Steven Y. Park, MD Every time you see a depiction of someone sleeping on TV or in the movies, you’ll see the person sleeping on his or her back, and oftentimes, snoring. The lay public, doctors, and even alternative and complementary practitioners naturally assume that you’re able to breathe properly at night. This couldn’t be further from the truth. (...)Read the rest of Breathe properly at night and learn to sleep better 2 comments | Tags: Specialist | Category: Diagnosis and treatment (Source: Kevin, M.D. - Medical Weblog) Kevin, M.D. - Medical Weblog blogs http://www.medworm.com/rss/comments.php?id=3822855 Wed, 04 Aug 2010 13:00:41 +0100 3822855