Obesity and obesity related illness accounts for an enormous health care expenditure in the US today: approaching 150 billion dollars annually.  In an era of health care reform and cost containment, preventative medicine is essential to success.  Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing health care costs by focusing on slimming waistlines throughout the US. According to a recent ...

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People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.” All too often, when that frustration becomes too ...

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Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception.  That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using ...

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Michelle Obama refers to childhood obesity as the tobacco of the 21st century. I agree. Obesity is quickly overtaking smoking as the nation’s No. 1 killer. As a pediatrician who sees firsthand the impact of overweight and obese children, we need to have conversations with our patient families that focus on obesity as a clinical issue. Right now, this isn’t happening. The rate of missed diagnosis for childhood obesity is over 95 percent, ...

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Lying in a hospital bed, my seriously obese patient can barely see her swollen and odorous right foot over her abdominal fat. The foot is soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity. Her two children, ages 6 and 12, hover from the hospital bed to the couch. In between, the bedside table is strewed with ...

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The joint statement on laboring in water and delivering in water (the latter also known as immersion births) from the American Academy Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) is making the rounds. I’ve linked to the full statement above, but in essence it says that some women find laboring in water helpful for pain relief (in the first stage of labor it reduces the need ...

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Sometimes it seems that life is unfair and the odds are stacked incredibly against us.  More than 1 in 3 persons will get cancer.  The chance of survival if you get lung, pancreatic or brain tumors is pathetically small.  The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers. However, there are remarkable stories of hope.  Here ...

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Is nerve block anesthesia better for surgery?A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More needles ... who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease your risk ...

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As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need -- even for those who ...

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Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants.  I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice.  When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected. My fear is ...

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