Are you a recovering alcoholic?Be honest.How about a recovering nicotine addict, or recovering from an addiction to some illegal drug, or maybe addiction to gambling, or sex, or football, or even your computer screen, or Angry Birds?I have worked in the addiction field most of my professional life. For me, addiction to a chemical includes physical and mental dependence, tolerance, withdrawal, and, of course, drug seeking behavior, despite recognized ...
Conditions
What you need to know about antithrombotic guidelines
The lack of evidence supporting the “economy class syndrome” myth in air travel made major news headlines recently. While certainly interesting and accurate, that topic was just one among many topics addressed in the larger framework of the new evidence-based guidelines.The American College of Chest Physicians (ACCP) released the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in its February issue ...
MKSAP: 35-year-old woman with right upper quadrant abdominal pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 35-year-old woman is evaluated for a 6-month history of right upper quadrant abdominal pain that has slowly increased in intensity and is worse on deep inspiration. The patient is otherwise well, and her only medication is an oral contraceptive pill that she has taken ...
A Grammy artist with Tourette Syndrome
Would you consider a career as a singer if you had involuntary tics from Tourette Syndrome?Well, it apparently didn’t stop 20-year-old Contemporary Christian musician Jamie Grace.In fact, Grace attributes singing with helping her cope with her disease.And now she is being rewarded with a Grammy nomination for best contemporary Christian music song, Hold Me. The song features TobyMac, who is a Grammy winning Christian recording and hip/hop artist. He ...
A physician shares her anxiety management tips
I started working with a new coaching client the other day. I'd already been following the twists and turns of her life saga for about a year, via excited emails she'd been sending me ever since reading my book Live a Life You Love."As you know, I've made all kinds of wonderful changes in my life," she told me over the phone, "I left a job I couldn't stand, sold ...
Why we need truth in labeling of medical conditions
Labels matter. We quickly form judgments based on them. If we hear someone called lazy, the label “lazy person” attaches in our mind even though we may not have even met the person. The same is true for labels given to various medical conditions. If the label for an illness uses language such as “fatigue,” we abstract from our experience and think we know what it’s like to suffer from ...
What you need to know about popular diets
Losing weight can help lower your chances for cancer if you’re overweight or obese.But not just any weight-loss plan will give your body the nutrients it needs to fight off diseases like cancer.Below, I’ve separated out the good from the bad among popular diets.Good nutrition is not a fast fix Diets that make the “good list” encourage long-term change. They also give you a variety of options from all ...
The psychological basis of Morgellons disease
If you are like most people, you have probably never heard of Morgellons disease or Morgellons. The first reason you have likely never heard if it is because it is so bizarre and uncommon. Most of what is known about it is based on rare case reports or anecdotal stories. The second reason is because it is not recognized in the medical community as a legitimate medical disease. It is ...
How erectile dysfunction might save your life
Just the other day, I saw a 52 year old man in my office for what I thought was a routine prostate issue. I walked in the exam room, introduced myself and immediately knew his prostate was fine. His eye contact was non-existent. He was nervous and his handshake was clammy and brief. I see these patients everyday. Their prostates are just fine. It's their love life that's the issue. ...
Why ultimate fighting is better than boxing
There seems to be a deep, even innate, need on the part of many young men to actually, or vicariously, strike out at other people to cause pain and injury while striving to dominate.In 1996, I wrote an editorial entitled "Blunt Force Violence in America" describing "a modern continuum from street fights to barroom brawls to domestic child, spousal, and elder abuse, to ultimate fighting to extreme fighting, to ...
MKSAP: 78-year-old woman is seen for management of her diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more ...
Avoid malpractice while treating minor head trauma in children
In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected ...
When medical advances do the world a disservice
There is a healthy debate over whether a lab that created an extremely infectious version of influenza ought to publish the genetic sequence. The debate speaks to a larger problem: sometimes, medical advances do the world a disservice. The medical field could use some soul-searching, just as physicists did in the wake of the Manhattan Project.A few years ago, I read a neat research finding. In a pregnant woman, ...
Why we should eliminate the diagnosis of ADHD
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.If ...
Treating heart failure on a budget
As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.One of ...
MKSAP: 60-year-old woman with pruritic hives
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical ...
How the CA-125 became a $50,000 blood test
What could be so simple as a blood test?A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.That was the thinking of my wife’s physician when she ordered a test called the "CA-125." ...
Understanding the pain of fibromyalgia
Many healthcare professionals find fibromyalgia difficult to believe as “a real disease” and most of all difficult to handle, and to be honest it is not so difficult to see why. Doctors and other healthcare professionals have learned how to search for diseases based on the specific symptoms the patients present, but fibromyalgia – and several other chronic pain syndromes – do not fit into that model.The patients are presenting ...
3 best practices for both physicians and patients to treat diabetes
As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based ...
MKSAP: 58-year-old woman with acute left-sided flank pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is ...
