A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles. But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction. The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their ...

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(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.) Dr. Stephen Cluff is like Yoda. Judging by body hair, he's more like Chewbacca. But he's short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet's voice. If I'm stumped on a case, I'll ask him. If I'm pissed off about department politics, I'll call him for advice. If I want ...

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It sounded too good to be true when I first heard about Theranos, a company that promised to revolutionize medical testing by making it possible to perform dozens of tests on a single drop of blood, rather than the several tubes that would typically be required. And that wasn't all. Theranos CEO Elizabeth Holmes, a Stanford dropout and media magnet whose wardrobe seems to consist solely of all-black outfits, promised ...

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Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube? All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t. It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional mishap with ...

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Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is ...

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In his last state of the union address, President Obama reinvigorated the nation’s interest in a long-sidelined disease/s: cancer. A call for a moonshot was announced, and the president in his address said, “I’m putting Joe in charge of mission control.” The last time such a national commitment towards this illness was announced was by the efforts of a cancer advocate, Mary Lasker. She advocated fiercely, and the National Cancer Act ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12. On physical examination, vital signs are normal, as is the remainder of the physical examination. Upper endoscopy discloses a 6-mm polyp in the ...

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The term, "evidence-based medicine" (EBM), provokes strong feelings from its proponents and its skeptics.  I spent a full day recently in discussions about EBM.  As the day proceeded I understood that evidence is wonderful when it fits the clinical question, but that too often the clinical question does not, and probably will not have adequate evidence. We have great evidence for some clinical questions.  We all know that ACE inhibitors decrease ...

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