They say that the path to hell is paved with good intentions. Few things in medicine illustrate that as well as how we've approached chronic pain management in the past 10 to 20 years. The advances that we have made in medicine in the past few decades have been truly remarkable. But, unfortunately, pain is one of the ailments we still do not treat well. One of the difficult aspects of ...

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Many readers know that I favor empiric antibiotic treatment for adolescent/young adult pharyngitis when the clinical signs and symptoms strongly suggest a bacterial infection. I favor narrow target antibiotics and only in the patients with Centor scores of 3 or 4 (and perhaps some 2s when the patient looks very ill). This would exclude over 50 percent of patients from antibiotics. Most organisms already have developed resistance to penicillin, amoxicillin, and ...

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From new longer-acting drugs to promising gene therapy trials, much is changing in the treatment of hemophilia, the inherited bleeding disorder in which the blood does not clot. I will mark Hemophilia Awareness Month by discussing research and treatment progress, as well as remaining challenges. 1. Many more treatment products are being introduced, including some that last longer. In people with hemophilia, a “factor” -- or blood ...

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The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated for a persistent rash for 6 years' duration. The rash waxes and wanes in severity, and it becomes pruritic only after he becomes hot and sweating, such as when he mows the lawn or exercises. It has always been limited to his back and lower chest. He ...

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The concept of “personalized medicine” gets thrown around a lot these days. And as an oncologist and a palliative care doctor, who advocates for using data to get information that can provide more personalized cancer care, I believe strongly in it. But what would truly personalized oncology look like? More than 14 million people are living with cancer in the United States, according to the National ...

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asco-logoEvery so often I see a patient who views cancer as a constant threat to be handled. The cancer becomes so significant that she feels she can never let her guard down. I always worry about this -- partly because that singular focus on fighting cancer can sometimes detract one from other aspects of life, and those facets that give ...

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The ink hadn't yet dried on the report of the 2015 Dietary Guidelines Advisory Committee before the assaults began. I guess in this day and age, that's not much of a big, fat surprise. Despite all the over-heated rhetoric I've seen about not trusting this report because the "government" can't be trusted, this report is not from the government. While we may, indeed, need to worry about what the political authorities ...

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A 75-year-old woman with progressive constipation. An 82-year-old man with unexplained anemia. A 39-year-old mother of two with intermittent blood in her stool. These are three of my patients. And sadly, they are three of nearly 150,000 Americans diagnosed with colorectal cancer every year. March is National Colorectal Cancer Awareness Month for good reason. In the United States, colorectal cancer is the third most commonly diagnosed cancer. It is also the ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications. On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. ...

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