“I only have 10 percent of my eyesight remaining, but that’s not the problem. I am looking for mercy.” My eyes drifted back and forth between Abu-Adnan’s face squinting into the distance, and the shuffling prayer beads swaddled in his right hand. I fizzled with frustration as my cochlea’s raced to transcribe his traumatic story into an appropriate emotional response. This 65-year-old Syrian refugee from the Golan Heights pleaded me for a ...

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When our daughter Florence was born, we were shocked that a tiny, seven-pound beauty could turn our household (and our entire lives) upside down. Why was it so difficult to deal with one human being, when we often took care of a department full of ill patients? How could someone so cute induce a state of perpetual anxiety, forcing us to question every single action we took? It was disconcerting to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia of several weeks' duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution ...

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They said, "Do everything." She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer's. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe ...

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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 in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A ...

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asco-logo The phone rang in my office one morning last week. Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.” (The opening statement could just as easily be from a man, and often is.) I quickly looked up her notes in the electronic medical record ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. ...

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A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure.  There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it ...

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In the wake of the horrific Orlando shootings, there has been renewed attention given to the U.S. Food and Drug Administration's (FDA) so-called ban on blood donations from gay men.  A congressman called the ban discriminatory, and demanded it's repeal -- a call joined by the American Medical Student Association. I can understand how many gay men feel.  I often donated blood at various American ...

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Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me. ...

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