Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis. Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, ...

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Imagine that you come home to find your daughter in tears. She’s been acting strangely for the past year, but she never tells you what’s going on. This time she finally tells you: She can’t stop thinking about killing herself with a knife in the kitchen. After an hour of talking, you realize that she doesn’t want to die, but she has obsessive thoughts about hurting herself. She’s overwhelmed, and ...

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Part of a series. Beginning at about age 40, our bodies begin a process of organ and functional decay of about 1 percent per year. Bone mineral density decline leads eventually to osteoporosis and fracture risk, cognition decline leads to memory and thinking impairments, and muscle decline leads to loss of strength while increasing the fracture risk of a fall. According to the Centers for Disease Control, almost ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated for a 3-week history of substernal chest pain. The pain is dull, nonradiating, and unrelated to activities. Sometimes the pain is worse after eating spicy foods and can be occasionally triggered by emotional stress. She has not had shortness of breath or ...

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Recently, a young child died following days of vomiting. He had been in shallow water in a Texas dike about a week before his death. The story was picked up as an alleged case of a rare condition called dry drowning or secondary drowning. The media accounts went viral, spreading significant fear in parenting communities and among those learning about these alleged conditions from the news ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has ...

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When a child is diagnosed with cancer, overwhelmed parents and patients are often laser-focused on the path to cure. Even though parents do not welcome pain or discomfort for their child, they may feel that symptoms are a necessary cost of curative care. Likewise, it is easy for us, as pediatric oncologists, to accept symptoms and side effects of treatment as normal. Important new research challenges this assumption and challenges ...

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The first thing I remember as I regained consciousness, lying in a hospital emergency room, was hearing a nurse ask my mom if I was allergic to any foods. With my eyes still closed, I said, “asparagus,” thinking this might reduce the chances of anyone serving me what was then a dreaded vegetable. “Asparagus,” repeated the nurse, making a note on my admission form. And then, with a chuckle and what must ...

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“Noncardiac chest pain” was Laurie Black’s discharge diagnosis. Her chest CT angiogram didn’t show a pulmonary embolus, her troponins were negative for a heart attack and her nuclear stress test was negative for coronary ischemia. “So what do you think it was?” she asked while I read through her hospital discharge summary. “I don’t know. Show me where the pain was,” I answered. “It started on my back, on the left side, and ...

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