Stephanie wrote in about a very common problem:

My daughter is 4 years old. She isn’t the tallest cat in town (she is about the 15th-25th percentile for height), and her BMI always ends up being in the high range (like over 85%). I worry about it. I am very health conscious for myself and my family. We live by all of the "rules." And yet. The family doctor doesn’t worry -- ...

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Hepatitis C virus (HCV) continues to be the number one cause of cirrhosis and liver cancer and the primary indicator for liver transplantation in the United States, yet it remains vastly underdiagnosed. More than three million people in the U.S. are infected. Guidelines support widespread screening for HCV, and excellent treatments are now available. So the question remains: Why is HCV underreported? When “good” news disguises bad A recently published Read more...

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered. And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by "experts" brim full with diagnostic exuberance -- sometimes well meaning, sometimes influenced by extensive drug company affiliations -- and always ungoverned by simple common sense, a respect for ...

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7 steps to eliminating the war analogy in cancer careFrom a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. ...

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Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell. My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, ...

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In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve.  Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but -- in general -- we still have a long way to go in our attitudes toward mental illness. I think it’s ...

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I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. ...

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Obesity and obesity related illness accounts for an enormous health care expenditure in the US today: approaching 150 billion dollars annually.  In an era of health care reform and cost containment, preventative medicine is essential to success.  Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing health care costs by focusing on slimming waistlines throughout the US. According to a recent ...

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People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.” All too often, when that frustration becomes too ...

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