The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle.  If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately.  This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically.  Was it something ...

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On November 8, voters in California, Maine, Massachusetts and Nevada approved ballot measures to legalize recreational cannabis. It is now legal in a total of eight states. And this creates potential problems for road safety. How do we determine who’s impaired and who’s not? The effects of alcohol vary based on a person’s size and weight, metabolism rate, related food intake and the type and amount of beverage consumed. Even so, ...

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I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — ...

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“I’m not really a pill person.” “I was never one for all those pills.” “I don’t really like taking those pills.” “I’m not really into taking pills.” As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!” Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields ...

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Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but ...

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A 67-year-old patient, whom I'll call Herb, recently came to see me for a check-up for his diabetes. He has suffered from complications from diabetes in the past, and his most recent numbers -- including his A1c -- were poor. I sat down to talk with Herb, but before I could say anything, he got straight to the point. Herb lives on a fixed income. Although he has Medicare coverage, his ...

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Codeine is a terrible choice for treating children’s pain and cough, and we ought to just stop using it. It’s like an old yogurt container, way at the back of your fridge -- sure, it was once tasty, and then for a while, you held on to it for sentimental reasons. “Remember that yogurt?” you’d say to your spouse. But it’s well past time to throw that stinky stuff away. For ...

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Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions -- maybe ask a few questions -- and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely. One of the most common of these medications is a statin. Imagine you exercise four ...

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In our current health care system, doctors should get to decide what medication is prescribed. Typically, the patient and doctor decide what is the best, then the prescription gets sent off to the pharmacy. When the patient goes to pick up the prescription, often they find a different one instead or are told that their health insurance coverage is not covering that prescription. Instead of receiving the best medication for ...

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Martha arrives for an appointment with her new primary care provider. She hesitantly hands over her pill boxes at the nurse’s request; it seems to take forever to enter them all into the computer. “You are taking a lot of blood pressure pills,” he comments. The doctor comes in and after a brief introduction, notes that she is taking five medications for her blood pressure. “Five?” Martha exclaims in disbelief. She hadn’t ...

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