I was glad she never asked if I had done this before. My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for ...

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Fecal microbiota transplantation (FMT) has emerged as an increasingly common treatment for patients with refractory Clostridium difficile infection (CDI). Unlike standard antibiotic approaches, which only exacerbate dysbiosis and may perpetuate CDI recurrence, FMT restores normal gut microbial community structure and function of the gastrointestinal tract. However, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice.

Before I jump into highlighting ...

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The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed. Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives. Then there are several cumbersome explanations about the appeal ...

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medpagetodayFrom MedPage Today:

  1. U.S. Still Poorly Prepared to Treat Obesity. Health professionals are poorly prepared to treat obesity, and they have biases and unfounded assumptions about the disease.
  2. Fibromyalgia: Need to Nap Increases as Symptoms Worsen. Daytime napping is associated with greater symptom severity in patients with fibromyalgia, supporting the notion that ...

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There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear ...

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Sleep apnea is a condition that afflicts millions of people.  There are two types of sleep apnea: central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about sleep apnea. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, ...

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pamela wible Ever wonder what patients really want from doctors? Is it the fancy buildings with marble fountains? Is it the board certifications and diplomas on the wall? Is it the expert medical jargon and starched white coats? Nope. None of the above. Listen up, docs: Patients just want the real you. Ya know -- you. The competent and caring you who really listens with compassion. The real you ...

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We all know them. We see them on TV. We read about them in the paper. And, with the explosion of social media, you hear about it from people you know. If you have a Facebook account with a sizable enough network of friends, you’ve probably seen at least one negative comment about vaccines. On one end of the spectrum, there are the seemingly innocent people who claim that they ...

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As our medical system attempts to evolve to better deal with the modern epidemics of lifestyle-driven chronic disease, much time and attention is being placed on the clinical models for prevention. Rightly so, and various viable models are popping up with names like lifestyle medicine, preventative medicine, and functional medicine. But one area that is hardly addressed is the payment structure and business model of the practices. Are there structures that ...

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As the measles outbreak gathers worrisome steam in parallel to the explosion of passionate rants both pro and anti-vaccination, I find myself wondering; what is this really about? Rather than get bogged down in the myriad of issues on either side- though at the outset I will say that as a pediatrician I unequivocally recommend vaccination; I will aim to look at the bigger picture. Is this issue really about trying ...

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Six years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP, who did a rapid strep test and prescribed me medication. I picked up my medication ...

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asco-logoMom. Dad. Happy. Sad. Friend. Trust. I remember playing this game. A friend would say one thing, and then I would say the first thing that came to my mind. For some reason, it would pass the time. I remember how some words would spark an emotion or a memory. Sometimes happy, sometimes not so happy. But, playing that game was one of ...

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"Nervous." I’ve heard that word a lot lately. It keeps falling from the mouths of my families in clinic, landing on the floor with a silent thud. I mean, we have a right to be. We should be. It is one of the most infectious diseases on the planet, today about 400 people worldwide will have died of it, and the number of infected people in the U.S. is climbing. As Read more...

Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam.  Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test.  Wow, she must be the most awesome, most well-read, most skilled, most enthusiastic anesthesiologist ever now!  Well, she always was, but ...

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She is always a difficult admission. The long chart review. The vague complaints. The entitled attitude. The misdirection. These are expected. As is the cake at her bedside after a diabetic crisis. The two-liter soda after an emergent fluid dialysis. The urine toxicology was positive for cocaine. The staff knows her well. I know her well. I give her the attention, kindness and empathy that I give to every patient. ...

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I saw this little news item from Shape Magazine about “vagina facials.” First of all, the post means vulva. The vagina is inside and the vulva is the outside (where your underwear touches your skin). The vestibule is in between. This what Shape Magazine had to say about it:

Created by Lisa Palmer, the facial came about after she “looked downstairs” and realized her vulva “was a bit wrinkly and dry compared to when ...

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You don’t have a second chance to make a great first impression.

If twenty random numbers were read aloud, most people would remember the first few numbers and the last few numbers.  We tend to remember beginnings and endings.  It is the same with patients; they tend to recall what they hear at the beginning and the end.  This is how our brains are wired; ...

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The flu season has really gotten into gear now with 46 of our 50 states reporting widespread influenza activity as of January 3, 2015. Influenza is a virus that infects the respiratory tract, causing sore throat, runny nose, fever, and cough. Rarely people with the flu will have nausea, vomiting and diarrhea, but this is not "stomach flu" which is a term some of us use to describe any one ...

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The power of placebos has long been known. People who believe that they are taking an effective drug frequently feel better. In fact, prior to the discovery of penicillin, it is likely that the placebo effect accounted for much of the benefit of medical care. A study published in the journal Neurology makes an interesting connection between the magnitude of the placebo effect and the medication’s perceived price. The study enrolled 12 ...

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“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient -- brightly alert, with a colorful headband and bright red lipstick -- was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, ...

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