Top stories in health and medicine, September 11, 2014From MedPage Today:

  1. Azithromycin Linked to Belly Blockage in Infants. Infants who received azithromycin (Zithromax) in the early days of life were at an increased risk for developing infantile hypertrophic pyloric stenosis (IHPS).
  2. Singulair Doesn't Ease Wheeze in Most Kids. Intermittent montelukast (Singulair) didn't alleviate wheezing in children, except possibly for those ...

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Amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig’s disease) is a truly horrible illness. It is a progressive fatal neurodegenerative disorder that leads to worsening muscle weakness. Weakness in the limbs initially makes handwriting sloppy and makes it hard to button clothes and eventually causes paralysis. Patients also develop weakness in the muscles that control swallowing and speech, eventually requiring them to use feeding tubes and computer text-to-speech software. Eventually the ...

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Bambi Syndrome saved my life An excerpt from Pet Goats and Pap Smears. Life changes in a heartbeat. In the “Events of the Cardiac Cycle” lab, four students are assigned to each dog. Instructions: Inject the live dog with epinephrine and study the EKG. Sever cardiac nerves. Carve open the chest and shock the heart. As the dog’s blood pressure drops, remove the heart. Now, stab ...

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A 33-year-old woman in Indiana, Purvi Patel, presented to an emergency room with vaginal bleeding and when it was obvious that she had very recently delivered a baby the doctors on call notified the authorities. The body of her 28-week gestation infant was recovered. The pathologist believed the baby had taken a breath so Ms. Patel was with charged with neglect of a dependent. Sometime later the police ...

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Contrary to what you may have heard, pain is not the fifth vital sign. It's not a sign at all. Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature. What do those four signs have in common? They can be measured. A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers ...

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She was having excruciating pain in her pelvic area.  I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs.  I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart.  ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain. The emergency room physician had dutifully ...

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7:00 a.m. Lights on.   Coffee, black and a banana. Paperwork.  27 patient visits, 3 emergencies, 35 phone calls.  Lots of computer time. Some laughs and a few tears. Paperwork.  Last family meeting.  Coffee, black.   In between: Thursday. Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range ...

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Top stories in health and medicine, September 10, 2014From MedPage Today:

  1. Bone Drugs Work; Effects and Risks Vary. Treatments for osteoporosis vary widely in terms of risk-benefit profile.
  2. Red Carpet Paves Way to Research $$$. Viewers of Stand Up To Cancer's (SU2C) fourth 1-hour live prime-time commercial-free program -- telecast over more than 30 broadcast and cable networks Friday night ...

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You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan. I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the ...

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I came across an interesting article in the New Yorker last week: "Why Chinese patients are turning against their doctors." It is a fascinating account of the evolution of the health care system in China, highlighting the major changes that have led to increased patient-doctor homicides. In a nutshell, in ancient China, traditional medicine reigned king, and people scoffed at the idea of Westernized medicine. This started changing in 1949 ...

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Much is being made of the AMA's recommendation to reimburse doctors for the time they take in having end-of-life discussions with their patients.  The recommendations appear to have a good chance of being covered by Medicare and certainly are a step in the right direction.  But will one conversation and the completed documents really work?  Well, like so many other situations -- it depends. How skilled is the medical provider ...

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There were many things I pictured myself doing as I endured four years of medical school: building relationships with my patients and their families, performing complicated procedures, sleeping with my shoes on so I could jump up at any moment when I was on call. One thing I didn’t imagine was that I would be learning about and becoming a part of the labor movement. My experience at UCSF ...

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Dont forget to feed the doctors and nurses I went to the hospital cafeteria one day last year and experienced an epiphany. It was around 4:30 p.m. and the place was supposed to close at 6:00 p.m. As I entered, the folks inside were covering up the food and putting it all away. "Did you want something, I mean, we can make something for you." "Nope, I guess not," ...

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The ALS Association, and the British version, the Motor Neurone Disease Association, have made boatloads of money off of the ice bucket challenge. Originally the idea was that a person would challenge another person to donate money for ALS research and if they hadn’t done so in 24 hours, they would dump a bucket of ice water over their head. It turns out that people like dumping ice buckets over ...

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Top stories in health and medicine, September 9, 2014From MedPage Today:

  1. Hand OA Linked with Diabetes. Diabetes was strongly associated with hand pain and joint tenderness in patients with erosive hand osteoarthritis (OA).
  2. Culture Shock: The Ebola Dilemma. An august group of experts spent 2 days discussing how the various experimental substances should be used, given that none -- repeat, ...

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Even in the 21st century, talking to your doctor about your symptoms matters. This is something I tell my medical students. Talk to your patients. Listen to your patients. Use their story to determine what tests and imaging tests to order, if needed. Don’t get fooled by technology or be in awe of its importance. It is the patient’s experience that matters.  It isn’t the other way around as we ...

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A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.” In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care -- the added cost of additional care, additional hospitalizations, and the additional ...

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A frustrating patient, and how that affects her physician There’s a patient I don’t like very much. I’ll call her Mrs. X. Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur. Every time she makes an appointment, ...

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"Dr. Sevilla, what do you think about the Ebola virus," a patient recently asked me. My patient and I talked about the recent news reports stating that over 1,500 people have died because of the virus. "There's a vaccine that's being developed," I told my patient. "Well, that's great. I'm definitely going to get it, if ..." "If?" I asked my patient. "Well, you know how these things go. If it's covered on my ...

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Even if you don’t live in a city yet that offers Uber’s rideshare app, you probably have heard about it, because the media has widely reported on job actions by taxi cab drivers -- and the gridlocked traffic that resulted -- that has taken place in Washington, DC and in other major cities across the world including London, Berlin, Paris and Madrid. Uber is an “on demand” smart phone app that allows users ...

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