You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is ...

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A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part ...

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Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes. It is common practice to leave a permanent tattoo at ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, ...

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An excerpt from Cure: A Journey into the Science of Mind Over Body. Linda Buonanno hugs me as soon as we meet, and shows me upstairs to her small, first-floor apartment in a housing block just off the freeway in Methuen, Massachusetts. Her living space is tidy but densely packed ...

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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 during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea ...

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Gluten is in the news again. Gluten and probiotics are among the two dietary issues that most consume my patients. I am asked for my opinion on them several times each week. Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of "good bacteria" with zeal and enthusiasm. Why do they do this in the absence ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated after a recent colonoscopy, which disclosed a 2.5-cm pedunculated polyp in the sigmoid colon. The polyp was removed in its entirety in a single piece. Biopsy results showed a well-differentiated adenocarcinoma confined to the submucosa without evidence of lymphovascular involvement and a 1-mm margin. There is no ...

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Patients are cool.   I did a colonoscopy on a hospitalized man who was saddled with the ravages of obesity, diabetes, sleep apnea and respiratory disease.  My partner had performed the initial consultation, and it was my task to bring light into a dark place by performing a colonoscopy.  I engaged in some conversation prior to the procedure, not simply to acquire relevant medical facts, but also to establish some rapport ...

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Overtesting and over treatment are big problems in modern medicine.  It sometimes goes like this: Have a minor complaint? It’s probably nothing, but we should do an exhaustive workup because there is a 0.00001 percent chance it could be cancer, maybe. However, if you happen to be that one patient in 10 million that had cancer, and we actually found it early by aggressive testing, then you would be glad you went for ...

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