Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully ...

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There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:

The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol ...

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shutterstock_180109973 There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others. Specifically, there is a potential interaction ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old asymptomatic man is evaluated during a routine examination. He has a long history of heart murmur. With normal daily activities, he has not experienced shortness of breath, chest discomfort, or palpitations. Blood pressure is 138/78 mm Hg, pulse rate is 82/min and regular, and respiration rate is 16/min. BMI is 27. ...

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How does heartburn turn into a multi-thousand dollar workup?  The simple answer: defensive medicine.  See how this scenario plays out daily in this latest episode from Healthcare Not Fair.

shutterstock_198931019 "Turn out the light, the party's over," sang color commentator Dandy Don Meredith on ABC's Monday Night Football when a seminal fourth quarter play occurred and the game was suddenly in the bag. For me, that's where it's at right now -- just a few ticks of the clock away First, for the American Heart Association then for the American Red Cross, ...

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Here is a behind-the-scenes peek into an operating room in the midst of Silicon Valley. Here, routinely there is a groundbreaking intersection of technology and medicine that's blurring the lines between what's possible today and what you'll come to expect as routine in the future. Imagine two experienced surgeons working side by side to replace a calcified, stenotic and tired aortic valve within a man's heart without ever having to cut into ...

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shutterstock_137498780 One of my favorite physician sayings is, "Don’t just do something, stand there!" Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for ...

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shutterstock_89752360 I went to the doctor yesterday, my semi-annual visit, as it were. These days I see a nurse practitioner, a woman. Recently, she and the practice she is a part of moved into a renovated building, state-of-the-art, they are calling it. It almost sparkles in its newness. The practice is owned by one of the large hospital corporations in our city. See ...

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“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.” The coronary care unit (CCU) rotation is a unique place. Postoperative cardiothoracic surgery patients among many other pathologies from heart failure to heart transplant fill the unit, and it is the job of the ...

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