Curiosity and apprehension. I experience this tension as a young man ushers me through large daunting doors with “Authorized Personnel Only” posted in bold red letters. Inside, a massive machine dominates the room, and yet my focus turns to the patient lying on the table, face covered in a white mask holding his head still while the technician targets the malignant brain tumor. “All right in there?” the specialist asks, and ...

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My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better ...

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Today, I talked at length with that lady whose husband has Creutzfeldt–Jakob disease (CJD). That patient -- the one with arbitrary myoclonic jerks, always naked and uncovered by blankets due to uncontrolled flailing, his penis and Foley catheter exposed. That one with overgrown mycotic toenails and eyes that are always only half-open, his gaze drifting everywhere. He was until now just a patient for me -- the CJD patient. Yet today ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is seen for follow-up evaluation of a tremor in his upper extremities that has been present since age 20 years. The tremor was mild for many years and did not interfere with his work but has become more prominent in recent years. He has difficulty writing and using utensils ...

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As the awareness and recognition of concussion in sports continue to increase and the frightening long-term outcomes for frequently and severely concussed athletes are realized, as a physician I cannot help but advocate drastic changes in football.  Of the major sports, it sees the highest rates of concussion, and for every highly publicized Greek tragedy of a broken NFL star (Jim McMahonJunior SeauDave ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman had a burning sensation involving the right side of her forehead and the tip of her nose for 2 days, followed by increased redness and the development of lesions involving the tip of her nose. Medical history is significant for hypertension, and her only medication is ramipril. On physical examination, ...

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"I have always depended on the kindness of strangers." - Blanche DuBois, A Streetcar Named Desire, Tennessee Williams It was near the end of 2008 that I developed symptoms that I recognized as sciatica.  The Internet is a wonderful source of information (and some misinformation).  I decided to educate myself.  In my reading, I encountered one study that indicated that patients who underwent surgery were better at one year, but about the ...

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In her new book In This Together: My Story, the former First Lady of Massachusetts, Ann Romney, describes receiving in her mid-40s a diagnosis of multiple sclerosis (MS). She offers vignettes of a “life upended”: her abandonment of therapeutic swimming because it made her hair “look bad” and the need to revise plans for her Park City home to include an elevator. In her case, MS is invisible, characterized by fatigue, ...

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Tackling: in so many ways, it's what football is all about. Now, of course running, passing and scoring (and strategy) are important parts of football too. But it's tackling that stops the opponent. Without tackling, you can't play football. Or can you? A policy statement just released by the American Academy of Pediatrics (AAP) suggests that we need to do some thinking about tackling and its impact -- literally -- on ...

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In May 2003, during my second year of pediatric residency, I had a right temporal lobectomy to remove a seizure focus in my right hippocampus.  Although the surgery proceeded without complications, I was unable to walk unsupported for several weeks after the operation.  My experiences taught me what makes an exceptional physician. An ...

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