I was recently asked to see an 89-year-old woman who was gravely ill in the intensive care unit. She was admitted with cholangitis due to bile duct stones causing complete obstruction leading to septic shock. It is a life-threatening situation, especially in elderly patients. She needed an emergency endoscopic procedure: ERCP. By the way, one minor detail that makes this case more interesting and the intensivist called it a "wrench" ...

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One day recently, while working as a nursing assistant, I heard a shrill, gravely cry for help pierce the air in the hallway of the long-term memory care facility where I work. I sprinted to the room where the pleading call was coming from, and in the two seconds it took to reach the room, a million different worst-case scenarios passed through my mind. Broken hip, pool of ...

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When COVID-19 hit, routine cancer screenings nearly came to a halt. Now those postponed appointments and overdue tests will likely result in delayed cancer diagnoses. Now more than ever it’s an opportune time to educate the community about the importance of regular cancer screenings. While we have powerful treatments for those diagnosed with cancer, nothing is more powerful than prevention or early detection. Colorectal cancer is the second leading cause of cancer-related ...

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An excerpt from Scope Forward: The Future of Gastroenterology Is Now in Your Hands. Over a decade ago, many of us still used landline phones, watched cable TV, rented DVDs, called for taxis, took photos using cameras, and drove over to Borders to browse and buy books. ...

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Future doctors will celebrate that they no longer prescribe the same drug at the same dosage for hypertension or pneumonia or arthritis or cancer or many other conditions. Who knows even if drugs will be the mainstay of medical treatment. Tomorrow’s treatments will be tailored to one’s age, gender, weight, race, overall medical condition, severity of the medical threat, and genetic profile, among other variables. We don't all wear the ...

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Physicians handle thousands of questions annually. We respond to inquiries from patients, their families, insurance companies, nurses, professional colleagues, pharmacies, pharmaceutical representatives, our staff, and even strangers. This is, of course, a part of our job, and it consumes a substantial amount of our time and energy. And, responding to questions is not as easy as you may think. Words matter, and a clumsy choice or omission can wound instead of ...

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What should patients know about diet and its effects on the microbiome? How should primary care clinicians address diet and its effects on the microbiome? What are your tips to address obesity? What are the gastroenterological manifestations of COVID-19? Supriya Rao is a gastroenterologist. She shares her story and her expertise in obesity and the diet-microbiome connection. Did you enjoy ...

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I am a female immigrant gastroenterologist from Pakistan, practicing in the city of Minneapolis. Having lived in this country for 22 years and married to a white man, I generally feel that I fit in pretty well. A couple of weeks ago at work, I walked into a procedure room and introduced myself to a 66-year-old white male from St. Cloud that I was about to do a procedure on. ...

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"Obesity is a topic that literally hits home for me.  For the past two years, the website WalletHub has voted the McAllen-Edinburg-Mission TX metroplex as the 'fattest city in America.'  As a health care provider, this is deeply disturbing because it puts my community at high risk for a wide variety of health problems, including but not limited to coronary artery disease, ...

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"Each morning before the doctors came in for rounds; I’d paint feverishly whatever abstraction came to mind and what evolved from my situation. When I completed my pieces, I felt like I had not only gotten out my frustrations and worry, but also found a place of joy and gratitude. I would put each canvas outside my hospital room, and soon ...

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"Three Fleet enemas?" I ask the nurse. She isn't much interested in a conversation with me about anything. She is busy. "This man, so far as I understand it, does not have a colon." It looks to me like they want to reconnect his colon," she says as if I hadn't said what I just said. "I am not a doctor," I remind her, "but I don't see how that is possible. Too ...

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“You are what you eat.”

Jean Anthelme Brillant-Savarin, a French lawyer, epicurean, and father of the low carbohydrate diet, penned these words in the 18th century. As we struggle through the COVID-19 pandemic, we search for personal ways to influence our health and our immune system to combat this pestilence. Food choices are an overlooked variable that may alter our fate.

Our human engagement with infections is played out ...

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I feel like I am reliving a bad dream. The race to find a treatment and/or cure to SARS-CoV-2 is reminiscent of decades of practicing gastroenterology while hepatitis C roamed the hospital wards as a death sentence for many. I found myself recently recalling a patient whose story ends with science finding a cure.

 As I peered around the ICU curtain, I could see a motionless ill man. I ...

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The first five liver transplant recipients were all dead within 23 days. The year was 1963, the surgeon was Dr. Thomas Starzl, and the operations were actually deemed a success for their surgical complexity. Since then, liver transplant (LT) has evolved from an experimental, often fatal procedure to the standard of care for end-stage liver disease (ESLD). Compared to the 0% 30-day survival rate of LT in 1963, the most ...

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Fat. One tiny word. One voluptuous, full-figured concept. Several weeks ago, amidst a conversation regarding the risk factors for cholelithiasis (i.e., gallstones) during a chief concern small group session for preclinical students, my preceptor ushered in an aurally convenient yet unsettling mnemonic utilizing alliteration that has apparently been in the works among medical education for a while now, known as “the 4 Fs”: female, fertile, forty, and … fat. Yes, you read that ...

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When I first landed this job as a case manager (social worker), I was given Robert R. as a client. He was at his worst then, soiling himself virtually every day, with no change of clothing available. I remember him wearing a piece of colored cloth around his waist, which served as a belt. When he would come in in such a condition, sometimes even tracking in feces on his shoes, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 10-day history of abdominal cramping, diarrhea, malaise, and nausea. Diarrhea is watery without mucus or blood. He returned 2 weeks ago from a 7-day trip to Lima, Peru. On physical examination, temperature is 37.7 °C (99.9 °F); the remaining vital signs ...

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"Are you my doctor?" Mary* asked me, as I, a resident physician, approached her bed. "Yes, I am one of the primary medical doctors taking care of you here," I confirmed with my standard, pre-scripted introduction — with little appreciation of the implications of these words. Mary was a 30-something-year-old woman who transferred to our hospital due to worsening alcohol-related liver disease. She had struggled with anxiety and depression since her teenage ...

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"I have a riddle," Paul says, as the dining room falls silent. "You're at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There's a room upstairs with three lamps, labeled X, Y, and Z. You can turn on and off as many switches as you want while you're downstairs, but you can only go upstairs once. And once you're upstairs, you ...

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I sit in Dr. Victor's small crowded waiting room, awaiting my turn. I am seated between two women, the one on my left probably 45, and the one on my right, somewhat older, both though younger than me. The lady on my right doesn't have much to say beyond telling me where she is from, and she is seeing Dr. Victor for the second time. The woman to my left is ...

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