"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, ...

Read more...

"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 ...

Read more...

"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 ...

Read more...

“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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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, ...

Read more...

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 ...

Read more...

"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 ...

Read more...

"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 ...

Read more...

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 ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no ...

Read more...

At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their ...

Read more...

Doctors dispense medical advice. That’s what we do. Folks come to our office with various medical issues. We talk to them. We poke around some of their body parts. Then, we exercise our medical judgment. We might order a CT scan. We might prescribe stuff. We might simply reassure them and send them on their way. This is a typical day in the life of a health care provider, formerly known ...

Read more...

What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student. Welcome to your first on-call weekend. These first few days, weeks, and months ...

Read more...

There's a pivotal scene in the 2007 Pixar movie Ratatouille, in which the restaurant critic Anton Ego takes a first bite of the movie's titular food. He is then whisked back to a moment in his childhood, during which his mom provides love and comfort through a helping of her homemade ratatouille. This scene is a homage to Marcel Proust's seminal "Madeleine Episode," as described In Search of Lost Time, published almost ...

Read more...

In our office, sometimes our secretaries listen to background music. A few days ago, while walking through the office, I heard an iconic song, written and performed by a songwriting legend. Even someone like me, who was never deep into the music scene, automatically recognized the song. I asked our receptionist, a young lady in her 20s, if she knew the song that was playing. She didn’t. I identified the ...

Read more...

From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label "toxins" already suggests that these are noxious agents. If one accepts this premise, it is entirely ...

Read more...

This eating contest season, there was only one death this year, as far as I can determine. A 41-year-old California man died in August while participating in a taco eating contest at a minor league baseball game. The coroner said he choked to death. In case you were wondering, the Associated Press thoughtfully stated: “It was not immediately known how many tacos the ...

Read more...

19 Pages

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories