Conditions

The answer to depression isn’t always an antidepressant

Conditions
March 18, 2017

Many patients are referred to me as a psychiatrist to treat their depression.  The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right?  Not always.

Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms.  Well, sometimes …

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Should we stop burping babies?

Conditions
February 7, 2017

One evening this past week, after my wife finished feeding our 5-week-old daughter, I took over baby duty. I sat her up on my lap and gave her a few thumps on the back. Not hard enough to hurt, obviously, but just to make her burp.

She didn’t burp. So I gave her a couple more gentle-but-firm whacks, still without a result.

And then I remembered the phone call I got a …

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The curious case of a swollen scrotum

Conditions
February 1, 2017

It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.

Frank Martin (name changed) has been sent from a walk-in …

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The story of a rare, serious complication of mononucleosis

Conditions
January 31, 2017

Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week.  She felt something was not quite right and asked me for advice.

“Trust your instinct, go get him, and bring him home.”

She brought him to my clinic the following day.  He looked mildly ill.  His vitals were stable; he was fatigued, slightly dehydrated, …

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Do patients with celiac disease need probiotics?

Conditions
January 28, 2017

One of the most common questions that I receive from patients diagnosed with celiac disease is if they should take a probiotic. The only available treatment for celiac disease, an autoimmune disease characterized by destruction of the absorptive surface of the small intestine which develops in genetically compatible individuals, is a gluten free diet. However, patients and providers often question whether supplementation with probiotics may hasten the healing process.

Probiotics are …

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Misophonia and suicide: Sound thinking is required

Conditions
January 26, 2017

If you Google “misophonia” you might be shocked to find numerous articles discussing the tragic suicide of 52-year-old Russian-born scholar, Dr. Michelle Lamarche Marrese. Journalist Joyce Cohen was the first to report Marrese’s suicide in the New York Post piece “She could hear everything and it cost her her life.” Cohen explains that she and Marrese had been corresponding about Marrese’s struggles with misophonia for over 14 months, and that …

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There’s absolutely no way to stop a cough. Here’s why.

Conditions
January 23, 2017

Coughing is one of the most common reasons parents bring their children to see me. And I can understand why. Coughing is noisy and uncomfortable and gets kids dirty looks in schools and subways. Even worse, coughing keeps kids and their parents awake. We’ve all been there, and no one likes to cough.

But coughing is there, usually, for a reason. Almost all coughs are from upper respiratory infections (that’s fancy …

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MKSAP: 24-year-old woman with sickle cell anemia

Conditions
January 21, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks’ gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. She has declined …

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A harrowing C-section, performed on a close friend

Conditions
January 4, 2017

We chat about the day, as I use a sharp knife to cut into her. We joke about my kids, as the blood is spurting. We reminisce about our friendship, as I rip open her tissue.

For most surgeons, their patients are asleep as they perform their surgery. In obstetrics, however, we want our patients awake, not only to witness their baby’s arrival, but also because it is safer. When I …

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An ode to a beloved ICU nurse manager

Conditions
January 3, 2017

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.

Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.

She had every possible attribute as a …

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How an oncologist used Pac-Man to teach his patient

Conditions
December 20, 2016

The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments.  It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms.  Although this is a good problem to have, finding time to stay current is easier said than done.  Even more difficult is making sure we can explain these …

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What’s the real reason women remove their pubic hair?

Conditions
November 28, 2016

A study published in JAMA Dermatology regarding women’s pubic hair grooming practices has people abuzz. This cosmetic act needs a formal medical name because “clamscaping” just doesn’t work on grant applications. Although why the authors couldn’t go with hair removal, I don’t know. The study wasn’t about styling, it was about removal. The study even made it into the New York Times. And yes, my first …

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Don’t use garlic to treat vaginal yeast infections

Conditions
October 26, 2016

Vaginal yeast infections are common, up to 75 percent of women will have at least one and 5 percent of women suffer from chronic yeast infections (meaning four or more a year). Many women out of frustration with allopathic medicine (preventing recurrent yeast infections can be challenging) or because of their beliefs turn to alternative medicine options. More and more I am hearing about vaginal garlic.

The problem with many alternative …

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This doctor stopped telling patients to lose weight. Here’s why.

Conditions
October 21, 2016

Several years ago, I was meeting a young woman in my clinic for the first time. She was healthy but had been obese most of her adult life, even though she had tried many methods of losing weight. We spoke for a few minutes about diet and exercise, and she agreed to see the nutritionist.

A few months later, she came back to check her progress. She had lost weight, about …

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Did a prostate cancer test save actor Ben Stiller’s life?

Conditions
October 12, 2016

Ben Stiller—one of the few comedians on this side of the pond who can make me laugh—said prostate-specific antigen (PSA) testing saved his life. I suspect he wasn’t being funny. Stiller had Gleason Grade 7 localized prostate cancer.

Is he right?

The honest answer is that we don’t know for certain. Before I get granular, we must visit proof, level of proof and burden of proof. The statement, “there’s …

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A story for those who pontificate about patient behavior

Conditions
October 8, 2016

I was offered my choice of bisphosphonates after breaking my shoulder and ended up with a diagnosis of osteoporosis. I initially opted for Reclast, a drug that only requires one dose a year albeit by IV infusion. I made an appointment to get the drug several weeks later. I wanted to have time to research my options. After reading as much as I could during that time, I made an …

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Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Conditions
September 19, 2016

sepsis-blog-9-2016

CHEST_sig_horiz_PMS-TMSeptember is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.

Earlier this …

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How nurses and law enforcement can work together

Conditions
September 7, 2016

The recent horrible events involving racial profiling, excessive force, and gun violence are deeply troubling but not new. Who can forget the Bronx shooting of Amadou Diallo in 1999 when 41 bullets rained down on his unarmed body. I can uniquely identify with the black experience because of my own numerous experiences of being pulled over for no other apparent reason except for being in the wrong neighborhood, wrong state …

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A miracle in the intensive care unit

Conditions
August 12, 2016

She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have.

Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days.. And finally said their …

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