OB/GYN

What are politicians doing about the shameful infant mortality rate?

Physician
January 13, 2014

The infant mortality statistics are out again. This always depresses me because: 1) The rates are atrociously high, and, 2) There is so much legislation passed to restrict abortion in the name of “life,” but politicians and judges seems awfully silent on infant mortality.

In the United States 6.4 infants out of every 1,000 born will not reach their first birthday. This is more than 24,000 infant deaths a year. The United States is also the leader …

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The legacy of Kenneth Edelin

Physician
January 9, 2014

The exam room and hospital bedside are usually non-partisan zones. Though there have been exceptions — anti-nuclear activists Dr. Benjamin Spock and Dr. Bernard Lown come to mind — physicians tend not to be particularly political people. And even when they are, their politics don’t usually intersect with their clinical work. When President Reagan was shot and joked with surgeons, “I hope you’re all Republicans,” the response from one doctor (a Democrat) …

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The desire to have a baby in the face of metastatic cancer

Physician
December 30, 2013

asco-logoShe came to see me, alongside her husband. She was 26-years-old, diagnosed with metastatic myeloma involving her bones, which had presented when she fractured her hip while jogging. Her disease had progressed on treatment and she was to start a clinical trial. Despite being pale, she looked well. I imagined she often heard, “Wow — you look too good to have …

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The 10 most popular KevinMD posts of 2013

Potpourri
December 30, 2013

KevinMD.com shares the stories of the many who intersect with our health care system, but are rarely heard from.  Over 2500 articles were published this year from these voices, including practicing physicians, patients, policy experts, nurses, social workers, medical students, and hospital chaplains, among others.

I sincerely appreciate your continued readership and conversation.

Here are the most popular posts of 2013.

    1. Dear lawmakers: This is what it’s like to be a doctor …

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Effects of the HPV vaccine last longer than 5 years

Meds
December 20, 2013

Part of Katie Couric’s controversy on her show about the HPV vaccine was the claim by her expert, Dr. Diane Harper, that the vaccine only lasts for 5 years. I mean, why promote a 5 year vaccine to adolescent girls that will wear off and leave them at risk during their 20s?

The problem with this controversy over the duration of vaccine effectiveness is that it is entirely manufactured.

Dr. …

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Katie Couric brings attention to the HPV vaccine

Meds
December 11, 2013

The HPV vaccine is in the news again. This time it is Katie Couric’s daytime talk show that is shining the spotlight. And, I am thankful.

A medicine that prevents cancer is worth giving airtime.

In the segment, Couric chose to highlight the experience of 3 mother-daughter duos and their experience with the HPV vaccine. One story ended in loss, one in pain, and one in quiet confidence. Couric also highlighted advice from …

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Doctors might not really have a grasp on the art of diagnosis

Patient
December 8, 2013

January of 2010 initiated me into the life of a chronic pain patient. For sixteen months I plunged into a diagnosis journey that brought with it ten misdiagnoses by eleven respected physicians, fifteen procedures and tests, twenty-two medications and crushing pelvic pain.

People have asked me if I am angry about it all; the misdiagnoses, prolonged pain, time spent, needless tests and sometimes painful procedures. Anger is not the presiding feeling, …

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Poverty can make you sick

Physician
November 29, 2013

Women in the Bronx get sick.

Pregnant women in the Bronx get really sick.

The patients of the Bronx live in a hard place that has some of the poorest zip codes in the United States. And if there’s anything I’ve learned from my medical training as a fellow at Montefiore — and now as an attending in maternal-fetal medicine — it’s that poverty can make you sick, not just theoretically, or …

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Understanding hypoactive sexual desire disorder

Conditions
November 24, 2013

Sexuality is an essential component of a full and healthy life. However, at one time or another, sexual problems plague more than 40 percent of women in the U.S. Among the sexual issues women experience, the #1 problem reported is low sexual desire. When that’s compounded by distress — which nearly a fourth of women say they have because of their low libido — you have the hallmarks of hypoactive …

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Breast density laws are based on anecdote

Conditions
November 24, 2013

You know that old joke. What’s a radiologist’s favorite plant? The hedge.

Radiologists are famous for equivocating, or hedging. “Pneumonia can’t be excluded, clinically correlate,” or “probably a nutrient canal but a fracture can’t be excluded with absolute certainty, correlate with point tenderness.”

Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice …

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MKSAP: 35-year-old pregnant woman with a history of pulmonary embolism

Conditions
November 23, 2013

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

A 35-year-old woman undergoes evaluation after home pregnancy testing indicated that she is pregnant. Her medical history includes a previous idiopathic pulmonary embolism. Her only medication is a daily prenatal vitamin.

On physical examination, temperature is 36.2 °C (97.1 °F), blood pressure is 110/65 mm Hg, pulse rate is 70/min, and respiration rate …

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MKSAP: 61-year-old woman with hot flushes

Conditions
November 16, 2013

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

A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, …

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Does acupuncture help pregnancy rates in IVF?

Conditions
November 12, 2013

Acupuncture has become, for many women, an accepted part of their infertility journey. Several studies, including a meta-analysis of 24 studies published in the journal Fertility Sterility in 2012, indicated higher pregnancy rates among women who had undergone acupuncture as part of their treatment protocol compared with women who had no acupuncture or a sham procedure. Any improvement in outcomes is welcome considering the emotional and financial drain of each cycle.

However, there …

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I felt abandoned by the system to which I had committed my career

Patient
November 5, 2013

The cold ultrasound probe pressed uncomfortably onto my abdomen. “It looks like an ovarian cyst,” the pleasant technician told me, “But of course we’ll run it by the radiologist.”

For the past few months, I had felt a dull, heavy pain in my right lower quadrant that sharpened when I coughed. I’d put off having it checked during my busy schedule as a third year medical student. However, the nagging knowledge …

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Hormone replacement and the profound importance of maybe

Meds
November 5, 2013

Recently, colleagues and I published what I consider a very important paper in the American Journal of Public Health, indicating that tens of thousands of relatively young women who have undergone hysterectomy are dying needlessly because of an over-generalized fear of hormone replacement. Publication in the the Journal of the American Medical Association of a rich compilation of findings from the Women’s Health Initiative (WHI) trial does nothing to change our …

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The $1000 Pap smear: A pathologist responds

Physician
October 29, 2013

Dr. Cheryl Bettigole, a New Jersey-based family practitioner and a National Physician’s Alliance board member, has written an interesting editorial in the New England Journal of Medicine in which she states she is no longer surprised when laboratories charge her patients $1000 or more for a Pap smear.

According to Dr. Bettigole, the reason for the exorbitant charges are not the actual Pap smear itself (although she does mention the fact liquid-based preps …

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The danger of buying breast milk over the Internet

Physician
October 29, 2013

Recent research confirms that buying breast milk on the Internet via milk-sharing sites may not be safe. Although breast milk purchased from online sites may be free or as cheap as $1-$2 an ounce, it may carry significant risk for babies. Clearly the benefits of breast milk are vast; pediatricians and health experts recommend exclusive breast feeding until 6 months of age.

However, simply put, breast milk obtained from unknown (or …

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Is the use of gestational surrogates in India ethical?

Physician
October 22, 2013

The use of gestational surrogates in India is a booming business, but is it ethical?

This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their genetically related offspring carried through pregnancy and birth by Indian women.

An estimated $500 million to $2.3 billion (U.S.) changes hands among commissioning couples, infertility clinics, brokers and Indian women who choose this way …

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Insurers should stop paying for robotic hysterectomies

Physician
October 21, 2013

A new study confirms what previous studies tell us. That a robotic hysterectomy is not a safer or a more efficient way to remove a uterus for non-cancerous (benign) surgery than a traditional laparoscopic approach. This study indicates that there is little difference between the two types of surgery with one glaring exception, a robotic hysterectomy was $2,489 more expensive than a laparoscopic hysterectomy.

Several months ago the American Congress of Obstetricians …

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Miriam Carey: The lessons of motherhood and mental illness

Conditions
October 10, 2013

We do not have medical records or diagnoses. The news is filled with speculation. What we do know is that Miriam Carey’s one-year-old daughter lost her mother, and that because the incident occurred in Washington, DC in front of the White House, it is shining a spotlight on the subject of mental health and motherhood. And the message should be simple. Diagnoses don’t matter. As part of our nation’s health …

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