Listening to our patients
Around 30 years ago, LRZ taught me a most important lesson. LRZ, one of my most fondly remembered patients, was a classic blue collar guy. He had a wonderful gregarious personality. He had significant systolic dysfunction, yet still worked hard for the city. Amongst other things he did, he shoveled the salt into trucks on snow and ice days. He functioned well most days.
One day he came to see me. In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics. As I picked up his chart I noted that he had gained 3 pounds. From past experience, I knew that he would soon...
Source: DB's Medical Rants - June 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
MKSAP: 52-year-old man with rheumatoid arthritis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing stairs due to persistent pain and swelling in the right knee. Medications are methotrexate, 25 mg weekly; prednisone, 10 mg/d; naproxen; and folic acid.
...
Source: Kevin, M.D. - Medical Weblog - May 14, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Don’t forget the power of over the counter remedies
I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.
As uncomfortable as the whole experience was (and it wasn’t my first rodeo either), I was reminded of something very important, which is that prescription drugs aren’t all they’re cracked up to be. In fact, the best pain relief I had from my kidney stone involved the little blue wonder pill (for w...
Source: Kevin, M.D. - Medical Weblog - May 3, 2016 Category: Journals (General) Authors: Edwin Leap, MD Tags: Meds Medications Primary care Source Type: blogs
I’m a doctor. I worry every time I prescribe painkillers to a patient. - Vox
"Please, I need my Oxycodone!" my patient, M, pleaded with me.
My eyes met his. I observed every fleeting facial expression, hoping to gauge his intentions. The discussion about whether to continue to prescribe this medication was one I'd had too many times with too many patients over the past few months.
"My arthritis is always worst in the winter," he said, rubbing his lower back.
It was a snowy afternoon in clinic, and M and I were in the midst of a debate. Oxycodone is an opioid medication, and, like other painkillers such as Oxycontin, Percocet, and Vicodin, it carries a significant risk of ...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs
I ’m a doctor. I worry every time I prescribe painkillers to a patient. - Vox
& quot;Please, I need my Oxycodone! & quot; my patient, M, pleaded with me. < br > < br > My eyes met his. I observed every fleeting facial expression, hoping to gauge his intentions. The discussion about whether to continue to prescribe this medication was one I & #39;d had too many times with too many patients over the past few months. < br > < br > & quot;My arthritis is always worst in the winter, & quot; he said, rubbing his lower back. < br > < br > It was a snowy afternoon in clinic, and M and I were in the midst of a debate. Oxycodone is an opioid medication, and, like other painkillers such as Oxycontin, Percocet,...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs
Adventure In Pain
Lots has happened since my last post, and this is a record of those events. I have to write it somewhere. It ' s interesting to me, part of the journey, but you ' ll be the judge. It ' s mostly whining.
Background for the reader: Last Wednesday I had an infusion of a study drug and an infusion of Zometa, and also began a week of oral Valtrex in case my back pain might be the prodrome for shingles. By Friday the pain in my back and abdomen was much more pronounced, continuing into Saturday. I posted about that here.Saturday, February 20, 2016:
I have a new respect for people who are obliged to ...
Source: Myeloma Hope - February 24, 2016 Category: Cancer & Oncology Tags: DEX dexamethasone kidney pain Source Type: blogs
Adventure In Pain
Lots has happened since my last post, and this is a record of those events. I have to write it somewhere. It's interesting to me, part of the journey, but you'll be the judge. It's mostly whining.
Background for the reader: Last Wednesday I had an infusion of a study drug and an infusion of Zometa, and also began a week of oral Valtrex in case my back pain might be the prodrome for shingles. By Friday the pain in my back and abdomen was much more pronounced, continuing into Saturday. I posted about that here.
Saturday, February 20, 2016:
I have a new respect for people who are obliged...
Source: Myeloma Hope - February 24, 2016 Category: Cancer & Oncology Tags: DEX dexamethasone kidney pain Source Type: blogs
Lots More Whining
Just can't get enough of it!
Last Wednesday's visit to Mayo Clinic marked the end of the every-week 200-mile round trips, but the results didn't shed much light on my medical condition. Is the "flare" in my vertebrae due to the myeloma itself, or is it inflammation caused by my immune system attacking the myeloma? We're hoping for the latter, of course, and sticking with the current medication study, but this does require more than a little faith.
Here is the whining:
Last night I was quite uncomfortable for much of the night. The neuropathic pain on the right side of my back became much wo...
Source: Myeloma Hope - February 20, 2016 Category: Cancer & Oncology Source Type: blogs
Lots More Whining
Just can ' t get enough of it!Last Wednesday ' s visit to Mayo Clinic marked the end of the every-week 200-mile round trips, but the results didn ' t shed much light on my medical condition. Is the " flare " in my vertebrae due to the myeloma itself, or is it inflammation caused by my immune system attacking the myeloma? We ' re hoping for the latter, of course, and sticking with the current medication study, but this does require more than a little faith.Here is the whining: Last night I was quite uncomfortable for much of the night. The neuropathic pain on the right side of my back became much w...
Source: Myeloma Hope - February 20, 2016 Category: Cancer & Oncology Source Type: blogs
LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many institutions in the U.S. Stop the madness!
Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs
MKSAP: 21-year-old woman with a rash in the lower extremities
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some relief. History is significant for gastroesophageal reflux disease and acne. Medications are over-the-counter famotidine as needed and minocycline.
On physical examination, temperature is 38.2 °C (100.8 °F), blood pr...
Source: Kevin, M.D. - Medical Weblog - December 26, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Know the signs of diverticulitis!
Diverticulosis is a condition that describes small pouches in the wall of the digestive tract that occur when the inner layer of the digestive tract bulges through weak spots in the outer layer. When these diverticula become inflamed, that is called diverticulitis. Diagnosis of diverticulosis/diverticulitis is made over several methods, including a physical exam which includes a digital rectal examination, blood tests, x-rays or CT scans of organs in the abdomen, a colonoscopy or a flexible sigmoidoscopy. Treatment for diverticulosis includes a diet high in fiber, fiber supplementation if needed, plenty of fluids and exerc...
Source: Nursing Comments - November 8, 2015 Category: Nursing Authors: Stephanie Jewett, RN Tags: Advice/Education Caregiving General Public Nursing/Nursing Students Patients/Specific Diseases abdominal pain bloating diverticulitis diverticulosis fever and chills gas nausea painfule urination rectal bleeding vomting Source Type: blogs
How a Simple Little Pill Ended Up Costing 1000 Percent More Than Its Ingredients
By DEVON HERRICK
A recent New York Times article profiled a pair of ultra-expensive pain medications designed to go easy on the stomach. Common pain relievers, like aspirin, ibuprofen and naproxen are prone to irritate the stomach if taken repeatedly throughout the day. A newer class of pain medication, called cox-2 inhibitors, are the preferred pain relievers for those who cannot take nonsteroidal anti-inflammatory drugs (NSAIDs) on a long term basis. Celecoxib, the generic version of Celebrex, is now available at a cost of about $2 per tablet, but that can add up to about $700 to $1000 per year.
More than a decade ago...
Source: The Health Care Blog - November 4, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB aspirin Devon Herrick Duexis Ibuprofen Naproxen New York Times Vimovo Source Type: blogs
How a Simple Little Pill Ended Up Costing 99 Percent More Than Its Ingredients
By DEVON HERRICK
A recent New York Times article profiled a pair of ultra-expensive pain medications designed to go easy on the stomach. Common pain relievers, like aspirin, ibuprofen and naproxen are prone to irritate the stomach if taken repeatedly throughout the day. A newer class of pain medication, called cox-2 inhibitors, are the preferred pain relievers for those who cannot take nonsteroidal anti-inflammatory drugs (NSAIDs) on a long term basis. Celecoxib, the generic version of Celebrex, is now available at a cost of about $2 per tablet, but that can add up to about $700 to $1000 per year.
More than a decade ago...
Source: The Health Care Blog - November 4, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB aspirin Devon Herrick Duexis Ibuprofen Naproxen New York Times Vimovo Source Type: blogs
Research & Reviews in the Fastlane 106
This study investigated the use of apneic oxygenation in the ICU. The researchers found no difference in the lowest O2 sat. However, it’s unclear if this study is applicable to the ED setting and it likely does not reflect our standard management (33% had BPAP during apnea, 40% had BVM during apnea). For now, collective anecdotes of efficacy reign while we await research in the ED setting.
The authors conclusion is that apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. Although this is the first randomized...
Source: Life in the Fast Lane - October 28, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Clinical Research ECG Education Emergency Medicine Intensive Care Pediatrics Public Health R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
