The swastika-donning patient who refused his lactulose
As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis. His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and hepatic encephalopathy.
It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service — and further by his dispositional affect that made me regularly question whether we were offering this patient the care which he...
Source: Kevin, M.D. - Medical Weblog - June 2, 2016 Category: Journals (General) Authors: Mark Edelstein Tags: Education Hospital Medical school Source Type: blogs
Hepatitis C and Dietary Supplements
The latest National Center for Complimentary and Integrative Health (NCCIH) Clinical Digest focuses on hepatitis C and several of the dietary and herbal supplements studied since many people who have hepatitis C have tried these various options. For example, a survey of 1,145 participants in the HALT-C (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) trial found that 23 percent of the participants were using herbal products. Although participants reported using many different herbal products, silymarin (milk thistle) was by far the most common. However, no dietary supplement has been shown to be efficacious f...
Source: BHIC - May 10, 2016 Category: Databases & Libraries Authors: Carolyn Martin Tags: General Source Type: blogs
MKSAP: 61-year-old woman with progressive dyspnea and fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose.
On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 112/64 mm Hg, pulse rate is 60/min, and respiration rate is 16/min; BMI is 36. Mild scleral icterus is noted. Cardi...
Source: Kevin, M.D. - Medical Weblog - May 7, 2016 Category: Journals (General) Authors: mksap Tags: Uncategorized Source Type: blogs
ARID1A Gene Knockout Improves Regeneration in Mice
Researchers have made the accidental discovery that removing the gene ARID1A in mice produces greater regenerative capacity. The team was focused on liver cancer research so most of their observations relate to liver regeneration, but they note that the improvement appears in other tissues as well:
The liver is unique among human solid organs in its robust regenerative capability. A healthy liver can regenerate up to 70 percent of its tissue after injury. However, when the liver has been repeatedly damaged - by chemical toxins or chronic disease - it loses its ability to regenerate. Following repeated injuries, cirrhosis...
Source: Fight Aging! - March 27, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Targeting Hepatic Stellate Cells to Reverse Liver Fibrosis
Researchers are working on a method of targeting stellate cells in the liver to prevent them from causing fibrosis when overactivated in response to infections, autoimmunity, and other causes of liver disease:
Liver fibrosis and its more severe form, cirrhosis, are caused by scar tissue that forms in the liver. The progressive stiffening of the liver, a hallmark of the disorders, occurs when a type of liver cell known as the hepatic stellate cell is "activated" and overproduces the stringy network of proteins called the extracellular matrix that binds cells together. Being able to turn cirrhosis around, especially in its ...
Source: Fight Aging! - March 7, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Trust is the foundation of quality patient care at the end of life
“It’s those pain medicines you are giving her. She’s very sensitive to them. I think that’s why she’s confused — she is doped up.”
Two months after receiving her diagnosis Mrs. M signed up for hospice. At our first visit, she was suffering and visibly uncomfortable. Her skin appeared excoriated from weeks of scratching. She was confused, restless, and racked by pain.
Mrs. M had metastatic liver cancer resulting from underlying cirrhosis. Her scarred liver functioned at minimal capacity even before the cancer appeared and obliterated her remaining healthy liver cells. Because of h...
Source: Kevin, M.D. - Medical Weblog - February 21, 2016 Category: Journals (General) Authors: Brian J. Carlisle, MD Tags: Physician Palliative care Source Type: blogs
Wheat Belly: Self-Directed Health?
Director chair, film slate and load horn.
Here’s a proposal for you: If, by following the Wheat Belly lifestyle, a long list of conditions are reduced or reversed at no risk, almost no cost, reversing even chronic and potentially fatal conditions . . . does that mean that the notion of self-directed health might be on the horizon, i.e., putting control over health back in our own hands?
I think it does. No, we will never implant our own defibrillators or take out our own gallbladders. But so many chronic health conditions afflicting modern humans recede that I believe that it is entirely reasonable to start talking a...
Source: Wheat Belly Blog - February 16, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle arthritis autoimmune diabetes eating disorder gluten grains Inflammation joint Weight Loss Source Type: blogs
Addressing Criticisms of the Disease Model
Volkow, Koob, and McLellan on the neurobiology of addiction.The New England Journal of Medicine recently published a review article, “Neurobiologic Advances from the Brain Disease Model of Addiction,” authored by three prominent figures in the field of addiction research: Nora Volkow, the director of the National Institute of Drug Abuse (NIDA); George Koob, the director of the National Institute of Alcohol Abuse and Alcoholism (NIAAA); and Thomas McLellan, founder and chairman of the Treatment Research Institute in Philadelphia. The article summarizes the research that has “increasingly supported the view that ...
Source: Addiction Inbox - February 15, 2016 Category: Addiction Authors: Dirk Hanson Source Type: blogs
Even your LIVER is fat
Wheat Belly Blog reader, Denise, posted this question:
“My doctor has prescribed a low fat diet due to a barrage of tests that ended up showing I have a very fatty liver. I am overweight, have high blood pressure, IBS and acid reflux. In all the reading I have done on here, I keep seeing to add fats . . . healthy ones . . . to your daily eating. How do I eat these and also stick to a low fat diet to please my doctor? I am 59, female, and really need to try to get healthier.”
Sorry, Denise, but it’s not your job to please your doctor. It’s your job to do what’s right for your health. Sadly, your doctor is ...
Source: Wheat Belly Blog - February 10, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle carbohydrates fatty liver gluten grains nald Source Type: blogs
Senators Wyden and Grassley Request Public Comments on Gilead Pricing
On the heels of their December 1, 2015, report on Gilead Sciences' pricing of Hepatitis C drugs Sovaldi and Harvoni, United States Senate Finance Committee leadership, namely Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR), have asked for public comments from the patient and healthcare stakeholder community on the report's findings.
As a refresher, the report determined that Gilead had priced their products by prioritizing revenue and maximizing profit over patient access. The way Gilead prioritized revenue and profit over patient access wound up severely limiting patient access, particularly among beneficiaries who ...
Source: Policy and Medicine - January 27, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 7
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Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Highly effective HCV treatment: once daily oral Sofosbuvir/Velpatasvir
The hepatitis C virus (HCV), a single-stranded RNA virus of the family Flaviviridae with six major genotypes, infects up to 150 million people worldwide. Chronic hepatitis C virus infection causes progressive liver fibrosis, which can lead to cirrhosis and hepatocellular carcinoma. There is now an effective oral regimen. New research findings are summarized in this short video from NEJM: This is a ribavirin-free single-tablet regimen. There 2 medications in the single tablet:- Sofosbuvir is a nucleotide analogue inhibitor of the HCV NS5B polymerase approved for the treatment of HCV in combination with a variety of other ag...
Source: Clinical Cases and Images - Blog - January 1, 2016 Category: Universities & Medical Training Tags: Gastroenterology NEJM Source Type: blogs
An Approach to Reversing Liver Fibrosis
This is one example of a number of lines of research aimed at interfering in the process of fibrosis, the generation of harmful scar tissue that can cause severe dysfunction in organs once underway:
Chronic damage to the liver eventually creates a wound that never heals. This condition, called fibrosis, gradually replaces normal liver cells - which detoxify the food and liquid we consume - with more and more scar tissue until the organ no longer works. Scientists have identified a drug that halts this unchecked accumulation of scar tissue in the liver. The small molecule, called JQ1, prevented as well as reversed fibrosis...
Source: Fight Aging! - December 9, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Society’s health should not be doctors’ responsibilities
I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.
And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the ACE, calcium channel blocker, and diuretic won’t overcome the cocaine he does every day. And the 42-year-old female that already has cirrhosis? Her smile lights up the exam room. But her liver...
Source: Kevin, M.D. - Medical Weblog - December 8, 2015 Category: Journals (General) Authors: Justin Reno, MD Tags: Physician Diabetes Primary care Source Type: blogs
Middle Age Can Be Hazardous to Your Health
By STEVE FINDLAY
Despite the many flaws in our healthcare system, we could always point to data showing that over the last few decades we were living longer and healthier lives—even if not quite as long and healthy as our contemporaries in many European and some Asian countries.
It now appears that’s no longer true for one segment of the U.S. population.
I’m talking, of course, about the surprising findings released last week that the death rate among non-Hispanic white men and women ages 45 to 54 increased from 1999 to 2013 after decreasing steadily for 20 years, as it did for other age cohorts and ethnic groups.
...
Source: The Health Care Blog - November 12, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Steven Findlay Source Type: blogs
