Doctors are teachers too
Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room.
The man who felt bad all over had a bilirubin twice the upper limit, his liver enzymes were elevated and although he didn’t have a fever, his white blood cell count was elevated. I explained to him and his wife that his bile ducts were plugged and he was being poisoned from inside by all that bile and there may eve...
Source: Kevin, M.D. - Medical Weblog - November 30, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Primary care Source Type: blogs
Randomized Trialomania
BY ANISH KOKA, MD
This story is old, but the age of the story should not detract from the lessons of the story.
It was 1982, the place was Tsukuba, Ibaraki Prefecture, Japan. Workers at Fujisawa pharmaceuticals began testing fermented broths of Streptomyces species that had been retrieved from soil samples at the base of Mount Tsukuba. They were working to solve the remaining achilles heel of organ transplantation – effective suppression of the immune system that would prevent the body from attacking its new guest. It had quickly became apparent to the medical community that the key to long term survival of patien...
Source: The Health Care Blog - November 18, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Anish Koka RCT Source Type: blogs
Are these prescription drugs preventing your weight loss?
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are:
Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others
Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies)
Antihistamines: diphenhydr...
Source: Wheat Belly Blog - September 13, 2016 Category: Cardiology Authors: Dr. Davis Tags: Depression Dr. Davis Drugs and wheat Nutritional supplements Weight loss Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat-Free Lifestyle anxiety Source Type: blogs
MKSAP: 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia of several weeks’ duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution of her symptoms. She takes no medications.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 110/58 mm Hg, pulse rate is 72/min, and respiration ...
Source: Kevin, M.D. - Medical Weblog - July 30, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Nephrology Source Type: blogs
People are going broke because they can’t afford care. It needs to end.
“I need help with my colitis.”
“Really? I thought we had things pretty well controlled.”
I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose of prednisone and a transition to budesonide, a steroid who’s metabolism greatly limits many of the nasty side effects of prednisone. And she had lots of prednisone side effects: swollen ankles, blood pressure creeping up...
Source: Kevin, M.D. - Medical Weblog - June 29, 2016 Category: Journals (General) Authors: Michael P. Jones, MD Tags: Policy GI Medications Source Type: blogs
Research and Reviews in the Fastlane 136
Welcome to the 136th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more...
Source: Life in the Fast Lane - May 26, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Intensive Care Pre-hospital / Retrieval Renal Resuscitation R&R in the FASTLANE recommendations research and reviews 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
Pomalyst, Darzalex, and Corticosteroids
Weekly Infusion Number 6: Blood draw, doctor visit, pre-medications, and Darzalex, about 6 hours total.
I took 20 mg dexamethasone last night, as part of the Pomalyst regimen, and received 100 mg of prednisone IV before the Darzalex, as part of that regimen.
As before no problems, no infusion reactions. This is getting boring.
Boring is good. I love boring. (Source: Myeloma Hope)
Source: Myeloma Hope - May 10, 2016 Category: Cancer & Oncology Tags: corticosteroids daratumumab Darzalex dexamethasone pomalidomide Pomalyst prednisone Source Type: blogs
Pomalyst, Darzalex, and Corticosteroids
Weekly Infusion Number 6: Blood draw, doctor visit, pre-medications, and Darzalex, about 6 hours total.
I took 20 mg dexamethasone last night, as part of the Pomalyst regimen, and received 100 mg of prednisone IV before the Darzalex, as part of that regimen.
As before no problems, no infusion reactions. This is getting boring.
Boring is good. I love boring. (Source: Myeloma Hope)
Source: Myeloma Hope - May 10, 2016 Category: Cancer & Oncology Tags: corticosteroids daratumumab Darzalex dexamethasone pomalidomide Pomalyst prednisone Source Type: blogs
Infusion Number Five
And the Orange County Marathon in California last Sunday, my 95th since diagnosis, Whooee - still on track for 100 marathons this year.
This was also the third weekly Darzalex infusion at our local hospital. Arriving at the infusion center at 7:45 am, I left at 2:45 pm, total seven hours. That includes a blood draw for a CBC and metabolic panel, a visit with the doctor, the pre-medications (Tylenol, Benadryl, and prednisone), and finally the Darzalex itself.
No issues. In particular, I have never had any kind of infusion reaction from Darzalex. Apparently that makes me a lucky myelomiac, because th...
Source: Myeloma Hope - May 3, 2016 Category: Cancer & Oncology Tags: daratumumab Darzalex Source Type: blogs
Infusion Number Five
And the Orange County Marathon in California last Sunday, my 95th since diagnosis, Whooee - still on track for 100 marathons this year.
This was also the third weekly Darzalex infusion at our local hospital. Arriving at the infusion center at 7:45 am, I left at 2:45 pm, total seven hours. That includes a blood draw for a CBC and metabolic panel, a visit with the doctor, the pre-medications (Tylenol, Benadryl, and prednisone), and finally the Darzalex itself.
No issues. In particular, I have never had any kind of infusion reaction from Darzalex. Apparently that makes me a lucky myelomiac, bec...
Source: Myeloma Hope - May 3, 2016 Category: Cancer & Oncology Tags: daratumumab Darzalex Source Type: blogs
Neutrophils 3700
I was guessing 1700 / uL, with a little false bravado, actually just hoping they would be over 1000, so I was shocked to see the smiling nurse with the printout showing 3700, nine times as many as yesterday's count of 400. Yesterday the doctor and nurses were concerned about neutropenia, asking me how I felt. Based on prior experience, however, I believed that the neutrophils were there all along, just not measurable for some reason. After a good night's sleep they have to be teased out of hiding, or out of some other phase, or whatever neutrophils do.
Note: I am not a doctor - what happens to neutrophi...
Source: Myeloma Hope - April 26, 2016 Category: Cancer & Oncology Tags: neutropenia neutrophils Source Type: blogs
Neutrophils 3700
I was guessing 1700 / uL, with a little false bravado, actually just hoping they would be over 1000, so I was shocked to see the smiling nurse with the printout showing 3700, nine times as many as yesterday ' s count of 400. Yesterday the doctor and nurses were concerned about neutropenia, asking me how I felt. Based on prior experience, however, I believed that the neutrophils were there all along, just not measurable for some reason. After a good night ' s sleep they have to be teased out of hiding, or out of some other phase, or whatever neutrophils do.
Note: I am not a doctor - what happens to neutrophil...
Source: Myeloma Hope - April 26, 2016 Category: Cancer & Oncology Tags: neutropenia neutrophils Source Type: blogs
Three Infusions
Two at Mayo Clinic, and now the third at a highly-rated local hospital. We have made twelve 200-mile round trips to Mayo in Rochester so far just this year, almost one per week, and I'm tired of the drive. Of course I'll do whatever it takes to stay alive, and Mayo is indeed a world-class center for myeloma treatment, so that sounds like whining. However, if the drive is not necessary, it is certainly more convenient (and safer) to have procedures like blood draws and even infusions done barely a 10-minute drive from home. My current Darzalex (daratumumab) regimen calls for weekly infusions for eigh...
Source: Myeloma Hope - April 24, 2016 Category: Cancer & Oncology Tags: Darzalex infusion Source Type: blogs
Three Infusions
Two at Mayo Clinic, and now the third at a highly-rated local hospital. We have made twelve 200-mile round trips to Mayo in Rochester so far just this year, almost one per week, and I ' m tired of the drive. Of course I ' ll do whatever it takes to stay alive, and Mayo is indeed a world-class center for myeloma treatment, so that sounds like whining. However, if the drive is not necessary, it is certainly more convenient (and safer) to have procedures like blood draws and even infusions done barely a 10-minute drive from home. My current Darzalex (daratumumab) regimen calls for weekly infusions for eigh...
Source: Myeloma Hope - April 24, 2016 Category: Cancer & Oncology Tags: Darzalex infusion Source Type: blogs
