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Dealing With Cyclic Vomiting Syndrome Given How Little Is Known About The Condition

I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of. I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.

The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients.  Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.

That is not much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, in part because they are memorable because they are so challenging to take care of.

Some things about the cyclic vomiting patient that pose particular challenges: Read more »

*This blog post was originally published at Movin' Meat*

Fecal DNA Testing: Is This The Future Of Colon Cancer Screening?

It’s Saturday morning, and I’m in an undisclosed location drinking a fabulous cup of coffee while turning the pages of The New York Times, knowing that ink and newsprint will be vanishing too soon. Yes, I do have an iPad now, but I haven’t figured out how to blog on it. Any suggestions?

Buried in the first section of the paper is an article on stool, which in my view as a gastro specialist, should have merited front page placement. Yes, we all know the adage, ‘one’s man’s trash is another man’s treasure’, but stool – as in excrement – should be prized by everyone. Perhaps, as a gastroenterologist, I have a jaundiced view on this issue, which explains my dyspeptic reaction.

All Whistleblower posts have an accompanying image, and I wonder what visual would be appropriate here.  I opted against my first choice, and choose instead a photo of our beloved Labrador Retriever, Shoshie, of blessed memory.

The Times reported a new program to Read more »

*This blog post was originally published at MD Whistleblower*

Home Allergy Awareness Leads Some To Question The Campaign’s Real Intentions

The NHS Choices Behind the Headlines project in the UK analyzes claims that there is an epidemic of home allergies. Excerpt:

At least 12 million Britons now suffer from allergies caused by dust mites, The Independent has today reported. The newspaper says that a report by the charity Allergy UK has revealed an epidemic of “home fever”, a range of symptoms caused by dust mites and other triggers around the home.

The report has been published as part of Indoor Allergy Week, which is intended to raise awareness of the kind of steps that can be taken to remove allergy triggers, or ‘allergens’, from the home. A survey in the report suggests that, currently, around two-thirds of people with allergies experience symptoms such as sneezing and itchy eyes caused by allergens including dust mites, chemicals, pets and mould.

This new report raises lots of questions, such as Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Eye Health As A Predictor Of Future Disability

The idea that the eyes are a window to the soul traces back through history in many forms, but the idea that the eyes might reveal medical secrets didn’t fall far behind the metaphor.

The clues lie on the retina, which reflects the same microvascular changes that might be seen elsewhere in the body from cardiovascular changes and other diseases. The question now is how to associate retinal changes to specific diseases.

To assess potential associations between retinal microvascular changes with disability in performing activities of daily living, researchers conducted a prospective cohort study of 1,487 community-dwelling, disability-free participants in the Cardiovascular Health Study.

The main outcome measure was Read more »

*This blog post was originally published at ACP Internist*

Research Points Out The Down Side Of Chasing Success

Bill Gates once said:

Success is a lousy teacher. It seduces smart people into thinking they can’t lose.

It’s clever, and it seems right.  Now there is science to prove it.

In a study published last week, scientists studied special imaging scans of doctors’ brains as they made simulated medical decisions.  Those doctors who paid attention to their mistakes made better decisions than those who were more interested in their successes: Read more »

*This blog post was originally published at BestDoctors.com: See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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