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Latest Posts

Learning To Use Exercise To Help Relieve Neck Or Shoulder Pain

Neck-painDo your neck and shoulders ache? Not long ago, you would have been told to rest, maybe use a neck brace, and wait until the pain had ebbed away. Doctors have changed their song about the best treatment for neck and shoulder pain. They now recommend movement instead of rest.

As described in Neck and Shoulder Pain, a newly updated Special Health Report from Harvard Health Publications, there is mounting scientific evidence for the role of stretching and muscle strengthening in treating people with neck and shoulder pain. After a whiplash injury, for example, people heal sooner and are less likely to develop chronic pain if they start gentle exercise as soon as possible. For those with long-term pain (called chronic pain), results from controlled studies show that exercise provides some relief.

One review of the research found that Read more »

*This blog post was originally published at Harvard Health Blog*

Considering Tuesdays With Morrie When Facing A Life-Threatening Diagnosis

Film adaptation of "Tuesdays with Morrie"

Many of you know about, or have read, the highly recommended book, Tuesdays With Morrie. I am reading it now with my 14-year-old son, Eitan, as part of an assignment for his ninth grade English class. Morrie, a college professor in Boston, was dying, withering away with ALS. Each Tuesday he would have a visit from one of his favorite former students, Mitch, a journalist from Detroit. Morrie, a man in his 70’s, mused about many things including the meaning of life and the inevitability of death. He was prepared for his end.

The other day I spoke about that book with a former high school English teacher – not Eitan’s. The circumstance was not good. The woman, 37, had been diagnosed with stomach cancer just six weeks ago. She’d been having heartburn and it wouldn’t go away. Endoscopy showed the cancer and other tests revealed its spread to her liver and lung – stage 4. The woman and her husband, her high school sweetheart, sat across from me at lunch. They have three young children, age Read more »

*This blog post was originally published at Andrew's Blog*

For Women, Atrial Fibrillation May Be More Difficult To Treat

American Heart Association Scientific Sessions 2011At the American Heart Association Scientific Sessions 2011, Dr. John Mandrola presented a poster on gender-specific results of atrial fibrillation ablation in a private practice setting. In this video interview with him about the poster, he mentioned that in his experience women appear to be more challenging to treat with atrial fibrillation ablation and do not appear to fare as well as men from it. In addition, it appeared that women were referred more often for AV node ablations than men.

Watch the video here (approximately 3 minutes).

*This blog post was originally published at Atrial Fibrillation Blog*

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*

Ethical Dilemmas Of Psychiatry: Should Confidentiality Ever Be Breached?

I’ve been asked several ‘ethical dilemmas’ in the past few weeks.  I’m putting them up on Shrink Rap, but please don’t get hung up on the details.  These aren’t my patients, but the details of the stories are being distorted to disguise those involved.  The question, in both cases, boils down to: Should the mental health professional report the patient to his professional board?

In the first case, a psychiatrist is treating a nurse who is behaving badly.  The nurse is stealing controlled substances from the hospital and giving them to friends who ‘need’ them.  She doesn’t intend to stop, and her contact with the psychiatrist was only for an appointment or two before she ended treatment.  Should the psychiatrist contact the state’s nursing board?   Is he even allowed to?

In the second case, Read more »

*This blog post was originally published at Shrink Rap*

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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