Posts filtered by tags: Pulmonology[x]


A stage IV lung cancer survivor story

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients. I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.) In 2015, Joe […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Conditions, Pulmonology, PA NP, Oncology/Hematology, CRNA

A lesson in never giving up

Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection. We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children … maybe you too … was gone. We […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Infectious Disease, Jim Henson, Conditions, Pulmonology, PA NP, Critical Care, CRNA

What happens when your go-to hospital is overcrowded

My local hospital in an affluent suburb of New York City displays its Outstanding Patient Experience Award 2018 and Magnet Recognized status on its website. My experiences tell a different story. This hospital is located approximately five to seven minutes from my home and is my go-to in an emergency. I have multiple medical conditions, […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, New York City, Patient, Pulmonology, PA NP, Hospital-Based Medicine, CRNA

Treating sleep apnea without CPAP

It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Conditions, Pulmonology, PA NP, CRNA

Your first 24-hour shift

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Physician, Pulmonology, PA NP, Critical Care, Hospital-Based Medicine, CRNA

MKSAP: 55-year-old man with severe COPD

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago […] Find jobs at Careers by Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, American College of Physicians, Conditions, Pulmonology, PA NP, CRNA

Should a HIPAA-questionable good deed go unpunished?

On a Saturday morning, Michael, a physician, was making his way through the hospital atrium after his weekend rounds.  On his way out, he noticed a family he knew well.  They were talking quietly and appeared distraught.  He asked them if they were okay.  They said that the husband’s mother had been admitted overnight with a malignant pleural effusion, and since all beds on the oncology floor were full, she had been placed on the general medicine service. The patient had a primary oncologist, bu...
Tags: Health, Practice Management, Michael, HIPAA, Physician, Pulmonology

A physician’s adventure in false billing

I am a retired family physician (FP) and do extensive traveling in my RV. Since I have multiple medical problems, I attempt to carry with a copy of my medical records with me. I am often surprised by the information that is included in the office dictation or the hospital record and wonder how that information was obtained since it was not elicited by asking me for the info. Case in point number one: My hospital admission for asthma exacerbated by infection. I was seen and managed by a pulmonary...
Tags: Health, Practice Management, Physician, Pulmonology

MKSAP: 52-year-old man with severe obstructive sleep apnea

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. He does not have problems with nasal congestion. Medical history ...
Tags: Health, American College of Physicians, CPAP, Conditions, Pulmonology

Every patient has a rich history behind their current state of health

As I was reviewing his chart, I noticed under social history that “freelance artist/painter” was listed as his occupation. I’ve never met a patient of such talent and honestly, I was excited to meet him. When I arrived at the ER, I was introduced to an unassuming elderly man. He wore a pair of worn out jeans and a burnt orange T-shirt. Tufts of white hair emanated from under his baseball cap. He ran out of home oxygen a day ago and was brought my ambulance for COPD exacerbation. After being on h...
Tags: Health, Education, Birch, Pulmonology, Hospital-Based Medicine

If Facebook knows me better than my spouse, why does my doctor know so little?

A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of breath. He became unable to cook for himself and spent most of his time in bed, propped up with pillows. To f...
Tags: Health, Facebook, Tech, Pulmonology, Hospital-Based Medicine

MKSAP: 58-year-old man with idiopathic pulmonary fibrosis (IPF)

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for idiopathic pulmonary fibrosis (IPF), which was diagnosed 2 years ago. He has cough and shortness of breath and now requires supplemental oxygen at rest. Previous evaluations have not identified any cause for his symptoms other than progressive IPF. He has participated in pulmonary rehabilitation and continues in a maintenance program. He i...
Tags: Health, American College of Physicians, Conditions, Pulmonology

Medical students: You are more than your grades

Recently, I entered an essay contest on advice you would give to future medical students. I sincerely believe that the best person to write an article offering advice to younger medical students should come from a person who didn’t match. Also known as me. Why, you say? Well, for everyone else, Match Day is a culmination of four years of mentally, physically, and emotionally taxing work. They might even forget how many times they cursed the resident that wouldn’t let them go home because, well, ...
Tags: Health, Education, Medical School, Pulmonology

Is this a medical miracle or a medical error in documentation?

I was a foreign medical graduate who in addition to some clinical practice, had begun a career first in managed care as a utilization management coordinator and then as a clinical researcher after finishing medical school and then pursuing a public health degree. A few years ago, life took some unexpected turns, and I found myself in a rather new field of health care known as clinical documentation improvement (CDI). I did not understand why a physician’s note or what they documented was not alw...
Tags: Health, CDI, Health IT, Physician, Pulmonology

A pulmonary physician’s take on vaping

Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping. Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device could make it easier and safer for smokers to kick the habit. As a pulmonary physician,...
Tags: Health, Conditions, Pulmonology

Learn typical community acquired pneumonia with a Medcomic

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP. The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, lancet-shaped diplococcus bacterium. Other common ca...
Tags: Health, Infectious Disease, Conditions, Pulmonology, Jorge Muniz

Who knew I went to medical school to save my own life?

When I was an intern the Durham VA Hospital, there was a sign taped to the ceiling of one of the workrooms. It said in big, bold letters: SUBDURAL HEMATOMA/PULMONARY EMBOLUS. This was to remind all house officers, at work in the middle of the night, about likely diagnoses for mysterious or confusing diagnostic puzzles. When you slapped your head in desperation and looked up, you would see the answer. So, who knew I went to medical school to save my own life? Some years after my internship, I beg...
Tags: Health, Conditions, Pulmonology, Hospital-Based Medicine, Durham VA Hospital

MKSAP: 75-year-old man with very severe COPD

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He has not benefited from pulmonary rehabilitation in the past. He quit smoking 3 years ago. His...
Tags: Health, American College of Physicians, Palliative Care, Conditions, Pulmonology, DLCO

Here’s why doctors must know prescription costs

As the health care debate drags on, prescription drug costs continue to rise by almost 10 percent annually. It is the rare patient who is spared this expense. Over the years, I have seen how these costs have affected my patients. At first, most patients had little in the way of co-pays. However, once the local economy deteriorated, co-pays skyrocketed as employers tried to curb their health care expenses. Now, large co-pays are the norm for health insurance plans across the nation. The solution ...
Tags: Health, Primary Care, Meds, Pulmonology

Retiring early from medicine: Is it ethical?

Eight weeks after I delivered my third child, I was diagnosed with a four-centimeter lung mass. Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer. Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician. Luckily, I soon found out my sit...
Tags: Health, Physician, Pulmonology, Oncology/Hematology

Learn pulmonary hypertension with a Medcomic

Pulmonary hypertension (PH) refers to increased pressure in the pulmonary circulation. It develops when pulmonary vessels become constricted and/or obstructed, which can occur in a wide variety of conditions. The increase in pressure is measured by right catheterization, and is defined as a mean pulmonary arterial pressure ≥ 25 mm Hg at rest. PH leads to right ventricular hypertrophy and enlargement as the ventricle pumps against increased resistance. Right-sided heart failure (cor pulmonale) c...
Tags: Health, World Health Organization WHO, Conditions, Pulmonology, Jorge Muniz

Many digital health solutions lack evidence: How physicians can help

Technology makes this an exciting time for health care. Not only are technological advances making health care better, they’re also making it more affordable. To get a taste of the potential of where health and technology are going, you only need to look as far the recent Fortune article titled, “Prepare for a Digital Health Revolution,” or to search through the more than 300,000 health apps available today. But is all this excitement just hype? Opinions differ. Last year the CEO of the American...
Tags: Health, Time, Tech, Mobile Health, American Medical Association AMA, Cardiology, Pulmonology, Digital Health Revolution

A patient readmission: Could it have been avoided?

It is not unusual to see a patient for a timely transition of care visit after a hospital admission and within a minute of entering the exam room know with all the bones in your body that this person needs to go back into the hospital. The funny thing is that when that happens, if the patient has Medicare, we may indirectly suffer financially from such “avoidable readmissions.” We belong to an ACO, an accountable care organization, which is one of the recent schemes Medicare created to save mone...
Tags: Health, Medicare, Emergency Medicine, Physician, Pulmonology, Hospital-Based Medicine, Allan Beck

Drug price hikes sometimes have catastrophic effects on patients

When I found out my patient was in the hospital again for the third time  in six months , I wondered why her asthma had flared. Was the cold weather bothering her? Was her treatment regimen inadequate? When I spoke with her, I discovered the heartbreaking truth: she had been limiting her albuterol inhaler use because she simply could not afford to take it as much as she needed. For many of the over 600,000 Massachusetts residents who suffer from asthma, albuterol is a necessity. Albuterol inhale...
Tags: Health, Massachusetts, Fda, Massachusetts State House, Meds, Pulmonology, Public Health & Policy

Why a pediatrician does what he does: Lessons from Caleb

A tired but beaming mom greeted me as I entered the room. In her lap was a content appearing, slightly chubby, cherubic faced baby. “This is Caleb … isn’t he beautiful” mom gushed. “He is named after his dad …” but then added in a softer voice, “but I’m not sure how much he plans to be involved.” Mom’s smile waned for a moment but quickly came back. “Looking forward to coming here often,” she said as she gave me a tight bear hug that literally took my breath away. Mom ended up being prophetic on...
Tags: Health, Mom, Caleb, Pediatrics, Physician, Pulmonology, Dad Caleb

MKSAP: 72-year-old man with cough and increasing dyspnea

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for a 2-year history of cough and a 1-year history of increasing dyspnea. He describes the cough as nonproductive, and his shortness of breath is worse with exertion. He does not have chest pain, orthopnea, paroxysmal nocturnal dyspnea, or any other symptoms. Medical history is otherwise unremarkable. He has a 15-pack-year smoking history but quit 40 years...
Tags: Health, American College of Physicians, Conditions, Pulmonology, DLCO

Even short term use of oral steroids (less than 30 days) linked to increased risk of severe infection (sepsis), blood clots and fracture

One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events. Of 1.5 million adults, 21% received at least 1 prescription for oral corticosteroids over 3 period.The most common indications for use were:- upper respiratory tract infections- spinal conditions- allergies. Within 30 days of drug initiation, there was an increase in rates of:- sepsis - veno...
Tags: Health, Facebook, Infectious Diseases, Allergy, Ves Dimov, Pulmonology

MKSAP: 67-year-old man with worsening exertional dyspnea

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has a history of severe COPD diagnosed 4 years ago and previously had minimal exertional symptoms. However, he now notes shortness of breath when walking short distances that is limiting his activity level. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical hi...
Tags: Health, American College of Physicians, Conditions, Pulmonology

Have a mean patient? Don’t take it personally.

My brother-in-law, Ron, was a curmudgeon; grumpy, sullen, even downright mean at times. By blood, he and my husband Bill were cousins. In the 1950s, when Bill was just a child, his mother died unexpectedly, and Ron’s mother took Bill in to live with her and her four children. They were an African-American family living in the midst of a middle-class, predominantly white Connecticut township. Their home, located on a wealthy family’s farmland, had one bedroom, wood heat and no running water. Each...
Tags: Health, Hospital, Connecticut, Bill, Ron, Physician, Pulmonology

I’m a U.S. doctor just back from Sudan, where hospitality from Muslims greeted me everywhere

Many Americans have never visited a predominantly Muslim country and may know relatively little about the faith of Islam. This is relevant in light of the Trump administration’s recent executive order attempting to reduce terrorist threats to the U.S. by halting the issuance of visas to travelers from seven predominantly Muslim countries. Having returned this month from Sudan, one of the countries affected by the ban, I wish to share my own firsthand experience of Islam – not Islamic extremists ...
Tags: Health, Sudan, Muslim, Islamic, Trump, Physician, Pulmonology