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Showing posts from April, 2018

A Rare Cause of Rectal Bleeding

‘I can’t stand the site of blood!’  We’ve all heard that adage.   Blood can provoke emotional reactions from even steely muscle-bound bodybuilders.  We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding.  Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage. If blood repels you, then gastroenterology should not be on your short, or even long list of professions under consideration.  We confront blood every day.  Of course, blood is the elixir of life as it courses into every remote recess of our bodies.  But, when blood loses its bearings, takes a wrong turn, and emerges errantly from our gastrointestinal tract, then gastroenterologists - or G-men -are called in.   Indeed, searching out the site of blood leakage in patients is one of our primary diagnostic tasks.  You might say that blood is our ‘bread & butter’. I recently evaluated a patient in my office that confounded

Warning! Coffee May Cause Cancer!

Are you getting a little tired of being warned that all kinds of stuff you do is unsafe?   I wrote a post recently about Warning Fatigue with regard to our office’s Electronic Medical Record which I fear will emit a flashing Red Alert if I prescribe a patient an aspirin. Now, I start every morning with a steaming cup of coffee.   In fact, there is one beside me right now, as I peck about my Dell keyboard to create this post.   My inner circle of intimates and those with whom I share a high percentage of DNA, are aware that I add something to the java, which is a rather atypical additive.   Curious readers may inquire further, although I cannot pledge here that I will make a full disclosure.    Persuade me to disclose, and I will give your request due consideration.. Recently, a judge in California ruled that various coffee companies, including Starbucks, must issue a cancer warning regarding a component of coffee called acrylamide   Violators would be subject to a mere $2,5

Why I Now Treat Hepatitis C Patients

In a prior post , I shared my heretofore reluctance to prescribe medications to my Hepatitis C (HCV) patients.   In summary, after consideration of the risks and benefits of the available options, I could not persuade myself – or my patients – to pull the trigger.   These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment. I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava.   While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes.   A Scouting Patrol of the Medical Indutrial Complex There was an astonishing development in HCV treatment that caused me to reevaluate my calculus.   New treatment emerged that was extremely safe and amazingly effective.   Now, ne

Avoiding Drug Interactions and Side Effects - Be Warned!

Eons ago, there was a television show where a non-human character would yell out, ‘ Warning ’, Warning ’, when he sensed imminent danger.     The series was called Lost in Space where we were entertained by a set of quirky characters on a cheesy set.   We loved that stuff.   It’s hard to imagine today’s millennials and younger folks being transfixed, as we were, with the deep television dramas of our day.   Who could match the subtle allegory and nuance of shows such as Green Acres or Gomer Pyle?   Some superficial viewers regarded The Andy Griffith Show as a homespun, idyllic view of small town America.   In truth it was a biting satire on the excesses and abuses of law enforcement in the 1960’s. Robot and Dr. Smith I am overwhelmed with the warnings that I receive in my work and in my life.   It seems that warnings, caveats and disclaimers are so omnipresent that they have lost their impact.   As I write this, I am seated in McDonalds, sipping a cold beverage that doe

The Joy of Appealing a Medical Insurance Company Denial

A few weeks ago, I saw a patient with some gastro issues.  So far, nothing newsworthy here since I am a gastroenterologist.  I ordered a CAT scan colonography, a special CAT scan that is designed to view the colon in detail.  It’s the CAT scan version of a colonoscopy.  Why didn’t I simply perform a colonoscopy, which, unlike a CAT scan, would contribute to the Whistleblower Retirement Fund?  That’s an easy one.  Care to take a guess? The patient refused to undergo a colonoscopy. The patient had no insurance and I don’t work for free. The patient is a ‘cat lady’ and loves all things CAT. The CAT scan was a better tool than colonoscopy to explain her symptoms. Playing Cat & Mouse with Insurance Companies I expect that my discerning readers can identify the correct choice.  I ordered the CAT scan because it was the best option for the patient, which the insurance company summarily denied.  I called the insurance company (always a fun and amusing exercise) and spoke