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Author Archive

The Emergency Medicine Mindset

Emergency medicine is difficult. We are presented with incomplete information filled with variables.  We are asked to balance risk verses benefits in every encounter, where, if wrong, a patient can die.  It’s a tremendous responsibility.  I love it! A mindset that is needed in emergency medicine is to think of the diagnosis first.  A patient

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Stopping the Sickle Cycle

When I was in PA school  in 1977 I was taught that the life expectancy for a sickle cell disease patient was mid teens. I knew this was a genetic hemoglobin issue, one amino acid out of place in the beta globin protein chain, but I had no idea how far we come in 40

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Update on Warts

Warts are a problem faced by many individuals, it is one of the more common complaints I address in my clinical practice.  What is a wart for starters?  Well a wart is virus that is contracted from person to person.  There are several types of warts seen in the human population most have no long

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The Entero-Endocrine System

What organ has the greatest impact on overall health and chronic illness?  Here’s a hint—it’s NOT the brain, heart, lungs, kidneys OR (despite the beliefs of many) the gonads.   The true “Alpha-organ” is the gut! More is being learned about the gastrointestinal (GI) system and its influence on our health and disease risk.  We now

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Outsmarting AFib with a Smartphone

Phillip is a 55 year old male who was seen in the ED 2 weeks ago for a rapid heart rate. He was diagnosed with new onset atrial fibrillation with a rapid ventricular response of 120. Since he could pin point the time when it began and it was within 10 hours, and he had

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Acne Update

Acne is one of the most common diagnoses I deal with on a daily basis. There are a lot of acne recommendations utilizing over the counter(OTC) therapies, as well as prescription medications. The course of discussion for this post is going to understanding the causes and science of the development of acne. This will help

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Iron Deficient Anemia??

John is a 40 year old male who was referred to GI medicine for colonoscopy by his primary care provider because of persistent microcytic anemia that did not correct with iron supplementation. The PCP was worried about occult GI bleeding  from a colon cancer despite a negative FOB test. The following is John’s lab slip

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Psoriasis Update for the Seekers for Knowledge

I was doing some recent reading on Psoriasis, and wanted to share some of my own insight of what seems to be the latest discoveries in the disease and the current treatments. Psoriasis is considered by many, including myself, to be a form of autoimmune disease. Psoriasis has a primary trigger, which to date seems

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Chest Pain and Emergency Medicine: Presentation and Risk Stratification

In emergency medicine, acute myocardial infarction (or cardiac ischemia) is the number one killer of men and woman in the United States.  Coronary artery disease can present in multiple different ways.  You can have someone present that is so ill that no one would miss the diagnosis. They are ashen gray, writhing around with chest

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I went to the hospital for low blood sugar

EMS was called to the home of a 24-year-old female who was altered. She started acting bizarre and eventually became unresponsive so her family called 911. The ambulance arrived and per protocol for an altered level of consciousness patient, checked her blood sugar which they found to be 30. The patient was given IV dextrose

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