All posts by doctorswithoutwaitingrooms


Lung Cancer: Advantages Of Low-Dose CT Scans

Annual low-dose CT scans are now recommended for smokers with 20 pack years, who are over 50 years of age and have stopped smoking within the past 15 years.

The screening test is progressively becoming more advisable because of improvements in technology, such as endoscopic biopsy, and improved criteria to prevent overtreating false positives.

The advantage of the test is that cancer can often be caught early, at which time 60% is curable, compared to only 7% five-year survival if the disease has spread.

It’s startling to realize how a few people take advantage of this test, currently averaging only 6%. Family practitioners have been slow to embrace this valuable preventative screening, and the American Lung association has increased It’s outreach to doctors and patients alike.

Lung cancer is still the nations top cancer threat,  killing upwards of 127,000 people in the United States each year, although the toll has lessened recently thanks to the declining smoking rates and new treatments.

—Dr. C.

Women’s Health Review: Mammogram Guidelines

Mount Sinai Health System (May 31, 2023) – When and how often to have a screening mammogram is a choice you must make. Different expert groups do not fully agree on the best timing for this test.

Before having a mammogram, talk to your provider about the pros and cons of having the test. Ask about:

  • Your risk for breast cancer
  • Whether screening decreases your chance of dying from breast cancer
  • Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it’s discovered

Mammography is performed to screen women to detect early breast cancer when it is more likely to be cured. Mammography is generally recommended for:

  • Women starting at age 40, repeated every 1 to 2 years. (This is not recommended by all expert organizations.)
  • All women starting at age 50, repeated every 1 to 2 years.
  • Women with a mother or sister who had breast cancer at a younger age should consider yearly mammograms. They should begin earlier than the age at which their youngest family member was diagnosed.

Mammography is also used to:

  • Follow a woman who has had an abnormal mammogram.
  • Evaluate a woman who has symptoms of a breast disease. These symptoms may include a lump, nipple discharge, breast pain, dimpling of the skin on the breast, changes of the nipple, or other findings.

Review: Gastrointestinal Bleeding Management

Upper gastrointestinal bleeding (UGIB) refers to gastrointestinal blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of ways, with or without hemodynamic compromise, including hematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, melena, and, rarely, hematochezia (bright red blood per rectum). Hematochezia is typically only seen with an extremely brisk UGIB; significant hemodynamic compromise is common in these patients.[1][2]

Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease (PUD), erosions, esophagitis, or varices.

UGIB results in more than 250,000 hospital admissions annually in the US, with a mortality of up to 11%.[3][4] Ordinarily, mortality is secondary to hypovolemic shock. Rapid evaluation, hemodynamic resuscitation, and appropriate pharmacologic and endoscopic interventions are the cornerstones of therapy.

Immune System: Is It A Guard Dog Or Wolf?

Without an immune system, we wouldn’t be here. Even the simplest creature, like bacteria, have types of defensive systems.

However, as we learned with Covid, the immune system can become mistimed, and be a detriment. Covid retards the innate immune system, and unleashes it later on when it no longer serves a useful purpose and actually damages tissue. In certain illnesses, like the common cold, most of the symptoms are actually CAUSED by the immune system.

in the case of allergies, symptoms are caused by the operation of our th2 immune system against a harmless entity, like pollen. With organ transplantation, our immune system recognizes the transplant as foreign; it has no reasoning capacity to realize that the transplanted tissue is necessary for us to live, and  to proceeds to reject the transplant.

In the case of the previous post, hydrocortisone, the prototypical shotgun that tamps down the immune system, benefited severe pneumonia.

With public health, immunizations, and a clean environment, infection is no longer the big killer is once was. Our immune system, designed to defend against a much more infectious world, is currently a real source of danger and disease.

Just like our coagulation system, once critical to stop the more frequent blood flowing in a violent world, Is now a bigger danger than ever because of our development of atherosclerotic blood vessel disease as we live longer.

Anticoagulants and anti-immunity treatments, some of them very expensive, are finding increased utility.

Please press the magnifying glass on the green field, and type in “immune system”. There are a number of previous posts of a more specific and detailed nature.

— Dr. C

Reviews: Hydrocortisone Use In Severe Pneumonia

NEJM Group (May 25, 2023) – Glucocorticoids can help mitigate the adverse consequences of pneumonia, but whether they can reduce mortality in severe community-acquired pneumonia is unknown. New research findings are summarized in a short video.


Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo.

Read more

Medical Update: A Review Of Tuberculosis In 2023

TB has been a gradually diminishing presence in the United States for decades, and currently there are only 2.4 cases per hundred thousand people in our country.

When I was in medical school, TB was still a big problem, and we learned about the fever, night sweats, weight loss and coughing up blood from active tuberculosis. With any of these symptoms, you should, of course, check with a physician.

These severe infections still happen but, currently, tuberculosis occurs primarily in immigrants from other countries, homeless people, prison inmates, people with Immune deficiency, such as cancel therapy and HIV infection.

TB is also  more common in Asians, Native Americans and Eskimos, and Hispanics.

The Ordinary middle class American citizen these days is unlikely to catch tuberculosis, unless they are exposed to somebody that has an active, open case, more likely in people described above.

On first contact, the Tubercle bacillus is almost always controlled by the immune system. Most of these primary cases are without symptoms, and after a few weeks could be picked up by an immune blood test, called the T-spot.TB, or the skin tuberculin test. The chest x-ray can also show a spot on the lung with primary tuberculosis. it is with reactivation that the severe symptoms of secondary TB, described above, can occur.

My own inclination would be to get tested with exposure to any of the groups mentioned above, especially if they have a cough.

Incidentally, there was a dip in tuberculosis incidence during the contagion versus COVID-19 pandemic, showing one more advantage in avoiding big, inside groups.

Catching tuberculosis at the earliest possible moment still continues to be important, especially since long drawn out disease in individuals who have defective immune systems has led to the development of drug resistant organisms.

—Dr. C.

Reviews: Brain Tumor Risk Factors & Symptoms

Mayo Clinic (May 17, 2023) – Learning about a brain tumor can be intimidating. Alyx Porter, M.D., a neuro-oncologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.

Video timeline: 0:00 Introduction 0:37 What is a brain tumor? 1:38 Who gets a brain tumor? / Risk factors 2:26 Symptoms of a brain tumor 3:36 How is a brain tumor diagnosed? 4:13 Treatment options 6:24 Coping methods/ What now? 7:14 Ending

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Heart Health: What To Know About Cholesterol

May 16, 2023: Patients have many questions about how to lower cholesterol and what to do after a high cholesterol diagnosis.

Dr. Ashish Sarraju answers some of these common questions including why fasting before your test is important, what all of the different tests tell your doctor and what you can do to help your heart.