Cervical stenosis and spinal cord compression – early recognition needed

July 7th, 2013 by

Primary care doctors need to consider if difficulty moving and/or feeling in the arms or legs or trouble with balance is actually coming from pressure on the spinal cord in the neck. Such a thing can often be corrected with surgery, but the earlier it is recognized, the better the outcome. Read: Delayed diagnosis of cervical spondylotic myelopathy by primary care physicians

Comments Off on Cervical stenosis and spinal cord compression – early recognition needed

Don’t Take Clinical Guidelines at Face Value Without Careful Consideration

July 7th, 2013 by

Clinical guidelines are very popular, as they should be, in trying to disseminate appropriate care. Unfortunately, these are often portrayed as clear-cut and indisputable. Unfortunately, the truth is that there is just as much debate and disagreement about them as most other things in medicine. There are numerous examples of multiple available guidelines for a given topic that are mutually incompatible. It is important to realize that these are products of a human process that is (1) imperfect and (2) in its infancy. Guidelines for Guidelines: Measuring Trustworthiness by David F. Ransohoff and Harold C. Sox.

Comments Off on Don’t Take Clinical Guidelines at Face Value Without Careful Consideration

A new suggestion: replace the peer-review process for medical literature

July 5th, 2013 by

The peer-review process in publishing scientific articles in health care is considered the gold standard, sacrosanct. Yet all who are involved with it know that it is highly imperfect, fraught with errors, biases and sometimes fraud. Yet, as pointed out in this article, the process itself has never been subjected to critical analysis. Dr. Adler, an experienced academic neurosurgeon, does so in this article with a fascinating suggestion for improvement.

Read: Adler 2012

Comments Off on A new suggestion: replace the peer-review process for medical literature

Caution with Interpretation of Rising Opioid Overdose Rates

July 3rd, 2013 by

The CDC has released new data suggesting a rise in opioid (“painkiller”) overdose rates in women. Clearly, the situation with prescribing opioids for pain control is serious and requires careful consideration. Nevertheless, good medicine mandates caution in order to prevent over-reaction with unintended consequences. The lesson is that health care providers have to be careful – as with most medications – and may, at times, have to make difficult choices and have difficult conversations with patients. But creating poorly considered legislation and/or mandating options that fail to recognize the very real potential good that these medications can do is not the right path. Many patients will suffer if there is not rational planning for how to provide the right medication, in the right amount, to the right patient.

Read “Opioid Overdose Rate Rises Amongst Women”

Comments Off on Caution with Interpretation of Rising Opioid Overdose Rates

Radiosurgical Hypophysectomy for Cancer Pain

July 3rd, 2013 by

An elderly man with widely metastatic prostate cancer and severe pain in several locations. We did a ‎radiosurgical ‎hypophysectomy (noninvasive, outpatient removal of pituitary gland using radiation) and he experienced immediate, near total pain relief. After several days, he had reduced pain medication from almost 500 mg morphine equivalents per day (in severe pain) to under 360 mg morphine equivalents per day (comfortable). Another option for severe ‎cancer ‎pain.

Radiation dosing to “remove” pituitary as outpatient

Comments Off on Radiosurgical Hypophysectomy for Cancer Pain


Skip to toolbar