If the Medical Intensive Care Unit has a scoreboard, I don't want to see it. Some days it feels like the home team always loses. Patients that look like they are about to recover take a nosedive. The real fighters eventually give up. The most hopeful clinicians must face the grim inevitable. But sometimes you just need one, good ...

Since graduation, I've had plenty of reminders - good and bad - that I am no longer a student. There is the ''PA-C'' behind my name and my shiny new state license. A paycheck arrives every two weeks like an airplane dropping supplies on a desert island. And, of course, I now hold myself to an even higher professional standard. While these ...

I had a student ask me recently if I had a dermatoscope and if I could show her how to use it. The answer was simple enough. No, I don't need one. This of course led to the logical question...Why? This blog post was inspired by this exchange. The simplest answer to this question is that if I see something that looks abnormal, I biopsy it. ...

Her only enemy was time. There was too much of it. As my patient lay in her bed and slowly suffocated, each tick of the clock brought a desperate battle to stave off panic. Ms. M had dealt with her difficult lungs for years. Without explanation, the delicate tissues and air sacs had hardened and scarred; they stiffened and refused to ...

You don't have to break the law to fail a pre-employment drug test. In fact, you could lose your job just by using countless products hanging on the wall of your local gas station. That's because at my hospital, when an employee's urine drops into that little plastic device during a pre-employment drug screen, it is checked for ...

Above, a 75-year-old patient with stage 4 metastatic melanoma. He came to us after a staged excision and graft. The black dots are new satellite nodal mets. Above, metastatic satellite lesions on the scalp of the same patient. He had the original scalp lesion treated numerous times with LN2. The lesion continued to be treated with LN2 ...

Move over Botox and Dysport. There's a new botulinum on the market. Incobotulinumtoxin A, or Xeomin, is the latest serotype A botulinum toxin available. Manufactured by Merz Aesthetics, it has been used in Europe since 2008 with over 84,000 patients treated to date worldwide. Xeomin was originally FDA approved in the US for ...

If I could give any future medical student advice about the ER, my three most important words would be: Vicks Vapor Rub. When I first entered the ER, I was prepared to be jaded, but I was not prepared for the smells: abscesses, STDs, rotten teeth, body odor, mildewed t-shirts, alcoholics, chain smokers, drug-addicts, and diarrhea diapers, to ...

Tired of buying over the counter products that just don't work? So are patients! One of my passions for what I do is finding just the fix for someone -- something that will work and improve their condition. Pharmacy aisles and mall cosmetic counters are now flooded with an overwhelming quantity of products of varying ...

I wrote a blog much earlier this year discussing the importance of abstaining from treating asymptomatic UTIs while making a feeble attempt to include a Harry Potter reference. This past week, a favorite patient of mine, an older woman who has been hospitalized repeatedly for an ESBL UTI and bacteremia called our office in a panic. She was ...