Edward J. Shahady, MD

September 02, 2008

Over the past 4 decades, our understanding of the role of elevated cholesterol in cardiovascular disease (CVD) has undergone radical change. During that time, we have moved from a belief that cholesterol does not matter and that atherosclerosis is an irreversible process to a strong conviction that treating elevated cholesterol, especially elevated low-density lipoprotein cholesterol (LDL-C), can slow and perhaps halt the progression of atherosclerosis. But it has been a slow process for several reasons. In the 1960s, the Framingham investigators demonstrated that elevated serum cholesterol is a risk factor for CVD.1

April 02, 2008

As many as 10% of Americans older than 20 years have type 2 diabetes, and more than 20% of the total population has the metabolic syndrome. Type 2 diabetes will develop in many of those with the metabolic syndrome.

April 02, 2008

As the numbers of patients with diabetes continue to climb, physicians and health policy experts are devoting increasing attention to strategies that can improve care for these patients. One of the strategies frequently mentioned is the Chronic Care Model, developed in 1998 by the MacColl Institute for Healthcare Innovation.

April 01, 2007

A 38-year-old secretary has had right wrist pain for the past 6 months. It was initially relievedby ibuprofen but is now persistent and makes it difficult for her to type. The pain is worse atnight.

February 01, 2007

During a routine diabetes follow-up visit, a 55-year-old man complains of increasing pain in his right groin and hip. He is also being treated for hypertension, and his body mass index is 28.

January 01, 2007

A 34-year-old man has had bilateralknee pain for the past 16 months andbilateral hip pain for the past 8 months.The pain is exacerbated by running, byweight bearing, and recently even by sittingfor extended periods. Moving froma sitting to a standing position is especiallydifficult. A week earlier, he visitedan urgent care center and was given naproxen and a 7-day course of prednisone,but neither medication alleviatedthe pain; in fact, he now feels worse.

January 01, 2007

A 16-year-old boy presents with severe left shoulder pain that began 20 minutes earlier when heslipped while walking down an incline and attempted to prevent a fall by grabbing a nearby structurewith his left hand. As his body went forward, the left shoulder was abducted and externallyrotated. The accident caused him immediate pain, and any subsequent movement of the injuredshoulder increases the pain. Previously, the patient was healthy.

January 01, 2007

A 24-year-old man seeks medical attention 3 weeks after he injured his little finger playingfootball. He reports that the finger “came out of place” at the middle knuckle (proximal interphalangeal[PIP] joint); he quickly put the finger back into place himself, quit playing, andiced it. About 2 hours later, he was unable tomove the finger without significant pain, andthe following day, inability to move it interferedwith his performance of tasks that requiredfine manual dexterity. Since then, thepain has decreased, but the finger remainsswollen and he has not been able to fully extendit at the middle knuckle. In addition, thetip of the injured finger is hyperextended.

January 01, 2007

A 42-year-old man complains of persistent right shoulder pain that for the past 6 months hasprevented him from participating in his usual weight-lifting routine and affected daily activities.He is able to comb his hair and scratch his back with his right hand with no increase in pain, butreaching across his body causes discomfort. NSAIDs provide only modest relief.

December 31, 2006

A healthy 11-year-old boy complains of a “bump below his kneecap” that hurts to touch and whenhe jumps. He first felt slight pain a month earlier. Since then, he has occasionally complained ofpain and a bump on the right knee.