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The clinical practice of scientific Medicine must be the most fascinating field in the world. Medicine has allowed me to profoundly understand human nature. The following are short but true stories that deal with humanity. 1. The man walked in to consult me about a simple rash. He liked to talk, and I listened. Before leaving, he said, "You know, my penis is small but my wife doesn't know it because she was a virgin when I married her." I asked him to drop his pants as I took my ruler and measured his penis. I said, "You're big." I made the man's day. Later that day, he returned to my clinic with a big basket of food. My receptionist asked me, "What did you do to make him so happy?" I just told him he's got a big penis. Apparently, as a child, his father had tortured him by saying that his penis was "small." Parents can be ignorant and cruel. In another case, a young man requested a physical before his wedding. He wanted to make sure his penis was of normal size. In the latter case, kids had once pulled his pants down and said that his penis was small. He was normal. I teach young men on how to love women. The penis is usually the least important.2. When men buy sex and get Gonorrhea, I used to give them two options. "El cheapo" treatment that consisted of Amoxicillin 500 mg X six tablets (3 grams + Probenecid and works in about 70% of infected males; this is an old regimen) or the more expensive shot of Ceftriaxone 125mg IM (Rocephin® generic), which works 99% of the time. They would always ask for the more expensive treatment, Ceftriaxone. Your doctor, through American pharmaceuticals generic companies, can now buy one gram/vial of Ceftriaxone for about $15; it used to cost 50 dollars or more. When appropriate and the patient is not allergic to the cephalosporins, I prescribe, exclusively, the generic Ceftriaxone. Since Chlamydia is often associated with Gonorrhea urethritis, I simply treat such patients with Doxycycline 100 mg twice per day for 7 days (costs about $8). In the treatment of Gonorrhea, Levofloxacin (Levaquin®) and Ciprofloxacin (Cipro®) may be significantly less effective in certain areas like Asia and California. For Chlamydia, patients may take a single 1-gram dose of Azithromax instead of Doxycycline. Patients with sexually transmitted diseases must be properly screened for syphilis and HIV. The partners must be treated, though I have seen a few divorces because of marital repercussions associated with STDs. Doctors can get so much up to date information from the Centers for Disease Control and Prevention at http://www.cdc.gov. Book publishers often charge students for this readily available free data. You can look up Malaria, Tuberculosis and so much more.3. The 52-year-old woman rolled into the emergency room complaining of severe "pelvic pain." Though she had had a total hysterectomy and had had one ovary removed, she was certain her pain was due to the remaining ovary. As she pointed to the area of pain, I said, "Your remaining ovary is on the other side." She had the acute irritable bowel syndrome, with constipation and lots of inhaled air (nitrogen) in the bowel. She revealed her stressor, and it was a "big one!" she was being audited by the Internal Revenue Service, IRS. In terms of the acute abdomen, a clinician must be capable of performing a pelvic exam, check for anemia, kidney stones, bladder infections and must always rule out an ectopic pregnancy (tubal) and acute Pelvic Inflammatory Disease (PID). As I talked to this poor woman, I said to myself if nitrogen (the major part of the air we swallow when stressed), were as light as helium, many of us would float into outer space.4. When little boys find their penises and begin touching them, the mothers panic and think the boy must have a medical condition. At times the get a circumcision that is not necessary. If the parent asks such boys, "What's wrong with your private part?" The child may make up a story by saying that his penis itches or hurts. I check these little boys and encourage parents to leave them alone. It is a natural event. If they think their son is masturbating in the bathroom, leave him alone as well. In this manner, there is no risk for an STD or pregnancy. One preacher, with Bible in hand knocked on the bathroom's door while screaming to his son, "I know you are in there masturbating!" Once in graduate school, the poor young man was highly troubled when he felt the need to relieve himself through masturbation. One can trace deviant adult behavior to childhood events. We all need parenting classes and formal counseling before becoming parents. Our kids may grow up to be happier and more productive adults. Luis Lomeli MD/Beta Format Author: LuisLomeliMD Keywords: Family Planning Penis Pelvic Pain Masturbation Hysterectomy IBS Irritable Bowel STD Public Education Luis Lomeli MD Added: July 10, 2007 Herpes Pharyngitis? "Strep Throat," Mononucleosis & more. Pharyngitis has many causes. Patients with anxiety report "pharyngitis" and a dry throat (Globus Hystericus). Many patients, especially singers, "lose" their voice when stressed.Lionel Richie (singer) "lost" his voice in the 1980's. His ENT (Ear-Nose-Throat) doctor subjected him to multiple procedures to no avail. He was "cured" by a "naturalist" or homeopathic person. Basically, he was treated with a placebo (nothing) and recovered.I dread seeing singers that have to perform but have "lost" their voice just before performing. I would dread to treat Renée Fleming, an opera singer, for "laryngitis" because she felt that she had lost her voice just before an engagement.In my opinion, the drug of choice for Strep Pharyngitis is Amoxicillin since 85% of it is readily absorbed. It is estimated that only 50% of an oral dose of Ampicillin is absorbed. My second choice is Cephalexin, which is inexpensive and costs about 15 cents per 500 mg capsule. If a person is allergic to Amoxicillin or Penicillin, the risk of being allergic to Cephalexin (a first generation cephalosporin) is about 10 to 12%.I do not recommend Bicillin-LA for Strep pharyngitis because the patient is exposed to the antibiotic from 2 to 4 weeks. It may be difficult to treat a reaction if the patient develops an allergy. In addition, it provides a very low dose since 1,600 units = 1 mg. That is, a 1.2 million dose of Bicillin-LA provides a mere 750 mg total dose over 2 to 4 weeks.I do not recommend Sulfamethoxazole/Trimethoprim (Bactrim®) or Septra®) for Strep Pharyngitis. Ask your attending physician regarding Cipro® and Levaquin® in the treatment of Strep pharyngitis.Ketex® (a macrolide derivative) may be relatively more toxic than Erythromycin Ethyl Succinate. You should look up the current controversy regarding Ketex® (Ketolide).If a patient is allergic to Amoxicillin and the Cephalosporins, I treat them with an IM injection of Lincocin®, a macrolide, followed by Erythromycin.Once a patient was treated for pharyngitis when in fact he had Bacterial Meningitis (Meningococcal) with associated brain swelling, and vomiting. His vomiting and dehydration caused him to feel a "sore throat." He died after his brain herniated through the Foramen magnum. I alerted the family and advised them to immediately bring me any family member with fever and headache. A few months later, I saved his nephew from acute meningitis.Clinical medicine is complex and intriguing.Luis Lomeli MD Author: LuisLomeliMD Keywords: Pharyngitis Herpes Mononucleosis Epiglottitis Globus Hystericus Luis Lomeli MD Strep Throat Added: April 11, 2007 Generic-Propecia Order-Levitra Generic-Packs

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