February 1st, 2007 by Dr. Val Jones in Opinion, True Stories
Tags: Fitness, News, Personal
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My dad is 76 years old. He takes one baby aspirin a day and has no medical conditions. He looks about 10 years younger than his age, and his mind is sharp and clear. How does he do it?
I think the secret is the time he spent working on a farm. At age 40 he retired from his consulting firm in Manhattan and bought some land in rural Canada. Without realizing what he was getting himself into, my dad bought some cattle to work the farm. When winter came he had to keep the animals in the barn, and he soon discovered that each steer and cow produced its own weight in manure every 2 weeks (that’s about a half ton for those of you city slickers out there). So all winter long my dad shoveled manure. He did this for 35 years.
My dad now keeps fit with regular sit ups and push ups in the morning and long walks every day. But to me, the secret to his success was the shoveling. Life is full of little ironies – sometimes “crappy work” can result in amazing health benefits.
Although the New York Times wrote a fairly scathing review of my mom’s book about their adventures in shoveling (which ultimately led to a yogurt business) – I think my dad got the last laugh. Healthy and well, he can look forward to a long and enjoyable retirement. I wonder if the folks in Manhattan (who choose to spend their lives shoveling a less physically challenging BS) can say the same?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 10th, 2007 by Dr. Val Jones in True Stories
Tags: Neurosurgery, Physical Medicine And Rehabilitation
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** This follows from the previous blog post**
A week later a 10 pound package came for me in the mail – it was a copy of the patient’s entire medical record. It took me almost an hour to find the part that had to do with the paralysis event, but as I read through the chart I saw my note and then gasped.
My note was simple: it documented my physical exam findings, the time I first found him paralyzed, the time I called the surgical team, the time it took them to get to the patient’s room. It was all clearly written and nicely documented. But the entry just above mine was from a nurse who had apparently turned the patient earlier that morning to wash his posterior. She noted that the patient was having some neck pain afterwards and that she had given him some Tylenol.
Then came my note.
And then came another note from the nurse, dated 3 months after the incident, and labeled “addendum:”
“Paged Dr. Jones to evaluate patient with complaint of inability to move lower extremities. Dr. Jones responded that she would examine him after rounds. I told Dr. Jones that it was an emergency but she said the patient would need to wait.”
I was horrified. That’s not at all what happened – the nurse was clearly afraid that she would be held responsible since she was the one who had moved the patient earlier that morning, possibly displacing his (recently operated upon) spine and causing a bleed. She obviously wrote the note to make it look as if the irreversible paralysis was due to the slowness of my response.
And so I felt helpless and very afraid – is this what will end my medical career? I thought about all my years of training, how careful I always tried to be, how much I cared for my patients – and would it all end with this insanity?
As it turned out, I had to prepare for a deposition. I studied every angle of the case, read every piece of the chart, sweated it out for many weeks. And then I got another call from the lawyer one day: “They’re settling out of court. You don’t have to come in. Just forget about it.”
I was relieved, but angry. I also felt very sorry for the patient. But most of all I wondered about the legalities of practicing medicine – how vulnerable we docs are, how a complication can be seen as malpractice… and how another healthcare professional can be so damaging. Sometimes practicing medicine scares me – lives are at stake, and even the best intentions can lead to life-altering events.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2007 by Dr. Val Jones in True Stories
Tags: Hospitals, Neurosurgery, News, Physical Medicine And Rehabilitation, Surgery
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An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”
Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”
I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.
“Nothing below my neck.”
I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.
I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.
Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.
And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.
“But I didn’t do anything wrong,” I told the attorney.
“Well, you’d better read the record,” he said ominously.
**See my next post for the end of the story!**
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 30th, 2006 by Dr. Val Jones in True Stories
Tags: News, Pain Management, Physical Medicine And Rehabilitation, Podiatry
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Good medical diagnosis and treatment often requires some detective work. One of my patients came to see me for foot pain recently. She described what sounded like a pretty typical case of plantar fasciitis – pain in the heel of her foot, worst with the first few steps in the morning, improving throughout the day. I recommended stretches, physical therapy, night splints, ibuprofen… but to my surprise nothing was really helping.
One wintery day she came back on a return visit and I happened to notice her footwear – boots with a very thin, flexible sole. Slowly I began to think of her tromping over ice, sand, gravel, and snow in these boots… I asked her if she could feel the ground under her feet.
“Yes, I can feel everything – I don’t like to walk around in the snow and ice because it kind of hurts to step on all the lumps and bumps. But I can’t just stay indoors all day, I have errands to run!”
I explained to my patient that I had a hunch that the rocks were bruising her plantar fascia, causing it to be inflamed and painful. I asked her to buy herself some thick soled boots – the kind where she couldn’t feel the lumps and bumps under her feet.
About a week later my patient called to tell me that her foot pain was much better. The new boots seemed to be doing the trick… “I never knew why my plantar fasciitis got worse in the winter times, doc. I thought it was the cold that made things worse.”
Well, I had learned a lot too… sometimes the best treatment option is not on the standard protocol list. The power of observation is one of a physician’s most important weapons.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 28th, 2006 by Dr. Val Jones in True Stories
Tags: Cancer, Hospitals, News, Pain Management, Personal
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Speaking from experience, back pain can be totally incapacitating. Several years ago I traveled to Colorado for my first ski trip in that beautiful state. As I was bending over to hoist my unimaginably heavy ski boot duffle bag over my shoulder, I suddenly felt a knife-like pain in my lower back. It took my breath away and I couldn’t stand up straight. My friends looked at me quizzically. I crawled into the ski lodge and lay on the floor, trying to understand what was going on. I assumed that the pain would pass in an hour or so… but three days later I still couldn’t really move. After some discussion with colleagues over the phone, I decided to call 911. My friend’s young kids were filled with glee as a firetruck pulled up to the lodge, and they brought in a stretcher to take me out. I felt like a total idiot – I hadn’t even hurt myself on the slopes. As a doctor I could imagine how eyes would roll in the ER when they heard: “32 year old female complaining of back pain after lifting her suitcase.” That doesn’t merit an ER visit, complete with firemen and ambulances, does it?
On my way to the hospital, tears filled my eyes with each jolt of the ambulance. I couldn’t control it, and I wondered if the ambulance team thought I was being a baby. I was stuffed inside an MRI machine soon after arriving in the ER, and the doctor who ordered it soon gave me the unexpected news: “everything looks just fine. Your MRI is normal.”
I couldn’t believe it. I was sure I had herniated a disk or ripped some muscles off my spine, or maybe I had burst a blood vessel in my spinal cord – or maybe I had cancer? Nope. Everything was normal.
I stayed overnight in the hospital – at one point I met the orthopedic surgeon on call. I could tell immediately that I was supremely uninteresting to him – nothing to operate on, give her some pain medicine and get her out of here! I just wanted someone to explain to me why everything was “normal” and yet each tiny movement made me whimper in pain.
Well, I wish I could tell you that I figured out the source of my pain, or that I found a miracle cure for it. As it turns out, it took about a month for me to move around comfortably again, nothing really helped the pain (vicodin made me sleepy and nauseated), and even now, from time to time I get a twinge of that old pain if I bend a certain way.
I guess what I learned is that pain is real – even if all the tests argue otherwise. And one thing’s for sure, I take all my patients’ pain complaints very seriously. “Throwing my back out” was the best education I could have had for my career in pain management.
Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
