March 20th, 2010 by David Kroll, Ph.D. in Better Health Network, True Stories
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This is a repost of my reflections on my father who passed away 13 years today. It took me 12 years to write the following eulogy and remembrance. While quite personal, I posted it here last year because I felt that my experiences were quite universal, shared by the families of the ten or twenty million alcoholics in the U.S. and the hundreds of millions worldwide. Moreover, I wanted to provide a face for my colleagues who work in the area of substance abuse and a reminder for my clinical colleagues of the people behind those they may dismiss as drunks and junkies.
In becoming one my most most highly-read and highly-commented posts, I thought I would share it again this year, especially for the new readers who’ve come on board in the last twelve months. Read more »
*This blog post was originally published at Terra Sigillata*
January 28th, 2010 by RamonaBatesMD in Better Health Network, Health Tips, Research
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It has been a while since I’ve had a patient with postoperative alcohol withdrawal. I can still recall my first exposure to this problem as a 3rd year medical student at the Veteran’s Hospital. It was my first clinical rotation – surgery service at the VA.
Browsing the CME articles on the JAMA website, I came across the article (full reference below): Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal. For me it was a nice review of the problem with updates on current drug use/protocol.
Their protocol is based on three distinct clusters of symptoms characterize alcohol withdrawal syndrome (AWS). Central nervous system excitation usually occurs within 12 to 48 hours after the last drink. Read more »
*This blog post was originally published at Suture for a Living*
January 13th, 2010 by Happy Hospitalist in Better Health Network, Opinion
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Bouncing back to the hospital refers to patients who were discharged from the hospital but return during some defined period of time. This will become important as insurance companies, including CMS, stop paying for patients who are readmitted within some defined period for the same condition. In medical circles, we usually refer to this as the 30 day readmission rate.
When hospitalist groups were first coming on the scene and were showing reduced length of stay, many folks falsely believed that hospitalists must have a higher percentage of patients bouncing back into the hospital. I have yet to see any research that indicates such trend every existed. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
August 4th, 2009 by DrWes in Better Health Network, Humor
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When looking for the cause of atrial fibrillation during a physical examination, not only can the doctor’s olfactory bulb be helpful, but so can the examination of what gets brought into the exam room.
Patient: “Hey doc, it’s just a Pepsi.”
Doctor: “Really? Can I see?”
Nothing a good knife and a piece of scotch tape can’t manufacture.
Case solved.
-Wes
*This blog post was originally published at Dr. Wes*
June 18th, 2009 by Bongi in Better Health Network, True Stories
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In my line of work there is sometimes a fine line between cruelty and kindness. Sometimes the line can seem to blur. Hang around me long enough and you will probably be shocked at some stage.
The guy had apparently fallen asleep next to his fire. When he rolled over into it his alcohol levels ensured that he only woke up once his legs were well done. Someone found him and brought him in late that night.
When I walked into casualties I could smell him. You can almost always smell the burn patients. I took a look. The one leg actually wasn’t too bad. It had an area of third degree wounds but they weren’t circumferential. I could deal with that later. The other leg, however, had the appearance of old parchment from about mid thigh to ankle right the way around. This could not wait for later.
In third degree circumferential burns, the damaged skin becomes very tight. Constricting is actually a better description because unless it is released the taught skin will so constrict the leg’s bloodflow that if left untreated the patient’s leg will die. It is like a compartment syndrome only the entire leg is the compartment. Interestingly enough in third degree wounds all the nerves have been destroyed so in these areas the patient has no feeling whatsoever. That means when we do the release (an escharotomy which is cutting the dead skin along the length of the leg in order to release the pressure and thereby return the bloodflow) no anaesthetic is needed. You just cut the skin and as soon as you hit an area that the patient feels you’ve gone too far. If you do it right they will feel nothing. The longer you wait the higher the chance that he will lose his leg. I knew what I needed to do. I also knew my students might never get to see this again before they might have to do it themselves in some outback hospital in their community service year.
I asked for a blade and gathered my students around me. I sunk the knife through the dead skin and ran it down the length of the leg. The wound burst open as the pressure was released. The patient didn’t flinch. Quite a number of the students did. One excused herself and ran out. I think she might have been crying. Despite me telling them that it wasn’t painful and it was in the best interests of the patient to actually see it was more than most normal people could take.
When I wrote my last post and expressed a form of traumatic stress I found the contrast within myself compared to this incident quite interesting. everything seems to be relative and during the job there will be things that leave scars and many things that traumatise/desensitise us. I was ok doing what that one student obviously thought was gruesome and bizarre because I was convinced it was in the best interests of the patient. When I did this procedure which, on the face of it, is so much more brutal than taking someone to shower, I was ok, but the shower incident was terrible for me. I ended up hoping the student didn’t see me as quite that monsterous. I also hoped she would get over the trauma I had inadvertently caused her.
