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Latest Posts

New Blood-Thinner Shifts Responsibility To Patients

I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa).

Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran.

Dr. Walton-Shirley details the very commonly done procedure of cardioversion (shock) for AF. As she clearly points out, the most important safety feature of shocking AF back to regular rhythm entails adequate blood thinning before and after the procedure. Thin blood prevents the possibility of clots dislodging after restoring normal contraction to the top chambers of the heart (atria).

Herein lies the rub with dabigatran, and the two soon-to-be-approved non-warfarin blood-thinning agents, apixaban and rivaroxaban. In the past, Read more »

*This blog post was originally published at Dr John M*

When The Body Rights Itself

It’s been a very busy few weeks. Medicine is like that — seldom is “business” steady. Like rainy weeks in the southeast when you think it will never be sunny again, there are weeks when you think everyone’s atria are fibrillating. So there were shocks, and burns, and wires installed. The heart rhythm was rocking, and so were we.

But in all this fury two cases stand out as a reminder that in spite of, not always because of, what we doctors do, the human body can right itself — like it did before their were drugs, procedures, and surgery. (Keep this quiet, though.)

Case 1: A semi-emergent consultation for atrial flutter (AF’s crazy sister) came in. “Something has to be done, Dr. M,” was the message. She was symptomatic and scared (not necessarily in that order), but after a bit of simple doctoring (a pill), the heart rate had slowed and the symptoms abated somewhat. Then after a heavy dose of an AF doctor’s greatest weapon, reassurance and education, we mutually decided on one of my secret treatments for acute AF/AFlutter: A deep breath, a chair, a book, and time. Just in case, though, a cardioversion (shock) was set up for the next morning. I knew that since this was a first episode, that given some time the heart may right itself, without any fury.

Bingo. The text message came the next morning: “Cardioversion cancelled. Patient converted to sinus rhythm right after you saw her yesterday.”  (Grin.) Read more »

*This blog post was originally published at Dr John M*

When Occam’s Razor Doesn’t Cut It

Occam’s razor is a well-known logical principle often applied in medicine. It states that the simplest explanation for a complaint or symptom is usually the correct one. Most of the time, Occam’s razor serves the diagnostician well, but when the actual problem is complex or unexpected, patients can be sent down expensive and even life-threatening diagnostic rabbit holes.

A friend of mine is an 80-pack-a-year smoker. He was complaining of shortness of breath, worsening over a couple of months, and his primary care physician sent him to a pulmonologist. The assumption was that the shortness of breath was related to COPD from his chronic smoking — and that indeed would have been the most likely explanation. Read more »

Another Shocking Day In The ED

Today’s included the therapeutic application of electricity

shocking_ekg

and a real oddity: an adolescent with a potassium of 1.8 (yes, I repeated it).

Emergency Medicine can be mundane occasionally, but days like today make for a really nice change.

*This blog post was originally published at GruntDoc*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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