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Latest Posts

Case Report: 21-Year-Old Male Experiencing Auditory And Visual Hallucinations

Bilateral symmetric claustrum lesions shown on MR imaging are rarely reported, especially transient and reversible lesions associated with seizures, such as herpes simplex encephalitis,1 unidentified encephalopathy,2 and acute encephalitis with refractory repetitive partial seizures.3 To our knowledge, there are no reports of symmetric bilateral claustrum lesions with mumps encephalitis.

A 21-year-old man had been experiencing cold like symptoms with headache and fever for a week when he vomited and had a tonic-clonic seizure and was subsequently taken to a nearby emergency hospital (day 1). He had been noticing spasms on the left side of his face for 2 days.  On his last visit to the hospital, he reported disorientation accompanied by fever; however, a brain MR imaging and CSF analysis showed no abnormalities. Because he was instatus epilepticus on hospitalization, midazolam was administered by intravenous infusion at 3.0 mg/h. Around this time, the patient started to experience visual hallucinations and reported seeing Read more »

*This blog post was originally published at AJNR Blog*

Newborns Commonly Given Dietary Supplements And Teas Linked To Seizures

About 9% of infants are given dietary botanical supplements or teas as young as 1 month old, prompting government researchers to warn physicians to look for side effects and other health risks.

Supplement use is common. Parents use them to help with fussiness, digestion, colic, and relaxation. Parents like them because there’s no prescription required, they’re traditional to many cultures, and they’re marketed as “natural.”

But, caution the authors of a paper that appeared in the journal Pediatrics, such supplements’ purity and potency are unregulated, they can interact with prescription medicines, they may contain heavy metals or other contaminants, and they may not adapt well to a newborn’s metabolism and body weight.

Supplement use is also common as a cause of emergency room visits. And they’re linked to seizures and death.

Researchers from the Food and Drug Administration and the Centers for Disease Control and Prevention used data from the Infant Feeding Practices Study II, a longitudinal survey of 2,653 women studied from late pregnancy through the first year of the child’s life. The sample was drawn from a nationally distributed consumer opinion panel of healthy adult mothers with healthy term or near-term infants.

*This blog post was originally published at ACP Internist*

How 3D TV Can Affect Your Health

I can’t read for any length of time in a moving vehicle — it makes me nauseous. This is because in order for the body to determine where it is at all times, the brain combines visual information, touch information, inner ear information, and internal expectations to judge its position in space.

Under most circumstances, the senses and expectations agree. When they disagree, there is conflict, and motion sickness can occur. In my case with reading in a car, my eyes that are fixed on the written page tell my brain that I am still. However, as the car goes over bumps and accelerates or decelerates, my inner ear disagrees resulting in my brain activating the nausea center and causing motion sickness.

Well, the same thing might happen with 3D TV. Read more »

*This blog post was originally published at Dr. Wes*

How To Track Epilepsy Online

I’ve written about several sites that let users track parameters related to their health management.

Here’s another example, SeizureTracker.com, that tracks seizure activity, appointments, and medication schedules through a simple calendar interface. You can download printable seizure logs or receive customized reports which include graphs comparing seizure activity and medication dosages. Read more »

*This blog post was originally published at ScienceRoll*

The Friday Funny: “Relevant Crazy Warning”

I think this is about the risk of seizures caused by video game flashing lights… But I’m not sure.

relevantcrazy

Latest Interviews

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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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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