February 23rd, 2010 by Shadowfax in Better Health Network, Opinion, True Stories
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The first seven patients I saw today were in the ED for:
- Dental Pain (ongoing for three years)
- Back Pain (third visit in one month, 18 in 2006)
- Migraine Headache (six visits in a month, and second ED visit in 18 hours)
- Back Pain (this one was legit)
- Chronic Recurrent Abdominal Pain (ran out of Oxycontin and doctor “out of town”)
- “Cyclic Vomiting Syndrome” (in which only narcotics stop the vomiting)
- Oxycontin withdrawal
Sometimes I wonder why I bother. I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain. Read more »
*This blog post was originally published at Movin' Meat*
February 17th, 2010 by Shadowfax in Better Health Network, True Stories
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Seems like I’ve been on a real run of chest pain patients lately. Which is fine — it’s part of the gig. I did have a very interesting pair the other night. They were seen in sequence, right next to one another, in room 7 and room 8. They were both totally healthy women in their mid-fifties. And they were both over-the-edge, crazy, crawling-out-of-the-gurney anxious.
Anxiety is an awful red herring in the work-up of chest pain. People who are having an anxiety attack often if not always manifest some chest pain (pressure, tightness, whatever) as a prominent symptom of their anxiety. On the other hand, someone having a heart attack who is experiencing chest pain will also be anxious — and for good reason! Read more »
*This blog post was originally published at Movin' Meat*
February 12th, 2010 by Shadowfax in Better Health Network, True Stories
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Sometimes in this job you just get lucky. You have an elusive and/or dangerous diagnosis just dropped in your lap. Something devastating that you would never have been able to tease out otherwise just gets handed to you by the patient. There’s a catch, though: you have to be smart enough to know when to listen to the patient, when not to blow off their crazy talk as just crazy.
So it was recently when I saw a guy with back pain. From the chart, it didn’t sound like anything complex: a middle-aged to older guy, maybe 60 or so, with a history of chronic back pain and multiple surgeries for the same. He was on Oxycontin 80 mg three times daily (a very high dose, and a red flag for an ER doc naturally suspicious of drug-seeking behavior). I went to see him, and it was clear in seconds that this dude was JPN: Just Plain Nuts. Read more »
*This blog post was originally published at Movin' Meat*
February 5th, 2010 by Shadowfax in Better Health Network, True Stories
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Anyone who has flown long-distance flights has heard the call: “If there is a doctor on board, please identify yourself to a flight attendant.” But it’s impossible to understand how that call induces the urge to flee to the lavatory and hide unless you are one of those unfortunate few who are on the hook, which is to say that you are qualified to respond, but you really really don’t want to.
“But Gee,” I can hear you think, “Aren’t you an ER doctor? Isn’t this sort of thing second nature to you? Don’t you revel in the adrenaline and glory?” Well, yes. But. First of all, there is the performance anxiety thing. I’m used to working with a very small audience. In Economy class, there may be 300 people watching me try to do my thing, and I’m just not used to that many people being in the exam room — and I know they are very interested in what’s going on. Read more »
*This blog post was originally published at Movin' Meat*
January 23rd, 2010 by Shadowfax in Better Health Network, Medical Art, True Stories
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An awesome case of pareidolia:
Mind Hacks:
The case of the haunted scrotum. A 45-year-old man was referred for investigation of an undescended right testis by computed tomography (CT). An ultrasound scan showed a normal testis and epididymis on the left side. The right testis was not visualized in the scrotal sac or in the right inguinal region. On CT scanning of the abdomen and pelvis, the right testis was not identified but the left side of the scrotum seemed to be occupied by a screaming ghostlike apparition (Figure 1). By chance, the distribution of normal anatomical structures within the left side of the scrotum had combined to produce this image. What of the undescended right testis? None was found. If you were a right testis, would you want to share the scrotum with that?J R Harding Consultant Radiologist, Royal Gwent Hospital
And I might add that “The Haunted Scrotum” would be a great name for a punk rock band.
*This blog post was originally published at Movin' Meat*
