June 20th, 2011 by DrWes in True Stories
Tags: Cath Lab, EKG, Electrophysiology, EP Lab, ER, Flouro, Heart Rate, P Waves, Pacemaker, RIght Bundle Branch Rhythm
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Easy case.
Seen it a hundred times.
Old guy (or gal).
Comes into ER.
Found “down.”
“Hey doc, looks like his hearts goin’ slow. I think he (or she) needs a pacer.”
“On any meds that might do this?”
“Nah.”
“How’s his (her) potassium?”
“4.3, normal.”
And like lots of times, you head in. Glad you can help. Call-team’s on their way, thanks to you. Called the device rep to make sure they can be there just in case, too. Cool as a cucumber. Nothin’ to it. Been here, done this.
You arrive to a guy (or gal) that looks pretty good. Maybe has one or two medical problems. Heart rate’s better thanks to the atropine and the fluids they gave him (her) on arrival. The intraosseus line in the tibia is impressive, too. (“At least he (she) wasn’t awake when that happened,” you think.)
So you review, examine, plan your approach. EKG on presentation? Ouch, heart rate agonal. Wide complex rhythm of right bundle branch rhythm. Look at the monitor: “lots more right bundle branch rhythm there, thank goodness, P waves, too.” you secretely notice.
Seems he (or she) is willing (how many times does he (or she) want to pass out at home?), understands what lies ahead, that the crew’s on their way. “We’ll be taking you over in just a few minutes. Any other questions?” There are none.
Perfect.
And after a while the crew arrives, assembles the poor guy (or gal) on the table and ships him (or her) over to the cath lab area. Chest is prepped, equipment assembled, antibiotics given, monitors connected…
… damn we’re good. Smooth operators.
So the local anesthetic is injected and the incisions made. Dissection to the pre-pectoralis fascia just above the breast muscle accomplished, even the wires passed easily into the vein using ultrasound guidance. Even having a nice chat with the guy (or gal).
Poetry in motion.
Sheaths placed in the vein over the guidewire, pacing leads placed through the sheath. Until, from the control room… Read more »
*This blog post was originally published at Dr. Wes*
June 19th, 2011 by AndrewSchorr in True Stories
Tags: Childhood Leukemia, Father, Graduation Present, High School Graduation, Kidney, Kidney Failure, Kidney Transplant
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This has been a busy time for my family as my daughter, Ruthie, has just graduated from high school. Because we live in a close-knit, fairly small town, we were all zipping around in the days afterward attending graduation parties. We knew many of the 400 or so young people who graduated. In most cases they are blessed with good health and the prospect of a fun summer followed by a college education. But the health picture isn’t sunny for all of them.
I heard this story at one of the parties this weekend: A leader of the senior class, who had leukemia as a child and received many heavy-duty medicines to cure it, is now facing a kidney transplant. His kidney function numbers have taken a nose dive. Usually the wait for a transplant would be a couple of years or more and dialysis for a teenager. In the meantime, this would totally disrupt his life. But there is another way. We’ve talked about it very recently in our videos about kidney transplant: receive a donated kidney from someone who is living.
That is exactly what is happening. The young man will receive a kidney from Read more »
*This blog post was originally published at Andrew's Blog*
June 17th, 2011 by KerriSparling in True Stories
Tags: CGM, Diabetes, Diabetes Diagnosis, Dr. George King, Endocrinology, Joslin Clinic, Joslin Medalists, Pump, PWD
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During the Joslin medalist meeting last week, I didn’t say anything. I wasn’t presenting or doing any kind of networking. I was invited as “media” (totally in quotes) but I attended as a grown-up child with diabetes, hoping to continue on that path of growing up.
I sat next to a woman named Eleanor (my beloved grandmother’s name) and she had been living with type 1 for 58 years. She asked to see pictures of my daughter. She offered me a cough drop after I spent a few minutes trying to clear my throat, and she stuck her hand out to take the wrapper, spying my pump tubing jutting out from my pocket. “I don’t wear a pump,” she said. “I do just fine with my needles. And you appear to be doing just fine with your pump. Do you need another cough drop?” I almost hugged her.
As Dr. George King, director of research at the Joslin Clinic, gave his opening remarks, quotes from the medalists were flashing up on the screen behind him. “I have learned to understand that perfection is not possible.” “Tomorrow is another chance to do better.” “Say YES to every opportunity.”
These people were incredible because of what they’ve accomplished with type 1 diabetes. Hilary Keenan, PhD and pat of the Joslin biostatistics team, stunned me with the stats on this group. Read more »
*This blog post was originally published at Six Until Me.*
June 17th, 2011 by John Mandrola, M.D. in Opinion, True Stories
Tags: Grateful, Hand written notes, Happy, Thank-You, Thanks
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I walked around the office today with a little extra spring in my step. It felt really good to be a doctor this day.
So when good sensations come, I always look back on why they happened. (Like cyclists do when they have really good legs. Maybe it was that bee pollen?)
But like having good legs on the bike, good sensations in the office come from more than one thing.
Eight hours of sleep?
A morning hug from my best friend, my wife Staci?
Two coffees?
A really good blueberry muffin?
No arrhythmia overnight in the AF ablation patients?
Good thresholds on yesterday’s (evidenced-based) ICD?
Perhaps.
But I felt really springy after being greeted by this… Read more »
*This blog post was originally published at Dr John M*
June 13th, 2011 by Dryden Epstein in Opinion, True Stories
Tags: Health Insurance, Malinda Bell, Malpractice Insurance, Medical care today, Medical Insurance, Medicare, Palliative Care, Payment, Rural hospitals
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I graduated from medical school in 1985, am board certified in EM and practiced 25 years—mainly inner city/trauma/teaching centers. However, the last 5 years were in a rural 25-bed hospital, 60 miles from a shopping mall or hospital with higher capabilities and specialists. My hourly rate was competitive and the hospital provided benefits included: malpractice, health, dental, & vision insurance, prescription coverage, paid vacation/CME allowance, and pension contribution.
Palliative Medicine (intensive symptom management for chronic or serious illness, coordination of care and clarification of patient/family treatment & life goals) is a subspecialty in urban settings but is lacking and most needed in the rural community setting. The chronically ill patient who is also typically elderly may present to the ED and be denied hospital admission after an ED physician evaluation. The doctor can “request” admission from an at-home Utilization Review nurse who checks the admission guidelines and if not met, reports the patient is to be sent home—even if it is over the objections of the physician who has evaluated the patient. There is no systematic follow-up of these patients, and they are told to “contact your primary care physician.” No one is making sure this happens. Some do not have primary care physicians and may be unable to obtain a timely appointment. The hospital does not have a social worker to coordinate care or provide assistance in the confusing navigation of insurance/appointments/outpatient testing, etc. There is no 24-hour pharmacy. Many of these patients do not have transportation or no longer drive and often live many, many miles from the hospital relying on neighbors, church folk, or county ambulance when they become ill.
In 2010, I opened Read more »
