June 5th, 2011 by Shadowfax in Opinion, True Stories
Tags: Blunt Chest Trauma, Dilemma, Emergency Medicine, Establishing Capacity, Ethics, Intubation, Life And Death Decisions, Mentally Competent, Patient Autonomy, Psychiatry, Right To Choose
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In my Monday post, I posed a challenging real-life dilemma we recently faced in the ER. As always, I modified the posited case from the actual facts but the broad outlines were true to life: A young person of questionable capacity wants to refuse lifesaving treatment.
Short answer, for those not interested in the discussion: This case is a no-brainer. You intubate. In this case, sadly, the outcome was not good. As I hinted, early hypoxia in the setting of blunt chest trauma is a bad sign. The patient was intubated, but became progressively more difficult to ventilate over the next couple of days and subsequently died. The family was at the bedside and, from what I understand, they were very happy to be able to be with him in his final hours. On the other hand, due to his drug abuse, he proved extremely difficult to sedate (even on max propofol!) and was agitated and combative, in restraints, until hypoxia began to take its toll. While I am confident I did the “right” thing, the tally sheet is decidedly mixed as to whether was beneficent in its effect.
Discussion: Read more »
*This blog post was originally published at Movin' Meat*
June 3rd, 2011 by KerriSparling in True Stories
Tags: Blood Sugar, Dexcom, Diabetes, Exercise, Gym, Low Blood Sugar, Nearly Passed Out, Type 1 Diabetes
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The Dexcom said 177 mg/dl and dropping, but after a full 60 minutes of cardio, I expected the graph to show a lower trend.
“Whatever,” I said, a little confused because my pre-workout blood sugar was 143 mg/dl. Felt foggy, but I was a little dehydrated so I figured I needed to get home and relax. Ignoring the cotton-ball haze I felt encased by, I grabbed my keys and gym backpack from the locker room and walked out into the parking lot. After trying to get into someone else’s black Honda Civic (forgetting, in my fog, that we replaced my old car for the Mom Car), I put the key in my car’s ignition and sat there for a few seconds.
And then a few seconds more.
It wasn’t until I was out there for about two full minutes that I thought “Hey, might want to double-check that Dexcom reading” with my meter. The receiver was now showing some double-down arrows. And my glucose meter confirmed with a bright, shiny 35 mg/dl.
“Oh, you suck,” I said directly to my diabetes. And like a fast, hot breeze, all the symptoms of the low hit in full force, as though seeing the number made it actually real. Read more »
*This blog post was originally published at Six Until Me.*
June 3rd, 2011 by ErikDavis in Quackery Exposed, True Stories
Tags: Canada, Certification, Certification Process, CNPCC, Fraud, IHN, IONC, Nutritionist, Ontario, Scam
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The team of nutritionists at D’avignon Digestive Health Centre on Danforth Avenue in Toronto are an impressive bunch — just consider their qualifications:
- Louise Comtois – CNP, RNCP, Colon Therapist
- Heidi Horowitz – CNP, RNCP, Live Cell Analyst
- Marnie Ryan – CNP, Colon Therapist
- Natasha Audette – RHN, Colon Therapist
- Jane Sloan – CNP, NNCP, RhA
CNP, RNCP, RHN, NNCP. I single out D’avignon only because they came up at the top of my Google search, but the story is consistent across the nutritionist community — there are an awful lot of letters next to the names of practitioners. So what exactly do they all mean? Read more »
*This blog post was originally published at Skeptic North » Erik Davis*
June 1st, 2011 by DrWes in True Stories
Tags: Atrial Fibrillation, Cardiology, Caregiver, Diabetes, Elderly, Geriatrics, Motherhood, Scheduling A Follow Up Visit With Your Doctor, Women's Health
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It was just a visit to manage her paroxysmal atrial fibrillation. She was long overdue for the visit. So she arrived as she had so many times before: with little fanfare and folderol. She sat patiently after her weight was obtained, vitals recorded, and medications verified. Clutching her purse, whe sat patiently as the examination door opened.
“Hello, Ms. Smith, how have you been doing?”
“Wonderfully, doctor. I haven’t had any more problems with my heart rhythm.” She leaned sideways to put down her purse on the floor next to her.
“Any dizziness, lightheadedness, shortness of breath, cough?…”
“No, I’m doing fine, thankfully,” her eyes glistening.
I proceeded to complete her history and catch up on a few details with her, then moved on to the physical examination. I watched as she got up on the exam table and noted her moving a bit more slowly than I had recalled.
“Is your strength doing okay?”
“Oh sure. Never better. Just slowing down a bit is all. But I’m not sure how well I’d be doing if it weren’t for my daughter.”
“How’s that?” Read more »
*This blog post was originally published at Dr. Wes*
May 29th, 2011 by AndrewSchorr in True Stories
Tags: Cancer, Coping, Dealing With, Growing Up, Illness, Leukemia, Oncology, Parenting, Psychology, role model, Stomach, The Web Savvy Patient
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Ruthie and Andrew
When I was diagnosed with leukemia my daughter, Ruthie, was just two and a half. She has vague memories of our household being turned upside down with worried, hushed conversations and friends and relatives calling A LOT. Because a leading specialist, Dr. Michael Keating from MD Anderson Cancer Center, advised against having treatment right away (something better was coming along), I did not have treatment for more than four years. By then Ruthie was seven. She has vivid memories then of me going off to Houston, accompanied by her mom, for a week of initial treatment and then successive weeks of treatment every month for quite a while back here in Seattle. She also remembers me tired, nauseous and, some days, in bed. The better memory is me participating in a clinical trial that worked and then returning to a full and active life.
Ruthie and I had never really talked about her observations of this until last night. Now, almost 18, Ruthie will be headed to college soon. It’s been a “journey.” As with many teenagers, they can be rebellious and oppositional, at times. But, in most cases, they eventually return to that loving person you remember. Ruthie has been making that return and, as she does, we’ve been talking more.
Last Friday night Ruthie called me in a panic. Read more »
*This blog post was originally published at Andrew's Blog*
